Incidental Findings in Cardiac CT Rarely Significant

October 7, 2009 – Rates of death were similar in patients with and without incidental findings (IF) identified with cardiac computed tomography (CT), and IF was not an independent predictor of noncardiac death, reported researchers in a study published in the online version of the October 2009 issues of the Journal of the American College of Cardiology.

As cardiac CT becomes more widely adopted, prompting the discovery of extracardiac IF to potentially increase, researchers in the study, Potential Clinical and Economic Consequences of Noncardiac Incidental Findings on Cardiac Computed Tomography, set out to determine “the incidence, clinical significance, and potential financial impact of noncardiac IF identified with cardiac computed tomography (CT).”

Of 966 patients (58 ± 16 years of age, 55.4 percent men, >98 percent outpatients), who underwent cardiac CT and had noncardiac structures evaluated after full field of view (32 to 50 cm) reconstruction, 401 (41.5 percent) patients had noncardiac IF. A total of 12 (1.2 percent) patients had clinically significant (CS) findings, and 68 (7.0 percent) patients had indeterminate findings. At follow-up (18.4 ± 7.6 months), none of the indeterminate findings became CS. After adjusting for age, IF were not an independent predictor of noncardiac death. Noncardiac death and cancer death in patients with and without IF were not statistically different. One patient suffered a major complication related to the investigation of an IF. The total direct cost associated with investigating IF was Canadian $57,596 (U.S. $83,035).

Based on their findings, the researchers concluded: “Although noncardiac IF are common, clinically significant or indeterminate IF are less prevalent. Rates of death were similar in patients with and without IF, and IF was not an independent predictor of noncardiac death. The investigation of IF is not without cost or risk. Larger studies are required to assess the potential mortality benefit of identifying IF.”

References: JMacHaalany, M.D., Jimmy, et al. Potential Clinical and Economic Consequences of Noncardiac Incidental Findings on Cardiac Computed Tomography. J Am Coll Cardiol, 2009; 54:1533-1541, doi:10.1016/j.jacc.2009.06.026.

For more information: http://content.onlinejacc.org/cgi/content/abstract/54/16/1533