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Cardiac computed tomographic angiography: evaluation of non-cardiac structures

  • Review Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Cardiac computed tomography is a promising new technology for non-invasive evaluation of the coronary arteries. As CT is inherently a high resolution volumetric imaging modality, data from structures other than the heart can be accessed in studies performed primarily for cardiac indications. Current generation scanners can easily detect abnormalities such as pulmonary emboli and aortic dissection on routine coronary CT angiograms. Many other abnormalities such as small pulmonary nodules can also be detected. While major abnormalities like aortic dissection are of obvious clinical importance, detection of incidental abnormalities such as small pulmonary nodules less than 4 mm in diameter has not yet been shown to positively affect patient outcomes, and may lead to unnecessary testing. Recommendations for image reconstruction and training in interpretation of incidental findings continue to evolve, but most agree that coronary CT angiography should be focused primarily on the coronary arteries.

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References

  1. Achenbach S, Daniel W. Computed tomography of the coronary arteries. J Am Coll Cardiol 2005;46:155-7.

    Article  PubMed  Google Scholar 

  2. Goldstein JA, Gallagher MJ, O’Neill WW, Ross MA, O’Neil BJ, Raff GL. A randomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain. J Am Coll Cardiol 2007;49:863-71.

    Article  PubMed  Google Scholar 

  3. Horton KM, Post WS, Blumenthal RS, et al. Prevalence of significant noncardiac findings on electron-beam computed tomography coronary artery calcium screening examinations. Circulation 2002;106:532-4.

    Article  PubMed  Google Scholar 

  4. Haller S, Kaiser C, Buser P, et al. Coronary artery imaging with contrast-enhanced MDCT: Extracardiac findings. Am J Roentgenol 2006;187:105-10.

    Article  Google Scholar 

  5. Patel S, Woodrow A, Bogot N, et al. Non-coronary findings on 16-row multidetector CT coronary angiography. Am J Roentgenol 2005;184:S3.

    Google Scholar 

  6. Onuma Y, Tanabe K, Nakazawa G, et al. Noncardiac findings in cardiac imaging with multidetector computed tomography. JACC 2006;48:402-6.

    PubMed  Google Scholar 

  7. Schragin JG, Weissfeld JL, Edmundowicz D, et al. Non-cardiac findings on coronary electron beam computed tomography scanning. J Thorac Imaging 2004;19:82-6.

    Article  PubMed  Google Scholar 

  8. Dewey M, Schnapauff D, Teige F, et al. Non-cardiac findings on coronary computed tomography and magnetic resonance imaging. Eur Radiol 2007;17:2038-43.

    Article  PubMed  Google Scholar 

  9. Hunold P, Schmermund A, Seibel RM, et al. Prevalence and clinical significance of accidental findings in electron beam tomographic scans for coronary artery calcification. Eur Heart J 2001;22:1748-58.

    Article  PubMed  CAS  Google Scholar 

  10. Gil BN, Kornowski R, Tamar G, et al. Prevalence of significant non-cardiac findings on coronary multidetector computed tomography angiography in asymptomatic patients. J Comput Assist Tomogr 2007;31:1-4.

    Article  PubMed  Google Scholar 

  11. Budoff MJ, Fischer H, Gopal A. Incidental findings with cardiac CT evaluation: Should we read beyond the heart? Catheter Cardiovasc Interv 2006;68:965-73.

    Article  PubMed  Google Scholar 

  12. Jacobs P, Mali W, Grobbe D, van der Fraaf Y. Prevalence of incidental findings in computed tomographic screening of the chest: A systematic review. J Comput Assist Tomogr 2008;32:214-21.

    Article  PubMed  Google Scholar 

  13. Kirsch J, Araoz P, Steinberg F, Fletcher J, McCollough C, Williamson E. Prevalence and significance of incidental extracardiac findings at 64-multidetector coronary CTA. J Thorac Imaging 2007;22:330-4.

    Article  PubMed  Google Scholar 

  14. Steinberg F, Araoz P, Williamson E, et al. Extracardiac findings at 64-multidetector Coronary CTA. Amelia Island, FL: North American Society of Cardiovascular Imaging; 2005.

    Google Scholar 

  15. Kline J, Courtney D, Beam D, King M, Steuerwald M. Incidence and predictors of repeated computed tomographic pulmonary angiography in emergency department patients. Ann Emerg Med Epub 5 October.

  16. Law Y, Huang J, Chen K, Cheah F, Chua T. Prevalence of significant extracoronary findings on multislice ct coronary angiography examinations and coronary artery calcium scoring examinations. J Med Imaging Radiat Oncol 2008;52:49-56.

