Incidental Findings on Cardiac Imaging

Abstract

AJR:191, September 2008 Their findings raise the question: Should we look for, report, and follow up on incidental findings identifiable during cardiac imaging examinations? According to the findings of Northam et al. and others [7–12], it may seem obvious that we should. More health information is better. Patients and their physicians can decide how to proceed with the additional data identified. For now, let us consider five counterarguments proposed by Budoff et al. [14] to the review of full-FOV data: “(a) > 50% of participants may have at least one noncalcified nodule; (b) the increased costs and radiation exposure associated with the resulting followup CT scans; (c) the cost and the morbidity of follow-up, including further testing, as well as biopsy or resection of benign noncalcified nodules (at least 25% of such procedures in several trials); (d) a small but difficult to quantify potential risk of cancer associated with multiple follow-up CT scans; and (e) a potential for increased anxiety of both the patient and the physician about nonsignificant pathology.” Budoff et al. [14] concluded: “We have reviewed all the relevant literature and sought to determine the potential benefits and harms of specifically overreading CTA for noncardiac pathology. The weight of the evidence suggests that it is most prudent to not specifically reconstruct and re-read CTA scans for lung nodules. If a noncardiac abnormality is visualized by the primary interpreter of the cardiac CT, appropriate referral or follow-up is prudent.” Supporting these conclusions, radiation oncologists Smitt and Mehta [15] found that although incidental findings were identified on 20% of 132 radiation-planning CT scans, only three patients had important previously unknown findings, and only one patient with neck adenopathy had potential outcome benefit from discovery. The findings by Northam et al. [13] balance the compelling arguments made by Budoff et Incidental Findings on Cardiac Imaging