Prognostic value of extracardiac incidental findings on attenuation correction cardiac computed tomography
Qureshi WT, Alirhayim Z, Khalid F, Al-Mallah MH. Prognostic value of extracardiac incidental findings on attenuation correction cardiac computed tomography. J Nucl Cardiol. 2016 ;23(6):1266-1274.
Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology
BACKGROUND: Attenuation corrected computed tomography (CTAC) is often performed to improve the specificity of single-photon emission tomography imaging. Extracardiac incidental findings are frequently observed. It is unclear whether these findings have any prognostic value.
METHODS: Consecutive patients (n = 1139) at a tertiary care center were retrospectively evaluated for incidental findings on CTAC. Clinically significant incidental findings were defined as findings warranting physician follow-up. Information regarding subsequent resource utilization was obtained by chart review. Cox proportional hazard model adjusted for demographic and clinical variables was used to evaluate association of these incidental findings with all-cause and cancer-specific mortality.
RESULTS: A total of 135 (12%) patients with incidental findings were identified, 83 of whom (68%) were newly diagnosed. Lung nodules were the most common finding, present in 92 (68%) patients. Over a median follow-up of 468 days, incidental findings were not significantly associated with increased risk of all-cause mortality (HR 1.34; 95% CI 0.77-2.33, P = 0.29) but was significantly associated with cancer-specific mortality (HR 3.21; 95% CI 1.26-8.14, P = 0.01). This association remained statistically significant when the analysis was limited to newly diagnosed incidental findings. Among patients with incidental findings, follow-up radiographic studies were conducted in 87%, and invasive procedures performed in 32%. Physician office-based follow-up of these findings occurred in 42% of patients and incidental finding-related hospitalization occurred in 14%.
CONCLUSIONS: This study shows that incidental findings are common and were associated with all-cause and cancer-specific mortality but only the later remained statistically significant after multivariable adjustment.
Medical Subject Headings
Artifacts; Cardiac Imaging Techniques; Comorbidity; Coronary Artery Disease; Female; Humans; Incidence; Incidental Findings; Male; Michigan; Middle Aged; Neoplasms; Prognosis; Reproducibility of Results; Risk Assessment; Risk Factors; Sensitivity and Specificity; Single Photon Emission Computed Tomography Computed Tomography; Survival Rate