    Article  PubMed  CAS  Google Scholar 

  17. de Feyter PJ, Krestin GP. Computed tomography of the coronary arteries. New York: Taylor and French; 2005.

    Google Scholar 

  18. Gosselin MV, Rubin GD, Leung AN, et al. Unsuspected pulmonary embolism: Prospective detection on routine helical CT scans. Radiology 1998;208:209-15.

    PubMed  CAS  Google Scholar 

  19. Storto ML, Di Credico A, Guido F, et al. Incidental detection of pulmonary emboli on routine MDCT of the chest. Am J Roentgenol 2005;184:264-7.

    Google Scholar 

  20. Gladish G, Choe D, Marom E. Incidental pulmonary emboli in oncology patients: Prevalence, CT evaluation and natural history. Radiology 2006;240:246-55.

    Article  PubMed  Google Scholar 

  21. Winston CB, Wechsler RJ, Salazar AM, et al. Incidental pulmonary emboli detected at helical CT: Effect on patient care. Radiology 1996;201:23-7.

    PubMed  CAS  Google Scholar 

  22. Goodman L. Small pulmonary emboli: What do we know? Radiology 2005;234:654-8.

    Article  PubMed  Google Scholar 

  23. Gottsegen J, Coplan N. The atherosclerotic aortic arch: Considerations in diagnostic imaging. Prev Cardiol 2008;11:162-7.

    PubMed  Google Scholar 

  24. Hayter R, Rhea J, Small A, Tafazoli F, Novelline R. Suspected aortic dissection and other aortic disorders: Multi-detector row CT in 373 cases in emergency setting. Radiology 2006;238:266-74.

    Article  Google Scholar 

  25. Kazerooni E, Bree R, Williams D. Penetrating atherosclerotic ulcers of the descending thoracic aorta: Evaluation with CT and distinction from aortic dissection. Radiology 1992;183:759-67.

    PubMed  CAS  Google Scholar 

  26. Patel H, Deeeb G. Ascending and arch aorta: Pathology, natural history and treatment. Circulation 2008;117:1883-9.

    Article  Google Scholar 

  27. Henderson R, Wigle E, Sample K, Marryatt G. Atypical chest pain of cardiac and esophageal origin. Chest 1978;73:24-7.

    Article  PubMed  CAS  Google Scholar 

  28. Wright RA, Hurwitz AL. Relationship of hiatal hernia to endoscopically proved reflux esophagitis. Dig Dis Sci 1979;24:311-3.

    Article  PubMed  CAS  Google Scholar 

  29. Takakuwa K, Halpern E. Evaluation of a “triple rule-out” coronary CT angiography protocol: Use of 64-Section CT in low-to-moderate risk emergency department patients suspected of having acute coronary syndrome. Radiology 2008;248:438-46.

    Article  PubMed  Google Scholar 

  30. Henschke CI, Davis SD, Roman RM, et al. Pleural effusions: Pathogenesis, radiologic evaluation, and therapy. J Thorac Imaging 1989;4:49.

    Article  PubMed  CAS  Google Scholar 

  31. McLoud TC, Flower CDR. Imaging the pleura: Sonography, CT, and MR imaging. AJR 1991;156:1145.

    PubMed  CAS  Google Scholar 

  32. Muller NL. Imaging the pleura. Radiology 1993;186:297.

    PubMed  CAS  Google Scholar 

  33. Naidich DP, Zerhouni EA, Siegelman SS. The pleura and chest wall. In: Naidich DP, Zerhouni EA, Siegelman SS, editors. Computed tomography of the thorax. 2nd ed. New York: Raven Press; 1991. p. 407.

    Google Scholar 

  34. MacMahon H, Austin JHM, Gamsu G, et al. Guidelines for management of small pulmonary nodules detected on CT scans: A statement from the Fleischner Society. Radiology 2005;237:395-400.

    Article  PubMed  Google Scholar 

  35. Toloza EM, Harpole L, McCrory DC. Noninvasive staging of non-small cell lung cancer: A review of the current evidence. Chest 2003;123:137S-46S.

    Article  PubMed  Google Scholar 

  36. Henschke CI, McCauley DI, Yankelevitz D, et al. Early lung cancer action project: Overall design and findings from baseline screening. Lancet 1999;354:99-105.

    Article  PubMed  CAS  Google Scholar 

  37. Swensen SJ, Jett JR, Hartman TE, et al. CT screening for lung cancer: Five year prospective experience. Radiology 2005;235:259-65.

    Article  PubMed  Google Scholar 

  38. Midthun DE, Swensen SJ, Jett JR, et al. Evaluation of nodules detected by screening for lung cancer with low dose spiral computed tomography. Lung Cancer 2003;41:S40.

