Incidental findings noted on calcium scoring CT scans

Transcription

1 Incidental findings noted on calcium scoring CT scans Poster No.: C-170 Congress: ECR 2009 Type: Scientific Exhibit Topic: Cardiac Authors: M. D. B. S. Tam 1, T. Latham 1, W. Howard 2, A. B. Tanqueray 2 ; 1 2 Norwich/UK, Southend/UK Keywords: DOI: cardiac CT, Incidental, cardiologist /ecr2009/C-170 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 15

2 Purpose To determine the number of incidental non-cardiac abnormal findings on calcium scoring cardiac CTs. Methods and Materials Triple-reading of 199 consecutive calcium scoring CT scans was conducted. A consensus meeting was then held to review the detected abnormalities, define the nature of the abnormalities,and to determine whether patient recall for further investigations was required. Results 55 out of 199 CT scans (27.6%) were abnormal. 69 abnormalities were detected across the 55 scans. Significant abnormalities included a squamous carcinoma of the lung and indeterminate pulmonary nodules requiring follow up. Parenchymal lung abnormalities included a tumour, nodules, consolidation, emphysema and bronchiectasis. Pleural plaques and pleural effusions were identified. Mediastinal abnormalities included lymphadenopathy and pericardial effusions. Upper abdominal abnormalities were also detected and included ascites and gallstones. Page 2 of 15

3 Fig.: Summary of abnormalities by region. Significant abnormalities included a primary lung carcinoma. Analysis of the intra-pulmonary nodules left 3 indeterminate pulmonary nodules measuring 7mm, 4mm and 2 mm respectively. These nodules were followed up according to our local protocol. Of the 14 lymph nodes, morphology such as the presence of a fatty hilum allowed the majority of the enlarged nodes to be classified as reactive. Other abnormalities such as pleural effusions, ascites and gallstones may have been known about by the referring clinician. Page 3 of 15

4 Fig.: 3 cm mass lesion with an associated pericardial effusion. This was demonstrated to be a non-small cell lung carcinoma. Page 4 of 15

5 Fig.: 7mm intra-pulmonary nodule which required follow-up. Page 5 of 15

6 Fig.: Bilateral pleural effusions and consolidation. Page 6 of 15

7 Fig.: COPD. Page 7 of 15

8 Fig.: Lower lobe bronchiectasis. Page 8 of 15

9 Fig.: Pleural plaque. Page 9 of 15

10 Fig.: 11mm pre-tracheal lymph node. Page 10 of 15

11 Fig.: 4.5 cm aortic root. Page 11 of 15

12 Fig.: Gallstones. Page 12 of 15

13 Fig.: Ascites. Page 13 of 15

14 Images for this section: Fig. 1: Summary of abnormalities by region. Significant abnormalities included a primary lung carcinoma. Analysis of the intra-pulmonary nodules left 3 indeterminate pulmonary nodules measuring 7mm, 4mm and 2 mm respectively. These nodules were followed up according to our local protocol. Of the 14 lymph nodes, morphology such as the presence of a fatty hilum allowed the majority of the enlarged nodes to be classified as reactive. Other abnormalities such as pleural effusions, ascites and gallstones may have been known about by the referring clinician. Page 14 of 15

15 Conclusion 28% of unenhanced calcium scoring CT scans show non-cardiac abnormalities. At least 1% of the abnormalities found were clinically signficant. One of these abnormalities was unambiguously important - the NSCLC. However, this was advanced disease and the presumed earlier detection is unlikely to have had an impact upon the patient outcome. Our levels of abnormal findings were in line with a recently published retrospective review of 100 CT angiograms who found 145 abnormalities, 16 (11%) of which were deemed to be clinically significant findings which required immediate intervention or evaluation. However, these were contrast-enhanced which would make lesion detection and characterisation more straight-forward (1). Another retrospective review of the reports from 1356 cardiac CT scans recommended further imaging follow-up in 4.2% (2). Furthermore, there is data from whole-body CT scan screening which states rates of detection of pulmonary nodules in up to 10% and incidental cancer rate of 1% albeit on whole-body and whole-lung large field of view data-sets (3). Is the presence of a hiatus hernia or gallstones important? The interpretation of a large number of abnormalities is dependent upon the clinical scenario. What is the clinical relevance of some of these findings in the general population, as compared to a population who have atypical chest pain? Should the whole acquistion be downloaded from the optical disc and reviewed - or just the small field of view sent to PACS? These findings raise the question of whether these investigations should be read by nonradiologists or specialists with no training in general CT. Page 15 of 15