Prevalence of Incidental Extracardiac Findings on Multidetector Computed Tomographic Coronary Angiography

Objective: To determine the prevalence, spectrum, and significance of incidental extracardiac findings in patients undergoing multidetector computed tomographic (MDCT) coronary angiography. Material and Methods: We performed a retrospective review of 375 consecutive patients referred for MDCT coronary angiography. All MDCT angiography examinations were performed by a 16-slice MDCT scanner. Extracardiac findings were classified as clinically insignificant or significant. Insignificant findings were those considered to be of minor clinical significance with no immediate follow-up or treatment required. Clinically significant findings were classified as moderately or highly significant. Moderately significant findings were those considered to be of potential clinical importance, requiring correlation with patient history or a follow-up examination. Highly significant findings were those considered to be of definite clinical importance requiring immediate workup and treatment. Results: A total of 242 extracardiac findings were found in 155 (41.3%) patients. Eighty-three (22.1%) patients had insignificant findings and 72 (19.2%) had significant findings. We found 13 highly significant findings including pulmonary embolism, aortic aneurysm, aortic dissection, lung cancer, esophageal carcinoma and hepatic metastasis distributed among 12 patients (3.2%), and 8 patients who eventually had therapeutic consequences. Conclusion: Because extracardiac structures such as lungs, mediastinum and upper abdomen are appropriate for assessment in MDCT coronary angiography and extracardiac findings are frequent, the reporting radiologist should be aware of the likelihood and frequency of these findings and their probable significance.