Incidental findings on hybrid SPECT-CT and PET-CT scanners: Is it time for new training and reporting guidelines?

Excerpt

The first report of incidental findings on CT scans that had been acquired during the evaluation of subjects with known or suspected coronary heart disease came from Hunold et al in 2001.1 In that report, 1812 consecutive patients underwent electron beam CT scanning for detection and quantification of coronary artery calcium. All scans were assessed for noncoronary findings using only a tissue window. Extra-coronary findings were identified in 52% of the patients but included cardiac findings. The latter accounted for 71% of the noncoronary findings in those patients. Aortic “disease” was identified in 23% of the total group of which 90% included those with varying degrees of calcification, and 10% included aortic ectasia (n = 41) and aortic aneurysm (n = 11). One patient had an ascending aortic dissection that required surgery. Noncoronary, noncardiac, and nonvascular findings included two bronchial and one previously unknown but inoperable esophageal carcinoma detected (0.16% of the total group). Numerous other noncardiovascular findings were noted, some of which led to additional testing including additional radiation. There was the usual potpourri of findings that one would expect in a population with a mean age of 59, ranging up to 86. No other life-saving findings were noted, but useful and previously unknown diagnoses were made such as hiatus hernias that may have explained chest pain. …