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Published in: La radiologia medica 3/2016

01-03-2016 | CHEST RADIOLOGY

Under-reporting of cardiovascular findings on chest CT

Authors: Nicola Sverzellati, Teresa Arcadi, Luca Salvolini, Roberto Dore, Maurizio Zompatori, Manuela Mereu, Giuseppe Battista, Ilenia Martella, Francesco Toni, Luciano Cardinale, Erica Maffei, Fabio Maggi, Filippo Cademartiri, Tommaso Pirronti

Published in: La radiologia medica | Issue 3/2016

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Abstract

Purpose

It is unclear whether (and, to what extent) radiologists look at and report cardiovascular abnormalities on non-cardio-synchronized standard chest computed tomography (CT). In this study, the frequency and the reporting rate of cardiovascular findings in chest CT examinations were retrospectively assessed.

Materials and methods

This study was approved by the institutional review board of each participating center. Four academic centers provided data on 447 subjects who underwent non-ECG-synchronized chest CT examinations for evaluating pulmonary fibrosis (161/447, 36 %), suspected pulmonary embolism (140/447, 31.3 %), or lung cancer staging (146/447, 32.7 %). A total of 220/447 (53.7 %) and 227/447 CT (46.3 %) examinations were evaluated and reported by junior and senior chest radiologists, respectively. Two radiologists with training in cardiac imaging reviewed the same chest CT images looking for the presence of incidental cardiovascular abnormalities using a preformatted score sheet. Inter-observer agreement was assessed using the kappa coefficient of agreement (k).

Results

Inter-observer agreement between the study reviewers was moderate to good (0.4–0.73) for most of the incidental cardiovascular findings. At least one incidental cardiovascular finding not documented in the original report was identified by the study reviewers in 225/409 (55 %) of chest CT examinations. A total of 168/266 (63.2 %) potentially clinically significant cardiovascular findings were unreported in the original reports of 177/447 (39.6 %) subjects (p < 0.0001). Senior radiologists tended to more frequently report coronary artery calcification (p = 0.0006), cardiac valves calcification (p = 0.0003), and ascending aorta enlargement (p = 0.01) compared to junior radiologists.

