P1839 Extracardiac findings in cardiac CT and MRI - a Maltese perspective

Abstract

Abstract Background Cardiac CT and MRI are relatively new, non-invasive modalities of cardiac imaging, obtaining excellent image quality mainly pertaining to the heart. However, both these modalities also obtain diagnostic quality images of extracardiac structures. International studies quote varying rates of positive extracardiac findings (ECF) ranging from 20-30% in cardiac MRI and 30-40% in CT. Purpose To evaluate the prevalence of incidental ECF in cardiac imaging in the Maltese Islands and assess for any differences in prevalence between sexes and age groups. Methods All patients having performed cardiac CT and cardiac MRI scans performed in the year 2017 in the Maltese Islands (n = 733) were enrolled. Imaging reports of these scans were retrospectively reviewed, making a note of the patient’s age and sex and any positive ECF. ECF were then subdivided according to clinical significance and anatomical site. Results Positive ECF were present in 219 (29.9%), whilst 514 (70.1%) had no ECF of note. When subdivided, 14.6% of MRI and 35.0% of CT were positive for ECF, p < 0.001. There was a propensity for older patients to have more positive findings, with these present in 11.9% of patients aged <20, 8.1% of patients aged 20-29, 18.2% of patients aged 30-39, 21.9% of patients aged 40-49, 30.1% of patients aged 50-59 and 40.5% of patients aged ≥60, p= <0.001. Females had a higher proportion of positive findings (38.1%) despite having less total scans (n = 312) when compared to men (23.8%, n = 421), p= <0.001. Of the positive findings, 72.1% were newly discovered. These were classified according to clinical significance with 17.7% of these findings classified as definitely resulting in a change in management, 19.0% most likely resulting in a change in management, 46.8% possibly resulting in a change in management and 16.5% being normal variants or expected post-operative changes. Findings were most commonly lung pathologies (28.8%) followed by gastrointestinal pathologies (21.5%) and liver and gall bladder pathologies (14.6%). Conclusions ECF in cardiac imaging are common in the Maltese islands with around a third of all scans having a positive finding. CT was the imaging modality that was more likely to pick up ECF. ECF are increasingly frequent in older patients and also more likely to be found in females, despite less women having been scanned than males. Most findings were newly discovered with a large proportion being of clinical relevance.