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Extracardiac findings at cardiac MR imaging: a single-centre retrospective study over 14 years
Felix C Sokolowski1, Philipp Karius1, Alejandra Rodríguez1
1Department of Radiology, Charite Medical School, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Chariteplatz 1, 10117, Berlin, Germany.
Insights
Extracardiac findings (ECF) are common in cardiac MRI, appearing in about one-third of patients. Clinically significant ECF that alter patient management occur in approximately 1% of cases, highlighting the importance of thorough radiologist review.
Area of Science:
- Radiology and Imaging Science
- Cardiovascular Imaging
- Medical Diagnostics
Background:
- Cardiac magnetic resonance (MR) imaging is a crucial diagnostic tool for cardiovascular conditions.
- Incidental extracardiac findings (ECF) are frequently observed during these examinations.
- Understanding the prevalence and significance of ECF is essential for comprehensive patient care.
Purpose of the Study:
- To determine the prevalence and clinical significance of extracardiac findings (ECF) in a large cohort undergoing cardiac MR imaging.
- To analyze associations between ECF and patient demographics, clinical indications, and management changes.
- To emphasize the role of radiologists in identifying and interpreting ECF in cardiac MR studies.
Main Methods:
- Retrospective analysis of 4376 cardiac MR imaging reports from 3553 patients (2000-2014).
- Definition of 'major ECF' as findings requiring follow-up.
- Statistical analysis using Poisson regression to evaluate associations with indication, age, and gender.
Main Results:
- Overall ECF prevalence was 34%; major ECF occurred in 3.4% of patients.
- Findings altering patient management were identified in 0.9% of cases.
- Higher ECF prevalence was noted in congenital heart disease cases; older age correlated with nonvascular ECF.
Conclusions:
- Extracardiac findings are prevalent in cardiac MR imaging, present in approximately one-third of patients.
- Clinically relevant ECF that change patient management are infrequent, found in about 1% of cases.
- Radiologist expertise is vital for detecting ECF, particularly in patients with congenital heart disease or vascular indications.
Objectives:
To determine the prevalence and significance of extracardiac findings (ECF) in a large set of cardiac magnetic resonance (MR) imaging examinations.
Methods:
The institutional review board (IRB) of the Charité approved this retrospective, single-centre study. A total of 4376 cardiac MR imaging reports of 3553 patients (age 37.4 ± 20 years, 60.8 % male) examined from 2000 to 2014 were included. Findings with a recommendation for follow-up were considered "major ECF". To analyse the association of indication, age and gender with ECF, Poisson regression and computed incidence rate ratios (IRR) were evaluated.
Results:
The overall prevalence of ECF was 34% (95% confidence interval [CI] 32.5-35.6%). Major ECF were present in 3.4% (95% CI 2.9-4.1%) while findings that changed patient management were found in 0.9% (95% CI 0.7-1.3%). In the cases of congenital heart disease, ECF prevalence was higher compared to myocarditis (IRR, 6.0; 95% CI 5.1-7.1%; p < 0.001), while the prevalence of major ECF was lower (IRR, 0.2; 95% CI 0.02-0.51%; p < 0.05). Older patient age was associated with more nonvascular ECF (p < 0.001). Female patients had the same probability of having an ECF as male patients (IRR, 1.04; 95% CI 0.95-1.1%; p = 0.43).
Conclusion:
ECF in cardiac MR imaging are present in about every third patient while relevant ECF that change patient management can be found in about one out of 100 patients. Our data suggest that it is important to involve well-trained radiologists in reading cardiac MR images, which often reveal ECF if congenital heart disease is the clinical indication.
Key Points:
• Extracardiac findings are present in about every third patient. • Relevant ECF changing patient management are found in one out of 100 findings. • Chance of ECF is high in patients with CHD and vascular indications.
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