Conclusions

Several cardiovascular abnormalities can be reliably identified on standard chest CT. Yet, they are often under-reported, even when they might be relevant to the patient’s work-up.
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Literature
2.
go back to reference Bruzzi JF, Remy-Jardin M, Delhaye D, Teisseire A, Khalil C, Remy J (2006) When, why, and how to examine the heart during thoracic CT: part 1, basic principles. AJR Am J Roentgenol 186(2):324–332. doi:10.2214/AJR.05.0717 CrossRefPubMed Bruzzi JF, Remy-Jardin M, Delhaye D, Teisseire A, Khalil C, Remy J (2006) When, why, and how to examine the heart during thoracic CT: part 1, basic principles. AJR Am J Roentgenol 186(2):324–332. doi:10.​2214/​AJR.​05.​0717 CrossRefPubMed
3.
go back to reference Shemesh J, Henschke CI, Shaham D, Yip R, Farooqi AO, Cham MD, McCauley DI, Chen M, Smith JP, Libby DM, Pasmantier MW, Yankelevitz DF (2010) Ordinal scoring of coronary artery calcifications on low-dose CT scans of the chest is predictive of death from cardiovascular disease. Radiology 257(2):541–548. doi:10.1148/radiol.10100383 CrossRefPubMed Shemesh J, Henschke CI, Shaham D, Yip R, Farooqi AO, Cham MD, McCauley DI, Chen M, Smith JP, Libby DM, Pasmantier MW, Yankelevitz DF (2010) Ordinal scoring of coronary artery calcifications on low-dose CT scans of the chest is predictive of death from cardiovascular disease. Radiology 257(2):541–548. doi:10.​1148/​radiol.​10100383 CrossRefPubMed
4.
go back to reference Remy-Jardin M, Faivre JB, Santangelo T, Tacelli N, Remy J (2010) Imaging the heart-lung relationships during a chest computed tomography examination: is electrocardiographic gating the only option? J Thorac Imaging 25(3):239–246. doi:10.1097/RTI.0b013e3181e0f8c9 CrossRefPubMed Remy-Jardin M, Faivre JB, Santangelo T, Tacelli N, Remy J (2010) Imaging the heart-lung relationships during a chest computed tomography examination: is electrocardiographic gating the only option? J Thorac Imaging 25(3):239–246. doi:10.​1097/​RTI.​0b013e3181e0f8c9​ CrossRefPubMed
7.
go back to reference Shriki JE, Shinbane J, Lee C, Khan AR, Burns N, Hindoyan A, Wilcox A (2012) Incidental myocardial infarct on conventional nongated CT: a review of the spectrum of findings with gated CT and cardiac MRI correlation. AJR Am J Roentgenol 198(3):496–504. doi:10.2214/AJR.11.7683 CrossRefPubMed Shriki JE, Shinbane J, Lee C, Khan AR, Burns N, Hindoyan A, Wilcox A (2012) Incidental myocardial infarct on conventional nongated CT: a review of the spectrum of findings with gated CT and cardiac MRI correlation. AJR Am J Roentgenol 198(3):496–504. doi:10.​2214/​AJR.​11.​7683 CrossRefPubMed
8.
go back to reference Jairam PM, Gondrie MJ, Grobbee DE, Mali WP, Jacobs PC, van der Graaf Y, Group PS (2014) Incidental imaging findings from routine chest CT used to identify subjects at high risk of future cardiovascular events. Radiology 272(3):700–708. doi:10.1148/radiol.14132211 CrossRefPubMed Jairam PM, Gondrie MJ, Grobbee DE, Mali WP, Jacobs PC, van der Graaf Y, Group PS (2014) Incidental imaging findings from routine chest CT used to identify subjects at high risk of future cardiovascular events. Radiology 272(3):700–708. doi:10.​1148/​radiol.​14132211 CrossRefPubMed
9.
go back to reference Flor N, Di Leo G, Squarza SA, Tresoldi S, Rulli E, Cornalba G, Sardanelli F (2013) Malignant incidental extracardiac findings on cardiac CT: systematic review and meta-analysis. AJR Am J Roentgenol 201(3):555–564. doi:10.2214/AJR.12.10306 CrossRefPubMed Flor N, Di Leo G, Squarza SA, Tresoldi S, Rulli E, Cornalba G, Sardanelli F (2013) Malignant incidental extracardiac findings on cardiac CT: systematic review and meta-analysis. AJR Am J Roentgenol 201(3):555–564. doi:10.​2214/​AJR.​12.​10306 CrossRefPubMed
12.
go back to reference Choy G, Kropil P, Scherer A, El-Sherief AH, Chung J, Rojas CA, Abbara S (2013) Pertinent reportable incidental cardiac findings on chest CT without electrocardiography gating: review of 268 consecutive cases. Acta Radiol 54(4):396–400. doi:10.1177/0284185113475918 CrossRefPubMed Choy G, Kropil P, Scherer A, El-Sherief AH, Chung J, Rojas CA, Abbara S (2013) Pertinent reportable incidental cardiac findings on chest CT without electrocardiography gating: review of 268 consecutive cases. Acta Radiol 54(4):396–400. doi:10.​1177/​0284185113475918​ CrossRefPubMed
14.
