title: Maximizing Information From Routine Staging Computed Tomography in Functional Neuroendocrine Neoplasms: Are There Findings Indicating the Presence of Carcinoid Heart Disease?
abstract: OBJECTIVE
  The aim of this study was to evaluate signs of right-sided heart dysfunction on staging computed tomography (CT) as indirect indicators of carcinoid heart disease.
  
  
  METHODS
  Patients with functionally active neuroendocrine neoplasm and different grades of tricuspid valve regurgitation (TR) were identified. Two readers independently reviewed contrast-enhanced staging CT performed within 90 days before or after echocardiography. Logistic regression and receiver operating analyses were used to asses the predictive value of right ventricle-left ventricle ratio (RV-LV ratio), ventricular septal bowing, retrograde contrast filling of the hepatic veins during contrast injection, and time to aortal enhancement greater than 100 Hounsfield units during bolus tracking for TR.
  
  
  RESULTS
  Forty-four examinations were evaluated (11 with TR = 0, 16 with TR = 1, 9 with TR = 2, and 8 with TR = 3). Right ventricle-LV ratio was found to predict TR less than or equal to 1 versus TR greater than 1 (P = 0.0188) and TR less than or equal to 1 versus TR equals 2 (P = 0.0082). A prolonged time to aortal enhancement greater than 100 Hounsfield units during bolus tracking predicted TR less than or equal to 1 versus TR greater than 1 (P = 0.0077). Area under the curve for RV-LV ratio was 0.86 when differentiating TR less than or equal to 1 versus TR equals 2. With a cutoff of 1.07, sensitivity was 0.89, and specificity was 0.72.
  
  
  CONCLUSIONS
  In patients with functionally active neuroendocrine neoplasm, an RV-LV ratio of more than 1.07 predicted TR with a relatively high sensitivity and moderate specificity and thus could serve as an indicator of subclinical carcinoid heart disease on routine staging CT.
authors.affiliation: From the *Klinik für Radiologie, Charité-Universitätsmedizin Berlin; †Scossis Statistical Consulting; ‡Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, and §Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Alexander Daniel Jacques
authors.initials: AD
authors.lastname: Baur
authors.forename: Florian
authors.initials: F
authors.lastname: Kunz
authors.forename: Carsten
authors.initials: C
authors.lastname: Schwenke
authors.forename: René
authors.initials: R
authors.lastname: Pschowski
authors.forename: Torsten Kai
authors.initials: TK
authors.lastname: Röpke
authors.forename: Marianne
authors.initials: M
authors.lastname: Pavel
authors.forename: Timm
authors.initials: T
authors.lastname: Denecke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002275:Carcinoid Heart Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology*; D015588:Observer Variation; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology
chemical_list: D003287:Contrast Media