Extracardiac findings on coronary computed tomography angiography in patients without significant coronary artery disease
To analyse extracardiac findings in patients without significant coronary artery disease (CAD) in general and in symptomatic patients in particular.
We searched the Radiology Information System database for coronary computed tomography angiographies (CTA) performed from 2000−2014 and retrospectively enrolled 3,898 patients without significant CAD (coronary stenosis < 50%) in CTA. In 2,330 symptomatic patients, we analysed the spectrum of extracardiac findings and identified pathologies potentially explaining chest pain. Finally, we investigated variables affecting the number of extracardiac findings detected in CTA.
Overall extracardiac findings were found in 1,177 patients (30.2%; 95%CI, 28.8−31.7%). 94 patients (2.4%; 95%CI, 2.0−2.9%) had extracardiac findings with a recommendation for follow-up, sixteen patients (0.4%; 95%CI, 0.3−0.7%) had incidental urgent, and another three patients (0.1%; 95%CI, 0.1−0.2%) had incidental malignant extracardiac findings. 185 of 2,330 symptomatic patients (7.9%; 95%CI, 6.9−9.1%) revealed extracardiac findings potentially explaining chest pain after exclusion of significant CAD. The number of extracardiac findings increased significantly with patient age (p < 0.001) and the cumulative experience of the CT reader (p < 0.001).
30.2% of patients undergoing CTA for exclusion of CAD had ECF, and 7.9% of symptomatic patients without significant CAD on their examination had findings that could potentially explain their symptoms.
• Of patients undergoing CTA, 2.8% have relevant incidental extracardiac findings.
• CTA could identify the differential diagnosis of chest pain when excluding significant CAD.
• Patient age and reader’s professional experience influence the number of detected ECFs.
KeywordsTomography, x-ray computed Coronary angiography Incidental findings Chest pain Angina pectoris
Coronary artery disease
Coronary computed tomography angiography
Field of view
Multiple-detector computed tomography
Noncardiac chest pain
Positron emission tomography
Radiology Information System
Single-photon emission computed tomography
Prof. Dewey has received grant support from the Heisenberg Program of the DFG for a professorship (DE 1361/14-1).
Compliance with ethical standards
The scientific guarantor of this publication is Prof. Dr. Marc Dewey
Conflict of interest
The authors of this manuscript declare relationships with the following companies:
Prof. Dewey has received grant support from the Heisenberg Program of the DFG for a professorship (DE 1361/14-1), the FP7 Program of the European Commission for the randomized multicentre DISCHARGE trial (603266-2, HEALTH-2012.2.4.-2), the European Regional Development Fund (20072013 2/05, 20072013 2/48), the German Heart Foundation/German Foundation of Heart Research (F/23/08, F/27/10), the Joint Program from the German Research Foundation (DFG) and the German Federal Ministry of Education and Research (BMBF) for meta-analyses (01KG1013, 01KG1110, 01KG1210), GE Healthcare, Bracco, Guerbet, and Toshiba Medical Systems.
Prof. Dewey has received lecture fees from Toshiba Medical Systems, Guerbet, Cardiac MR Academy Berlin, and Bayer (Schering-Berlex).
Prof. Dewey is a consultant to Guerbet and one of the principal investigators of multicentre studies (CORE-64 and 320) on coronary CT angiography sponsored by Toshiba Medical Systems. He is also the editor of Coronary CT Angiography and Cardiac CT, both published by Springer, and offers hands-on workshops on cardiovascular imaging (www.ct-kurs.de). Prof. Dewey is a consultant to the editor of Radiology and an associate editor of European Radiology. Institutional master research agreements exist with Siemens Medical Solutions, Philips Medical Systems, and Toshiba Medical Systems. The terms of these arrangements are managed by the legal department of Charité-Universitätsmedizin Berlin.
Prof. Dr. Bernd Hamm has received research grants from GE Healthcare, Schering, Siemens Medical Solutions, and Toshiba Medical Systems. Speakers Bureau: Siemens Medical Solutions and Schering.
Statistics and biometry
One of the authors has significant statistical expertise.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
- 1.SCOT-HEART Investigators (2015) CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial. Lancet 385:2383–2391Google Scholar
- 3.Taylor AJ, Cerqueira M, Hodgson JM et al (2010) ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Cardiovasc Comput Tomogr 4:407.e401–407.e433Google Scholar
- 10.Kim JW, Kang EY, Yong HS et al (2009) Incidental extracardiac findings at cardiac CT angiography: comparison of prevalence and clinical significance between precontrast low-dose whole thoracic scan and postcontrast retrospective ECG-gated cardiac scan. Int J Cardiovasc Imaging 25(Suppl 1):75–81CrossRefGoogle Scholar
- 13.Karius P, Schuetz GM, Schlattmann P, Dewey M (2014) Extracardiac findings on coronary CT angiography: a systematic review. J Cardiovasc Comput Tomogr 8(174-182):e171–e176Google Scholar
- 15.Brown LD, Cai TT, DasGupta A et al (2001) Interval estimation for a binomial proportion. Statistical Science 16:101–133Google Scholar
- 21.Turkvatan A, Akdur PO, Akgul A, Olcer T, Cumhur T, Duru E (2009) Prevalence of incidental extracardiac findings on multidetector computed tomographic coronary angiography. Turkiye Klinikleri J Med Sci 29:169–175Google Scholar
- 31.Buckens CF, Verkooijen HM, Gondrie MJ, Jairam P, Mali WP, van der Graaf Y (2012) Unrequested findings on cardiac computed tomography: looking beyond the heart. Plos One:7Google Scholar
- 33.MacMahon H, Naidich DP, Goo JM et al (2017) Guidelines for management of incidental pulmonary nodules detected on CT images: From the Fleischner Society 2017. Radiology. https://doi.org/10.1148/radiol.2017161659
- 40.Matsumoto M, Okada E, Ichihara D et al (2010) Age-related changes of thoracic and cervical intervertebral discs in asymptomatic subjects. Spine (Phila PA 1976) 35:1359–1364Google Scholar