title: Clinical relevance and scope of accidental extracoronary findings in coronary computed tomography angiography: a cardiac versus thoracic FOV study.
abstract: OBJECTIVE
  To assess the spectrum and clinical relevance of extracoronary findings in coronary CT angiography (CCTA), and to compare a small (cardiac) field of view (FOV) to a large (thoracic) FOV setting.
  
  
  METHODS
  1084 consecutive patients (mean 57 years) with low-to-intermediate risk of coronary artery disease were enrolled. 542 CCTA scans were interpreted with small FOV (160-190mm(2)) encompassing the cardiac region. In another 542 CCTA (patients matched for age and gender), read-out of an additional full FOV (>320mm(2)) covering the thorax was performed. Clinical relevance of extracoronary findings was considered as either "significant" or "non-significant". "Significant" findings were subclassified as either score 1: findings necessitating immediate therapeutic actions, or score 2: findings with undoubted clinical or prognostic relevance, requiring clinical awareness, follow-up or further investigations (non-urgent). "Non-significant" findings were assigned to either score 3: findings not requiring follow-up or further tests, or as score 4: irrelevant incidental findings.
  
  
  RESULTS
  Significantly more patients with extracoronary findings were identified by using a full FOV with 43.2% (234/542) compared to a small FOV with 33.6% (182/542) (p=0.001). Similarly, a higher total number of extracoronary findings (n=394) was found on full FOV compared to small FOV (n=250) (p<0.001). The detection rate of clinically significant findings was higher by using full FOV compared to small FOV (25.6% versus 15.4%) (p<0.001), out of those 2.2% versus 1.8% of findings required immediate actions (score 1), and 23.4% versus 13.6% (p=0.0001), respectively were of clinical relevance (non-urgent, score 2). The rate of malign findings was 0.2%, and of acute pulmonary embolism 0.1%. More lung pathologies were observed by using full FOV compared to small FOV (22% versus 7%) (p<0.0001), and the detection rate of intrapulmonary nodules increased by 2.1%. Prevalence of aortic valve calcification (n=72) was 13.3%, out of those 7% had less than 2cm(2) aortic valve orifice area.
  
  
  CONCLUSIONS
  The interpretation of extracoronary findings on CCTA scans is mandatory given high prevalence of clinically significant findings by using a full "thoracic" FOV.
authors.affiliation: Department of Radiology II, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Iman
authors.initials: I
authors.lastname: Aglan
authors.forename: Daniel
authors.initials: D
authors.lastname: Jodocy
authors.forename: Stefan
authors.initials: S
authors.lastname: Hiehs
authors.forename: Peter
authors.initials: P
authors.lastname: Soegner
authors.forename: Renate
authors.initials: R
authors.lastname: Frank
authors.forename: Berhard
authors.initials: B
authors.lastname: Haberfellner
authors.forename: Andrea
authors.initials: A
authors.lastname: Klauser
authors.forename: Werner
authors.initials: W
authors.lastname: Jaschke
authors.forename: Gudrun M
authors.initials: GM
authors.lastname: Feuchtner
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D012737:Sex Factors; D014057:Tomography, X-Ray Computed