go back to reference Kaplan S, Aronow WS, Lai H, DeLuca AJ, Weiss MB, Dilmanian H, Spielvogel D, Lansman SL, Belkin RN (2007) Prevalence of an increased ascending and descending thoracic aorta diameter diagnosed by multislice cardiac computed tomography in men versus women and in persons aged 23 to 50 years, 51 to 65 years, 66 to 80 years, and 81 to 88 years. Am J Cardiol 100(10):1598–1599. doi:10.1016/j.amjcard.2007.06.059 CrossRefPubMed Kaplan S, Aronow WS, Lai H, DeLuca AJ, Weiss MB, Dilmanian H, Spielvogel D, Lansman SL, Belkin RN (2007) Prevalence of an increased ascending and descending thoracic aorta diameter diagnosed by multislice cardiac computed tomography in men versus women and in persons aged 23 to 50 years, 51 to 65 years, 66 to 80 years, and 81 to 88 years. Am J Cardiol 100(10):1598–1599. doi:10.​1016/​j.​amjcard.​2007.​06.​059 CrossRefPubMed
15.
go back to reference Lu TL, Huber CH, Rizzo E, Dehmeshki J, von Segesser LK, Qanadli SD (2009) Ascending aorta measurements as assessed by ECG-gated multi-detector computed tomography: a pilot study to establish normative values for transcatheter therapies. Eur Radiol 19(3):664–669. doi:10.1007/s00330-008-1182-8 CrossRefPubMed Lu TL, Huber CH, Rizzo E, Dehmeshki J, von Segesser LK, Qanadli SD (2009) Ascending aorta measurements as assessed by ECG-gated multi-detector computed tomography: a pilot study to establish normative values for transcatheter therapies. Eur Radiol 19(3):664–669. doi:10.​1007/​s00330-008-1182-8 CrossRefPubMed
17.
18.
go back to reference Moncada R, Baker M, Salinas M, Demos TC, Churchill R, Love L, Reynes C, Hale D, Cardoso M, Pifarre R, Gunnar RM (1982) Diagnostic role of computed tomography in pericardial heart disease: congenital defects, thickening, neoplasms, and effusions. Am Heart J 103(2):263–282CrossRefPubMed Moncada R, Baker M, Salinas M, Demos TC, Churchill R, Love L, Reynes C, Hale D, Cardoso M, Pifarre R, Gunnar RM (1982) Diagnostic role of computed tomography in pericardial heart disease: congenital defects, thickening, neoplasms, and effusions. Am Heart J 103(2):263–282CrossRefPubMed
19.
go back to reference Boxt LM, Lipton MJ, Kwong RY, Rybicki F, Clouse ME (2003) Computed tomography for assessment of cardiac chambers, valves, myocardium and pericardium. Cardiol Clin 21(4):561–585CrossRefPubMed Boxt LM, Lipton MJ, Kwong RY, Rybicki F, Clouse ME (2003) Computed tomography for assessment of cardiac chambers, valves, myocardium and pericardium. Cardiol Clin 21(4):561–585CrossRefPubMed
22.
go back to reference Ng CS, Wells AU, Padley SP (1999) A CT sign of chronic pulmonary arterial hypertension: the ratio of main pulmonary artery to aortic diameter. J Thorac Imaging 14(4):270–278CrossRefPubMed Ng CS, Wells AU, Padley SP (1999) A CT sign of chronic pulmonary arterial hypertension: the ratio of main pulmonary artery to aortic diameter. J Thorac Imaging 14(4):270–278CrossRefPubMed
23.
go back to reference Coblentz CL, Babcook CJ, Alton D, Riley BJ, Norman G (1991) Observer variation in detecting the radiologic features associated with bronchiolitis. Invest Radiol 26(2):115–118CrossRefPubMed Coblentz CL, Babcook CJ, Alton D, Riley BJ, Norman G (1991) Observer variation in detecting the radiologic features associated with bronchiolitis. Invest Radiol 26(2):115–118CrossRefPubMed
24.
go back to reference Winer-Muram HT, Tann M, Aisen AM, Ford L, Jennings SG, Bretz R (2004) Computed tomography demonstration of lipomatous metaplasia of the left ventricle following myocardial infarction. J Comput Assist Tomogr 28(4):455–458CrossRefPubMed Winer-Muram HT, Tann M, Aisen AM, Ford L, Jennings SG, Bretz R (2004) Computed tomography demonstration of lipomatous metaplasia of the left ventricle following myocardial infarction. J Comput Assist Tomogr 28(4):455–458CrossRefPubMed
25.
go back to reference Kang DK, Thilo C, Schoepf UJ, Barraza JM Jr, Nance JW Jr, Bastarrika G, Abro JA, Ravenel JG, Costello P, Goldhaber SZ (2011) CT signs of right ventricular dysfunction: prognostic role in acute pulmonary embolism. JACC Cardiovasc Imaging 4(8):841–849. doi:10.1016/j.jcmg.2011.04.013 CrossRefPubMed Kang DK, Thilo C, Schoepf UJ, Barraza JM Jr, Nance JW Jr, Bastarrika G, Abro JA, Ravenel JG, Costello P, Goldhaber SZ (2011) CT signs of right ventricular dysfunction: prognostic role in acute pulmonary embolism. JACC Cardiovasc Imaging 4(8):841–849. doi:10.​1016/​j.​jcmg.​2011.​04.​013 CrossRefPubMed
26.
