title: Under-reporting of cardiovascular findings on chest CT.
abstract: OBJECTIVE
  It is unclear whether (and, to what extent) radiologists look at and report cardiovascular abnormalities on non-cardio-synchronized standard chest computed tomography (CT). In this study, the frequency and the reporting rate of cardiovascular findings in chest CT examinations were retrospectively assessed.
  
  
  METHODS
  This study was approved by the institutional review board of each participating center. Four academic centers provided data on 447 subjects who underwent non-ECG-synchronized chest CT examinations for evaluating pulmonary fibrosis (161/447, 36 %), suspected pulmonary embolism (140/447, 31.3 %), or lung cancer staging (146/447, 32.7 %). A total of 220/447 (53.7 %) and 227/447 CT (46.3 %) examinations were evaluated and reported by junior and senior chest radiologists, respectively. Two radiologists with training in cardiac imaging reviewed the same chest CT images looking for the presence of incidental cardiovascular abnormalities using a preformatted score sheet. Inter-observer agreement was assessed using the kappa coefficient of agreement (k).
  
  
  RESULTS
  Inter-observer agreement between the study reviewers was moderate to good (0.4-0.73) for most of the incidental cardiovascular findings. At least one incidental cardiovascular finding not documented in the original report was identified by the study reviewers in 225/409 (55 %) of chest CT examinations. A total of 168/266 (63.2 %) potentially clinically significant cardiovascular findings were unreported in the original reports of 177/447 (39.6 %) subjects (p < 0.0001). Senior radiologists tended to more frequently report coronary artery calcification (p = 0.0006), cardiac valves calcification (p = 0.0003), and ascending aorta enlargement (p = 0.01) compared to junior radiologists.
  
  
  CONCLUSIONS
  Several cardiovascular abnormalities can be reliably identified on standard chest CT. Yet, they are often under-reported, even when they might be relevant to the patient's work-up.
authors.affiliation: Section of Diagnostic Imaging, Department of Surgical Sciences, University of Parma, Padiglione Barbieri, University Hospital of Parma, V. Gramsci 14, 43100, Parma, Italy. nicolasve@tiscali.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Sverzellati
authors.affiliation: Department of Radiology, SDN Foundation, IRCCS, Naples, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Arcadi
authors.affiliation: Radiologia Clinica, Di.S.C.O., Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Salvolini
authors.affiliation: UOS Radiologia Toracica e TC, Istituto di Radiologia Fondazione Policlinicio San Matteo IRCCS, Pavia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Dore
authors.affiliation: Radiology Unit, Cardio-Thoracic-Vascular Department, University Hospital S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zompatori
authors.affiliation: Section of Integrated Imaging and Radiological Therapies, Department of Neuroscience, University of Chieti, Chieti, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Mereu
authors.affiliation: Division of Radiology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Battista
authors.affiliation: Section of Diagnostic Imaging, Department of Surgical Sciences, University of Parma, Padiglione Barbieri, University Hospital of Parma, V. Gramsci 14, 43100, Parma, Italy.
authors.forename: Ilenia
authors.initials: I
authors.lastname: Martella
authors.affiliation: Division of Radiology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Toni
authors.affiliation: Institute of Radiology, University of Turin, AOU San Luigi Gonzaga, Orbassano, Turin, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Cardinale
authors.affiliation: Department of Radiology, Erasmus Medical Center University, Rotterdam, 3015, Rotterdam, The Netherlands.
authors.forename: Erica
authors.initials: E
authors.lastname: Maffei
authors.affiliation: Department of Bioimaging and Radiological Sciences, Catholic University of Rome, Rome, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Maggi
authors.affiliation: Department of Radiology, Erasmus Medical Center University, Rotterdam, 3015, Rotterdam, The Netherlands.
authors.forename: Filippo
authors.initials: F
authors.lastname: Cademartiri
authors.affiliation: Department of Bioimaging and Radiological Sciences, Catholic University of Rome, Rome, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Pirronti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000209:etiology*; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging; D011658:Pulmonary Fibrosis / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Cardiac findings; Chest computed tomography; Incidental; Overlooking