    Article  Google Scholar 

  39. Henchske CL, Yankelevitz DF, Mirtcheva R. CT screening for lung cancer: Frequency and significance of part-solid and nonsolid nodules. Am J Roentgenol 2002;178:1053-7.

    Google Scholar 

  40. Hasegawa M, Sone S, Takashima S, et al. Growth rate of small lung cancers detected on mass screening CT. Br J Radiol 2000;73:1252-9.

    PubMed  CAS  Google Scholar 

  41. Glazer GM, Gross BH, Quint LE, et al. Normal mediastinal lymph nodes: Number and size according to American Thoracic mapping. Am J Roentgenol 1985;144:261-5.

    CAS  Google Scholar 

  42. Winer-Muram HT. The solitary pulmonary nodule. Radiology 2006;239:34-49.

    Article  PubMed  Google Scholar 

  43. Mulshine JL, Sullivan DC. Lung cancer screening. N Engl J Med 2005;352:2714-20.

    Article  PubMed  CAS  Google Scholar 

  44. Swensen S, Aberle CD, Kazerooni EA, Patz N, Galvin JR, Henschke C. Society of thoracic radiology ad-hoc committee on lung cancer screening with CT. J Thorac Imaging 2005;20:321.

    Article  Google Scholar 

  45. Henschke CI, Austin JH, Berlin N, Bauer T, Giunta S, Gannis F, et al. Minority opinion: CT screening for lung cancer. J Thorac Imaging 2005;20:324-5.

    Article  PubMed  Google Scholar 

  46. Henschke CI, Yankelevitz DF, Libby DM, McCauley D, Pasmantier M, Altorki NJ, et al. Early lung cancer action project—Annual screening using single-slice helical CT. Ann N Y Acad Sci 2001;952:124-34.

    Article  PubMed  CAS  Google Scholar 

  47. Bogot NR, Kazerooni EA, Kelly AM, Quint LE, Desjardins B, Nan B. Intraobserver and intraobserver variability in the assessment of pulmonary nodule size on CT using film and computer display methods. Acad Radiol 2005;12:948-56.

    Article  PubMed  Google Scholar 

  48. Budhoff M, Gopal A. Incidental findings on cardiac computed tomography. Should we look? J Cardiovasc Comput Tomogr 2007;1:97-105.

    Article  Google Scholar 

  49. Wyman RA, Chang SM, Chiu RY, Wann S. Survey of current practices of the specialty of physicians interpreting cardiac and noncardiac findings of coronary computed tomographic angiography. Am J Cardiol 2007;100:1782-5.

    Article  PubMed  Google Scholar 

  50. Wann S, Nassef A, Jeffrey J, Messer J, Wilke N, Duerinckx A, et al. Ethical considerations in CT angiography. Int J Cardiovasc Imaging 2007;23:379-88.

    Article  PubMed  Google Scholar 

  51. McMahon P, Kong C, Weinstein M, Weeks J, Kuntz K, Shepard J, et al. Estimating long-term effectiveness of lung cancer screening in the Mayo CT screening study. Radiology 2008;248:278-87.

    Article  PubMed  Google Scholar 

  52. Bach P. Untreated patients in “CT screening for lung Cancer: Update 2007”. Oncologist 2008;13:1030-2.

    Article  PubMed  Google Scholar 

  53. Budhoff M, Achenbach S, Berman D, Fayad Z, Poon M, Taylor A, et al. Task Force 13: Training in advanced cardiovascular imaging (computed tomography). J Am Coll Cardiol 2008;51:409-14.

    Article  Google Scholar 

  54. Weinreb J, Larson P, Woodard P, Stanford W, Rubin G, Stillman A, et al. American College of Radiology clinical statement on noninvasive cardiac imaging. Radiology 2005;235:723-9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Wisconsin Heart Hospital, 10000 Bluemound Road, Milwaukee, WI, 53226, USA

    Samuel Wann MD, MACC

  2. The Department of Medicine, Cardiology Section, Washington University School of Medicine, St. Louis, MO, USA

    Peter Rao MD

  3. The Oklahoma Heart Institute, Tulsa, OK, USA

    Roger Des Prez MD, FACC

Authors
  1. Samuel Wann MD, MACC
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  2. Peter Rao MD
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  3. Roger Des Prez MD, FACC
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Correspondence to Samuel Wann MD, MACC.

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Wann, S., Rao, P. & Prez, R.D. Cardiac computed tomographic angiography: evaluation of non-cardiac structures. J. Nucl. Cardiol. 16, 139–150 (2009). https://doi.org/10.1007/s12350-008-9035-z

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  • DOI: https://doi.org/10.1007/s12350-008-9035-z

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