go back to reference Shaw LJ, Hendel R, Borges-Neto S, Lauer MS, Alazraki N, Burnette J, Krawczynska E, Cerqueira M, Maddahi J, Myoview Multicenter R (2003) Prognostic value of normal exercise and adenosine (99 m)Tc-tetrofosmin SPECT imaging: results from the multicenter registry of 4,728 patients. J Nucl Med 44(2):134–139PubMed Shaw LJ, Hendel R, Borges-Neto S, Lauer MS, Alazraki N, Burnette J, Krawczynska E, Cerqueira M, Maddahi J, Myoview Multicenter R (2003) Prognostic value of normal exercise and adenosine (99 m)Tc-tetrofosmin SPECT imaging: results from the multicenter registry of 4,728 patients. J Nucl Med 44(2):134–139PubMed
27.
go back to reference Koos R, Kuhl HP, Muhlenbruch G, Wildberger JE, Gunther RW, Mahnken AH (2006) Prevalence and clinical importance of aortic valve calcification detected incidentally on CT scans: comparison with echocardiography. Radiology 241(1):76–82. doi:10.1148/radiol.2411051163 CrossRefPubMed Koos R, Kuhl HP, Muhlenbruch G, Wildberger JE, Gunther RW, Mahnken AH (2006) Prevalence and clinical importance of aortic valve calcification detected incidentally on CT scans: comparison with echocardiography. Radiology 241(1):76–82. doi:10.​1148/​radiol.​2411051163 CrossRefPubMed
28.
go back to reference Yamamoto H, Shavelle D, Takasu J, Lu B, Mao SS, Fischer H, Budoff MJ (2003) Valvular and thoracic aortic calcium as a marker of the extent and severity of angiographic coronary artery disease. Am Heart J 146(1):153–159. doi:10.1016/S0002-8703(03)00105-4 CrossRefPubMed Yamamoto H, Shavelle D, Takasu J, Lu B, Mao SS, Fischer H, Budoff MJ (2003) Valvular and thoracic aortic calcium as a marker of the extent and severity of angiographic coronary artery disease. Am Heart J 146(1):153–159. doi:10.​1016/​S0002-8703(03)00105-4 CrossRefPubMed
30.
go back to reference Ghaye B, Ghuysen A, Willems V, Lambermont B, Gerard P, D’Orio V, Gevenois PA, Dondelinger RF (2006) Severe pulmonary embolism: pulmonary artery clot load scores and cardiovascular parameters as predictors of mortality. Radiology 239(3):884–891. doi:10.1148/radiol.2392050075 CrossRefPubMed Ghaye B, Ghuysen A, Willems V, Lambermont B, Gerard P, D’Orio V, Gevenois PA, Dondelinger RF (2006) Severe pulmonary embolism: pulmonary artery clot load scores and cardiovascular parameters as predictors of mortality. Radiology 239(3):884–891. doi:10.​1148/​radiol.​2392050075 CrossRefPubMed
33.
go back to reference Jairam PM, de Jong PA, Mali WP, Gondrie MJ, Jacobs PC, van der Graaf Y, Study-Group P (2014) Age and sex based reference values for incidental coronary artery and thoracic aorta calcifications on routine clinical chest CT: a powerful tool to appreciate available imaging findings. Atherosclerosis 235(2):546–553. doi:10.1016/j.atherosclerosis.2014.05.949 CrossRefPubMed Jairam PM, de Jong PA, Mali WP, Gondrie MJ, Jacobs PC, van der Graaf Y, Study-Group P (2014) Age and sex based reference values for incidental coronary artery and thoracic aorta calcifications on routine clinical chest CT: a powerful tool to appreciate available imaging findings. Atherosclerosis 235(2):546–553. doi:10.​1016/​j.​atherosclerosis.​2014.​05.​949 CrossRefPubMed
34.
35.
go back to reference Kaprio J, Koskenvuo M (1990) Cigarette smoking as a cause of lung cancer and coronary heart disease. A study of smoking-discordant twin pairs. Acta Genet Med Gemellol (Roma) 39(1):25–34 Kaprio J, Koskenvuo M (1990) Cigarette smoking as a cause of lung cancer and coronary heart disease. A study of smoking-discordant twin pairs. Acta Genet Med Gemellol (Roma) 39(1):25–34
36.
go back to reference Kasper W, Konstantinides S, Geibel A, Olschewski M, Heinrich F, Grosser KD, Rauber K, Iversen S, Redecker M, Kienast J (1997) Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol 30(5):1165–1171CrossRefPubMed Kasper W, Konstantinides S, Geibel A, Olschewski M, Heinrich F, Grosser KD, Rauber K, Iversen S, Redecker M, Kienast J (1997) Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol 30(5):1165–1171CrossRefPubMed
37.
Metadata
Title
Under-reporting of cardiovascular findings on chest CT
Authors
Nicola Sverzellati
Teresa Arcadi
Luca Salvolini
Roberto Dore
Maurizio Zompatori
Manuela Mereu
Giuseppe Battista
Ilenia Martella
Francesco Toni
Luciano Cardinale
Erica Maffei
Fabio Maggi
Filippo Cademartiri
Tommaso Pirronti
Publication date
01-03-2016
Publisher
Springer Milan
Published in
La radiologia medica / Issue 3/2016
Print ISSN: 0033-8362
Electronic ISSN: 1826-6983
DOI
https://doi.org/10.1007/s11547-015-0595-0

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