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Published on: August 28, 2018
Extracardiac findings on coronary computed tomography angiography in patients without significant coronary artery
Philipp Karius1, Alexander Lembcke1, Felix C Sokolowski1
1Charite Medical School, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Chariteplatz 1, 10117, Berlin, Germany.
Insights
Coronary computed tomography angiography (CTA) reveals extracardiac findings in 30.2% of patients without significant coronary artery disease (CAD). In symptomatic individuals, CTA identified potential causes for chest pain in 7.9%, highlighting its diagnostic value beyond CAD.
Area of Science:
- Radiology
- Cardiology
- Medical Imaging
Background:
- Coronary artery disease (CAD) is a common cause of chest pain.
- Coronary computed tomography angiography (CTA) is frequently used to exclude significant CAD.
- Extracardiac findings (ECF) can also cause chest pain and may be incidentally detected during CTA.
Purpose of the Study:
- To analyze extracardiac findings in patients undergoing CTA for CAD exclusion.
- To identify ECFs in symptomatic patients that may explain their chest pain.
- To investigate factors influencing the detection of ECFs.
Main Methods:
- Retrospective analysis of 3,898 patients without significant CAD (<50% stenosis) from CTA scans (2000-2014).
- Detailed analysis of ECFs in 2,330 symptomatic patients.
- Investigation of variables associated with the number of detected ECFs.
Main Results:
- Overall ECFs detected in 30.2% of patients.
- Relevant incidental ECFs requiring follow-up or urgent/malignant findings in 2.8% of patients.
- In symptomatic patients without significant CAD, 7.9% had ECFs potentially explaining their chest pain.
- Number of ECFs increased with patient age and reader experience.
Conclusions:
- CTA is valuable for detecting ECFs in patients evaluated for CAD.
- A significant proportion of symptomatic patients without CAD have ECFs that can explain their symptoms.
- Patient age and radiologist experience impact ECF detection rates.
Objective:
To analyse extracardiac findings in patients without significant coronary artery disease (CAD) in general and in symptomatic patients in particular.
Methods:
We searched the Radiology Information System database for coronary computed tomography angiographies (CTA) performed from 2000-2014 and retrospectively enrolled 3,898 patients without significant CAD (coronary stenosis < 50%) in CTA. In 2,330 symptomatic patients, we analysed the spectrum of extracardiac findings and identified pathologies potentially explaining chest pain. Finally, we investigated variables affecting the number of extracardiac findings detected in CTA.
Results:
Overall extracardiac findings were found in 1,177 patients (30.2%; 95%CI, 28.8-31.7%). 94 patients (2.4%; 95%CI, 2.0-2.9%) had extracardiac findings with a recommendation for follow-up, sixteen patients (0.4%; 95%CI, 0.3-0.7%) had incidental urgent, and another three patients (0.1%; 95%CI, 0.1-0.2%) had incidental malignant extracardiac findings. 185 of 2,330 symptomatic patients (7.9%; 95%CI, 6.9-9.1%) revealed extracardiac findings potentially explaining chest pain after exclusion of significant CAD. The number of extracardiac findings increased significantly with patient age (p < 0.001) and the cumulative experience of the CT reader (p < 0.001).
Conclusion:
30.2% of patients undergoing CTA for exclusion of CAD had ECF, and 7.9% of symptomatic patients without significant CAD on their examination had findings that could potentially explain their symptoms.
Key Points:
• Of patients undergoing CTA, 2.8% have relevant incidental extracardiac findings. • CTA could identify the differential diagnosis of chest pain when excluding significant CAD. • Patient age and reader's professional experience influence the number of detected ECFs.
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