title: Current role of cardiac and extra-cardiac pathologies in clinically indicated cardiac computed tomography with emphasis on status before pulmonary vein isolation.
abstract: OBJECTIVE
  The aim of this study was to assess the incidence of cardiac and significant extra-cardiac findings in clinical computed tomography of the heart in patients with atrial fibrillation before pulmonary vein isolation (PVI).
  
  
  METHODS
  224 patients (64 ± 10 years; male 63 %) with atrial fibrillation were examined by cardiac 64-slice multidetector CT before PVI. Extra-cardiac findings were classified as "significant" if they were recommended to additional diagnostics or therapy, and otherwise as "non-significant". Additionally, cardiac findings were documented in detail.
  
  
  RESULTS
  A total of 724 cardiac findings were identified in 203 patients (91 % of patients). Additionally, a total of 619 extra-cardiac findings were identified in 179 patients (80 % of patients). Among these extra-cardiac findings 196 (32 %) were "significant", and 423 (68 %) were "non-significant". In 2 patients (1 %) a previously unknown malignancy was detected (esophageal cancer and lung cancer, local stage, no metastasis). 203 additional imaging diagnostics followed to clarify the "significant" findings (124 additional CT, costs 38 314.69 US dollars). Overall, there were 3.2 cardiac and 2.8 extra-cardiac findings per patient. Extra-cardiac findings appear significantly more frequently in patients over 60 years old, in smokers and in patients with a history of cardiac findings (p <0.05).
  
  
  CONCLUSIONS
  Cardiac CT scans before PVI should be screened for extracardiac incidental findings that could have important clinical implications for each patient.
authors.affiliation: Institute for Diagnostic and Interventional Radiology, University Medical Center of Georg-August-University, Goettingen.
authors.forename: J M
authors.initials: JM
authors.lastname: Sohns
authors.affiliation: Institute for Diagnostic and Interventional Radiology, University Medical Center of Georg-August-University, Goettingen.
authors.forename: J
authors.initials: J
authors.lastname: Menke
authors.affiliation: Institute for Diagnostic and Interventional Radiology, University Medical Center of Georg-August-University, Goettingen.
authors.forename: W
authors.initials: W
authors.lastname: Staab
authors.affiliation: Radiology, University Hospital of Cologne.
authors.forename: J
authors.initials: J
authors.lastname: Spiro
authors.affiliation: Institute for Diagnostic and Interventional Radiology, University Medical Center of Georg-August-University, Goettingen.
authors.forename: M
authors.initials: M
authors.lastname: Fasshauer
authors.affiliation: Institute for Diagnostic and Interventional Radiology, University Medical Center of Georg-August-University, Goettingen.
authors.forename: J T
authors.initials: JT
authors.lastname: Kowallick
authors.affiliation: Cardiology and Pneumology, University Medical Center of Georg-August-University, Goettingen.
authors.forename: L
authors.initials: L
authors.lastname: Bergau
authors.affiliation: Institute for Diagnostic and Interventional Radiology, University Medical Center of Georg-August-University, Goettingen.
authors.forename: P A
authors.initials: PA
authors.lastname: Zwaka
authors.affiliation: Cardiology and Pneumology, University Medical Center of Georg-August-University, Goettingen.
authors.forename: C
authors.initials: C
authors.lastname: Unterberg-Buchwald
authors.affiliation: Institute for Diagnostic and Interventional Radiology, University Medical Center of Georg-August-University, Goettingen.
authors.forename: J
authors.initials: J
authors.lastname: Lotz
authors.affiliation: Institute for Diagnostic and Interventional Radiology, University Medical Center of Georg-August-University, Goettingen.
authors.forename: A
authors.initials: A
authors.lastname: Schwarz
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D017115:Catheter Ablation / Q000191:economics; D017023:Coronary Angiography / Q000379:methods*; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D005858:Germany; D017048:Health Care Costs / Q000706:statistics & numerical data; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted / Q000191:economics; D021621:Imaging, Three-Dimensional / Q000191:economics; D033162:Incidental Findings; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000191:economics / Q000379:methods*; D009367:Neoplasm Staging; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000601:surgery*; D012189:Retrospective Studies