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Prognostic value of extracardiac incidental findings on attenuation correction cardiac computed tomography

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Attenuation corrected computed tomography (CTAC) is often performed to improve the specificity of single-photon emission tomography imaging. Extracardiac incidental findings are frequently observed. It is unclear whether these findings have any prognostic value.

Methods

Consecutive patients (n = 1139) at a tertiary care center were retrospectively evaluated for incidental findings on CTAC. Clinically significant incidental findings were defined as findings warranting physician follow-up. Information regarding subsequent resource utilization was obtained by chart review. Cox proportional hazard model adjusted for demographic and clinical variables was used to evaluate association of these incidental findings with all-cause and cancer-specific mortality.

Results

A total of 135 (12%) patients with incidental findings were identified, 83 of whom (68%) were newly diagnosed. Lung nodules were the most common finding, present in 92 (68%) patients. Over a median follow-up of 468 days, incidental findings were not significantly associated with increased risk of all-cause mortality (HR 1.34; 95% CI 0.77-2.33, P = 0.29) but was significantly associated with cancer-specific mortality (HR 3.21; 95% CI 1.26-8.14, P = 0.01). This association remained statistically significant when the analysis was limited to newly diagnosed incidental findings. Among patients with incidental findings, follow-up radiographic studies were conducted in 87%, and invasive procedures performed in 32%. Physician office-based follow-up of these findings occurred in 42% of patients and incidental finding-related hospitalization occurred in 14%.

Conclusions

This study shows that incidental findings are common and were associated with all-cause and cancer-specific mortality but only the later remained statistically significant after multivariable adjustment.

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Abbreviations

CTAC:

Attenuation corrected computed tomography

CT:

Computed tomography

HR:

Hazard ratio

CI:

Confidence interval

mSv:

Millisieverts

CAD:

Coronary artery disease

SPECT:

Single photon emission computed tomography

SD:

Standard deviation

CCT:

Coronary computed tomography

US:

United States

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Disclosures

The authors have indicated that they have no financial conflict of interest.

Author information

Authors and Affiliations

  1. Henry Ford Hospital/Wayne State University, 2799 W. Grand Blvd., Detroit, MI, 48202, USA

    Zaid Alirhayim MD & Mouaz H. Al-Mallah MD, MSc, FACC, FAHA, FESC

  2. Wake Forest University School of Medicine, Winston Salem, NC, 27157, USA

    Waqas T. Qureshi MD & Fatima Khalid MD

  3. The University of Kansas Medical Center, Kansas City, KS, 66160, USA

    Zaid Alirhayim MD

  4. Wayne State University, 540 E Canfield St., Detroit, MI, 48201, USA

    Mouaz H. Al-Mallah MD, MSc, FACC, FAHA, FESC

  5. King Abdul-Aziz Cardiac Center, King Abdul-Aziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, MC 1413, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia

    Mouaz H. Al-Mallah MD, MSc, FACC, FAHA, FESC

Authors
  1. Waqas T. Qureshi MD
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  2. Zaid Alirhayim MD
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  3. Fatima Khalid MD
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  4. Mouaz H. Al-Mallah MD, MSc, FACC, FAHA, FESC
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Corresponding author

Correspondence to Mouaz H. Al-Mallah MD, MSc, FACC, FAHA, FESC.

Additional information

See related editorial, doi:10.1007/s12350-015-0244-y.

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Qureshi, W.T., Alirhayim, Z., Khalid, F. et al. Prognostic value of extracardiac incidental findings on attenuation correction cardiac computed tomography. J. Nucl. Cardiol. 23, 1266–1274 (2016). https://doi.org/10.1007/s12350-015-0223-3

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  • DOI: https://doi.org/10.1007/s12350-015-0223-3

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