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Published on: August 28, 2018
Under-reporting of cardiovascular findings on chest CT
Nicola Sverzellati1, Teresa Arcadi2, Luca Salvolini3
1Section of Diagnostic Imaging, Department of Surgical Sciences, University of Parma, Padiglione Barbieri, University Hospital of Parma, V. Gramsci 14, 43100, Parma, Italy. nicolasve@tiscali.it.
Insights
Radiologists often miss reporting cardiovascular findings on standard chest CT scans. A significant number of these incidental findings, some clinically relevant, are under-reported, impacting patient care.
Area of Science:
- Radiology
- Cardiovascular Imaging
- Medical Diagnostics
Background:
- Standard chest computed tomography (CT) is widely used for pulmonary and oncologic evaluations.
- The incidental detection and reporting of cardiovascular abnormalities on these non-cardio-synchronized scans remain under-investigated.
- Assessing the frequency and reporting rates of cardiovascular findings is crucial for improving diagnostic yield.
Purpose of the Study:
- To determine the frequency of cardiovascular abnormalities detected on non-ECG-synchronized chest CT.
- To evaluate the reporting rate of these incidental cardiovascular findings by radiologists.
- To assess the clinical significance and under-reporting of these findings.
Main Methods:
- Retrospective analysis of 447 non-ECG-synchronized chest CT examinations from four academic centers.
- Examinations were reviewed by junior and senior chest radiologists, and subsequently by cardiac imaging specialists.
- Inter-observer agreement was assessed using the kappa coefficient.
Main Results:
- At least one incidental cardiovascular finding was identified in 55% of reviewed chest CTs.
- Potentially clinically significant cardiovascular findings were unreported in 39.6% of subjects.
- Senior radiologists were more likely to report coronary artery calcification, cardiac valve calcification, and ascending aorta enlargement.
Conclusions:
- Standard chest CT reliably identifies several cardiovascular abnormalities.
- These incidental findings are frequently under-reported, even when clinically relevant.
- Improved reporting of cardiovascular findings on chest CT can enhance patient management.
Purpose:
It is unclear whether (and, to what extent) radiologists look at and report cardiovascular abnormalities on non-cardio-synchronized standard chest computed tomography (CT). In this study, the frequency and the reporting rate of cardiovascular findings in chest CT examinations were retrospectively assessed.
Materials And Methods:
This study was approved by the institutional review board of each participating center. Four academic centers provided data on 447 subjects who underwent non-ECG-synchronized chest CT examinations for evaluating pulmonary fibrosis (161/447, 36 %), suspected pulmonary embolism (140/447, 31.3 %), or lung cancer staging (146/447, 32.7 %). A total of 220/447 (53.7 %) and 227/447 CT (46.3 %) examinations were evaluated and reported by junior and senior chest radiologists, respectively. Two radiologists with training in cardiac imaging reviewed the same chest CT images looking for the presence of incidental cardiovascular abnormalities using a preformatted score sheet. Inter-observer agreement was assessed using the kappa coefficient of agreement (k).
Results:
Inter-observer agreement between the study reviewers was moderate to good (0.4-0.73) for most of the incidental cardiovascular findings. At least one incidental cardiovascular finding not documented in the original report was identified by the study reviewers in 225/409 (55 %) of chest CT examinations. A total of 168/266 (63.2 %) potentially clinically significant cardiovascular findings were unreported in the original reports of 177/447 (39.6 %) subjects (p < 0.0001). Senior radiologists tended to more frequently report coronary artery calcification (p = 0.0006), cardiac valves calcification (p = 0.0003), and ascending aorta enlargement (p = 0.01) compared to junior radiologists.
Conclusions:
Several cardiovascular abnormalities can be reliably identified on standard chest CT. Yet, they are often under-reported, even when they might be relevant to the patient's work-up.
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