title: Prognostic value of extracardiac incidental findings on attenuation correction cardiac computed tomography.
abstract: Attenuation corrected computed tomography (CTAC) is often performed to improve the specificity of single-photon emission tomography imaging. Extracardiac incidental findings are frequently observed. It is unclear whether these findings have any prognostic value.
  
  
  
  Consecutive patients (n = 1139) at a tertiary care center were retrospectively evaluated for incidental findings on CTAC. Clinically significant incidental findings were defined as findings warranting physician follow-up. Information regarding subsequent resource utilization was obtained by chart review. Cox proportional hazard model adjusted for demographic and clinical variables was used to evaluate association of these incidental findings with all-cause and cancer-specific mortality.
  
  
  
  A total of 135 (12%) patients with incidental findings were identified, 83 of whom (68%) were newly diagnosed. Lung nodules were the most common finding, present in 92 (68%) patients. Over a median follow-up of 468 days, incidental findings were not significantly associated with increased risk of all-cause mortality (HR 1.34; 95% CI 0.77-2.33, P = 0.29) but was significantly associated with cancer-specific mortality (HR 3.21; 95% CI 1.26-8.14, P = 0.01). This association remained statistically significant when the analysis was limited to newly diagnosed incidental findings. Among patients with incidental findings, follow-up radiographic studies were conducted in 87%, and invasive procedures performed in 32%. Physician office-based follow-up of these findings occurred in 42% of patients and incidental finding-related hospitalization occurred in 14%.
  
  
  
  This study shows that incidental findings are common and were associated with all-cause and cancer-specific mortality but only the later remained statistically significant after multivariable adjustment.
authors.affiliation: Wake Forest University School of Medicine, Winston Salem, NC, 27157, USA.
authors.forename: Waqas T
authors.initials: WT
authors.lastname: Qureshi
authors.affiliation: Henry Ford Hospital/Wayne State University, 2799 W. Grand Blvd., Detroit, MI, 48202, USA.|The University of Kansas Medical Center, Kansas City, KS, 66160, USA.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Alirhayim
authors.affiliation: Wake Forest University School of Medicine, Winston Salem, NC, 27157, USA.
authors.forename: Fatima
authors.initials: F
authors.lastname: Khalid
authors.affiliation: Henry Ford Hospital/Wayne State University, 2799 W. Grand Blvd., Detroit, MI, 48202, USA. mouaz74@gmail.com.|Wayne State University, 540 E Canfield St., Detroit, MI, 48201, USA. mouaz74@gmail.com.|King Abdul-Aziz Cardiac Center, King Abdul-Aziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, MC 1413, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia. mouaz74@gmail.com.
authors.forename: Mouaz H
authors.initials: MH
authors.lastname: Al-Mallah
mesh_terms: D016477:Artifacts; D057791:Cardiac Imaging Techniques / Q000706:statistics & numerical data*; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D033162:Incidental Findings; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D009369:Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality*; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D000072098:Single Photon Emission Computed Tomography Computed Tomography / Q000706:statistics & numerical data*; D015996:Survival Rate
keywords: Incidental findings; attenuation corrected computed tomography; cardiac imaging; mortality