title: Incidental findings on cardiac computed tomography in incident hemodialysis patients: the predictors of arrhythmic and cardiovascular events in end-stage renal disease (PACE) study.
abstract: BACKGROUND
  This is the first study that has examined non-cardiac incidental findings in research cardiac computed tomography (CT) of hemodialysis patients and their relationship with patient characteristics.
  
  
  METHODS
  We performed a cross-sectional analysis in the Predictors of Arrhythmic and Cardiovascular Events in End-Stage Renal Disease (PACE) study, a prospective cohort study on incident hemodialysis patients. Non-cardiac structures in the cardiac CT scan were reviewed and evaluated. The type and frequencies of non-cardiac incidental CT findings were summarized. Univariate and multivariate logistic regression were performed to analyze the associations between gender, older age, obesity, history of cardiovascular disease (CVD), smoking status, history of chronic pulmonary disease and history of cancer with presence of any incidental CT findings and, separately, pulmonary nodules.
  
  
  RESULTS
  Among the 260 participants, a total of 229 non-cardiac incidental findings were observed in 145 participants (55.8% of all participants). Of these findings, pulmonary nodules were the most common incidental finding (24.2% of all findings), and 41.3% of them requiring further follow-up imaging per radiology recommendation. Vascular and gastrointestinal findings occurred in 11.8% and 15.3% of participants, respectively. Participants 65 years or older had a higher odds of any incidental findings (Odds Ratio (OR) =2.55; 95% Confidence Intervals (CI) 1.30, 4.99) and pulmonary nodules (OR=4.80; 95% CI 2.51, 9.18). Prior history of CVD was independently and significantly associated with any incidental findings (OR=2.00; 95% CI 1.19, 3.40); but not with the presence of pulmonary nodules.
  
  
  CONCLUSIONS
  We demonstrate that the prevalence of incidental findings by cardiac CT scanning is extremely high among patients on hemodialysis. Further investigations to follow-up on the high occurrence of incidental findings during our research study and potentially clinical studies raises important practical, ethical and medico-legal issues that need to be carefully considered in research projects using imaging studies.
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. bjaar@aol.com.
authors.forename: Bernard G
authors.initials: BG
authors.lastname: Jaar
authors.forename: Lili
authors.initials: L
authors.lastname: Zhang
authors.forename: Svetlana V
authors.initials: SV
authors.lastname: Chembrovich
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Sozio
authors.forename: Tariq
authors.initials: T
authors.lastname: Shafi
authors.forename: Julia J
authors.initials: JJ
authors.lastname: Scialla
authors.forename: Gordon F
authors.initials: GF
authors.lastname: Tomaselli
authors.forename: Joao A C
authors.initials: JA
authors.lastname: Lima
authors.forename: Wen Hong Linda
authors.initials: WH
authors.lastname: Kao
authors.forename: Rulan S
authors.initials: RS
authors.lastname: Parekh
authors.forename: Lucy A
authors.initials: LA
authors.lastname: Meoni
mesh_terms: D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D005260:Female; D006801:Humans; D033162:Incidental Findings; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D006435:Renal Dialysis / Q000401:mortality / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging / Q000453:epidemiology; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data