Prevalence of Noncardiac Findings on Clinical Cardiovascular MRI

Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA.
American Journal of Roentgenology (Impact Factor: 2.73). 04/2011; 196(4):W380-6. DOI: 10.2214/AJR.09.3112
Source: PubMed


The purpose of our study was to determine the prevalence and significance of noncardiac findings on clinical cardiovascular MRI and to identify the cardiovascular MRI sequences that most frequently depict noncardiac findings.
Images from 495 clinical cardiovascular MRI studies performed during 2006 were reviewed specifically for noncardiac findings by a cardiovascular imaging fellowship-trained radiologist without knowledge of the prior study interpretation. Noncardiac findings were classified as benign (e.g., gynecomastia), indeterminate (e.g., pleural effusion), or worrisome (e.g., lung nodule). The cardiovascular MRI sequences depicting the noncardiac finding were recorded.
On image review, 295 noncardiac findings were identified in 212 (43%) of 495 studies, including 148 benign, 133 indeterminate, and 14 worrisome noncardiac findings. Of these, 47% of indeterminate and 57% of worrisome noncardiac findings were not previously known. Cardiovascular MRI sequences that most frequently showed noncardiac findings included the single-shot fast steady-state free precession (SSFP) scout images (63% of all noncardiac findings) and axial T1-weighted fast spin-echo thoracic images (60% of all noncardiac findings), with 99% of management-changing noncardiac findings visualized on one of these two sequences.
Noncardiac findings on clinical cardiovascular MRI are common. Although only a small minority of studies contain management-changing noncardiac findings, the vast majority of management-changing noncardiac findings are seen on thoracic SSFP scout and axial T1-weighted thoracic fast spin-echo images.

Download full-text


Available from: Faisal Khosa

  • No preview · Article · Nov 2011 · Radiology
  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine the prevalence and importance of extracardiac findings (ECF) in patients undergoing clinical CMR and to test the hypothesis that the original CMR reading focusing on the heart may underestimate extracardiac abnormalities. 401 consecutive patients (mean age 53 years) underwent CMR at 1.5 T. Main indications were ischaemic heart disease (n = 183) and cardiomyopathy (n = 164). All CMR sequences, including scout images, were reviewed with specific attention to ECF in a second reading by the same radiologist who performed the first clinical reading. Potentially significant findings were defined as abnormalities requiring additional clinical or radiological follow-up. 250 incidental ECF were detected, of which 84 (34%) had potentially significant ECF including bronchial carcinoma (n = 1), lung consolidation (n = 7) and abdominal abnormalities. In 166 CMR studies (41%) non-significant ECF were detected. The number of ECF identified at second versus first reading was higher for significant (84 vs. 47) and non-significant (166 vs. 36) findings (P < 0.00001). About one fifth of patients undergoing CMR were found to have potentially significant ECF requiring additional work-up. The second dedicated reading detected significantly more ECF compared with the first clinical reading emphasising the importance of active search for extracardiac abnormalities when evaluating CMR studies. • Many patients undergoing cardiac MR have significant extracardiac findings (ECF) • These impact on management and require additional work-up. • Wide review of scout and cine sequences will detect most ECFs. • Education of radiologists is important to identify ECFs on CMR studies.
    No preview · Article · Jan 2012 · European Radiology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Non-cardiac findings (NCFs) are seen in more than a third of cardiac computed tomographic and cardiac magnetic resonance imaging studies. The prevalence and importance of NCFs in transthoracic echocardiographic (TTE) imaging is unknown. The aim of this study was to determine the prevalence of NCFs on TTE imaging. The subcostal images of all comprehensive adult TTE studies performed at one institution in December 2008 were retrospectively reviewed for NCFs by a radiologist with fellowship training in cardiovascular and abdominal radiology and blinded to the TTE report findings and clinical histories. Additional TTE image orientations were assessed in a subset of 300 studies. NCFs were categorized as benign (e.g., simple hepatic cyst), indeterminate (e.g., ascites), or worrisome (e.g., liver metastases). If an indeterminate or worrisome NCF was identified, the patient's electronic medical record was reviewed to determine if the NCF was previously known. Of 1,008 TTE studies (443 inpatient, 565 outpatient) in 922 patients, 77 NCFs were identified in 69 patients (7.5%). These included 20 benign (26%), 52 indeterminate (67%), and five worrisome (7%) NCFs. Intermediate and worrisome NCFs were more common in inpatient TTE studies (9% vs 3% outpatient, P = .002). The additional views demonstrated 2% more NCFs. Record review demonstrated that 60% of worrisome and 67% of indeterminate NCFs were previously known. No unknown NCF ultimately led to a change in patient management. Clinical TTE studies demonstrate NCFs in 7.5% of all patients, with an increased prevalence on inpatient studies. Although 75% of NCFs were potentially management changing, the majority of these were previously known and very unlikely to lead to management changes. Further study is needed to validate these findings in other populations and to assess their clinical impact.
    Full-text · Article · Mar 2012 · Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography
Show more