title: Potential clinical and economic consequences of noncardiac incidental findings on cardiac computed tomography.
abstract: OBJECTIVE
  We sought to determine the incidence, clinical significance, and potential financial impact of noncardiac incidental findings (IF) identified with cardiac computed tomography (CT).
  
  
  BACKGROUND
  Cardiac CT is gaining acceptance and may lead to the frequent discovery of extracardiac IF.
  
  
  METHODS
  Consecutive patients undergoing cardiac CT had noncardiac structures evaluated after full field of view (32 to 50 cm) reconstruction. IF were categorized as clinically significant (CS), indeterminate, or clinically insignificant. Patient follow-up was performed by telephone, and verified with hospital records and/or communication with physicians.
  
  
  RESULTS
  Of 966 patients (58 +/- 16 years of age, 55.4% men, >98% outpatients), 401 (41.5%) patients had noncardiac IF. A total of 12 (1.2%) patients had CS findings, and 68 (7.0%) patients had indeterminate findings. At follow-up (18.4 +/- 7.6 months), none of the indeterminate findings became CS. Although 3 patients with indeterminate findings were diagnosed with malignant lesions, they were unrelated to the IF. After adjusting for age, IF were not an independent predictor of noncardiac death. Noncardiac death and cancer death in patients with and without IF were not statistically different. One patient suffered a major complication related to the investigation of an IF. The total direct cost associated with investigating IF was Canadian $57,596 (U.S. $83,035).
  
  
  CONCLUSIONS
  Although noncardiac IF are common, clinically significant or indeterminate IF are less prevalent. Rates of death were similar in patients with and without IF, and IF was not an independent predictor of noncardiac death. The investigation of IF is not without cost or risk. Larger studies are required to assess the potential mortality benefit of identifying IF.
authors.affiliation: Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, Canada.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Machaalany
authors.forename: Yeung
authors.initials: Y
authors.lastname: Yam
authors.forename: Terrence D
authors.initials: TD
authors.lastname: Ruddy
authors.forename: Arun
authors.initials: A
authors.lastname: Abraham
authors.forename: Li
authors.initials: L
authors.lastname: Chen
authors.forename: Rob S
authors.initials: RS
authors.lastname: Beanlands
authors.forename: Benjamin J W
authors.initials: BJ
authors.lastname: Chow
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging*; D017023:Coronary Angiography / Q000191:economics / Q000379:methods; D003327:Coronary Disease / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006801:Humans; D033162:Incidental Findings; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000379:methods*