Incidental findings in CT imaging of coronary artery bypass grafts: results from a Canadian multicenter prospective cohort

I Boldeanu,J Perreault Bishop,T M Kieser,G Soulez,L.-M Stevens,A Lamy,S Nepveu,C Chartrand-Lefebvre,N Noiseux

doi:10.1186/s13104-018-3168-1

Abstract

ObjectiveTo assess the prevalence and clinical significance of incidental findings identified during computed tomography imaging of coronary artery bypass grafts.ResultsThis prospective study includes 144 patients undergoing coronary graft patency assessment using computed tomography. Incidental findings were classified as significant if they were considered to need an immediate action or treatment, short-term work-up or follow-up, or minor. A total of 211 incidental findings were present in 109 (75.7%) patients. Seventy-one incidental findings (33.6%) were cardiac and 140 (66.4%) were extracardiac. Most common cardiac incidental findings were atrial dilatation [39 patients, 48 incidental findings (67.6%)] and aortic valve calcifications (7 patients, 9.9%). Among the 140 extracardiac incidental findings, the most common were lung nodules (51 patients, 54 nodules, 38.6%), and emphysema (21 patients, 15%). Thirty-six (25.7%) extracardiac incidental findings were significant and notably, 23 (63.9%) were lung nodules. Follow-up was recommended in 37 cases, among which all patients with significant lung nodules (23 patients, 62.2%). In conclusion, most common computed tomography incidental findings in patients with coronary grafts were lung nodules and emphysema.

Highlights

Heart disease remains the main cause of hospitalization and death in industrialized countries, with a significant health care burden [1]
computed tomography (CT) scanning for coronary calcium scoring or coronary CT angiography is limited to the heart and involves limited portions of the extracardiac anatomy
CT acquisition performed for coronary artery bypass graft surgery (CABG) evaluation involves more lung volume to be assessable, since scanning will cover from the length of the mammary arteries as well as the heart

Summary

Results

CT follow up was recommended for the 23 significant pulmonary nodules. Recommendations for clinically significant extracardiac findings, other than pulmonary nodules, were abdominal, cervical or breast ultrasonography. Pulmonary nodules (23 patients, 62.2% of significant IF) and hepatic lesions (6 patients, 16.2%) were the most common. Additional files 3 and 4 describe cases of incidental lung and hepatic findings. Cases of thyroid nodule (3 patients, 8.1%) and enlarged mediastinal lymph nodes (3 patients, 8.1%) were observed, as well as a single case of left ventricular hypertrophy (2.7%) and one of pulmonary infiltrate (2.7%). Among patients with significant lung nodules versus without any nodules, the proportions of current or former smokers were 70.0% (16/23) and 76.8% (73/95), respectively (p = 0.590)

Introduction

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Discussion

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