title: Extra-cardiac findings in cardiovascular magnetic resonance: what the imaging cardiologist needs to know.
abstract: Cardiovascular magnetic resonance (CMR) is an established non-invasive technique to comprehensively assess cardiovascular structure and function in a variety of acquired and inherited cardiac conditions. A significant amount of the neck, thorax and upper abdomen are imaged at the time of routine clinical CMR, particularly in the initial multi-slice axial and coronal images. The discovery of unsuspected disease at the time of imaging has ethical, financial and medico-legal implications. Extra-cardiac findings at the time of CMR are common, can be important and can change clinical management. Certain patient groups undergoing CMR are at particular risk of important extra-cardiac findings as several of the cardiovascular risk factors for atherosclerosis are also risk factors for malignancy. Furthermore, the presence of certain extra-cardiac findings may contribute to the interpretation of the primary cardiac pathology as some cardiac conditions have multi-systemic extra-cardiac involvement. The aim of this review is to give an overview of the type of extra-cardiac findings that may become apparent on CMR, subdivided by anatomical location. We focus on normal variant anatomy that may mimic disease, common incidental extra-cardiac findings and important imaging signs that help distinguish sinister pathology from benign disease. We also aim to provide a framework to the approach and potential further diagnostic work-up of incidental extra-cardiac findings discovered at the time of CMR. However, it is beyond the scope of this review to discuss and determine the clinical significance of extracardiac findings at CMR.
authors.affiliation: Cardiovascular Magnetic Resonance Unit, NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Bristol, UK.|Department of Clinical Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK.|School of Physiology, Pharmacology and Neurosciences, Faculty of Biomedical Sciences, University of Bristol, Medical Sciences Building, University Walk, Bristol, BS8 1TD, UK.
authors.forename: Jonathan C L
authors.initials: JC
authors.lastname: Rodrigues
authors.affiliation: Department of Clinical Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Lyen
authors.affiliation: Department of Clinical Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK.
authors.forename: William
authors.initials: W
authors.lastname: Loughborough
authors.affiliation: Cardiovascular Magnetic Resonance Unit, NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Bristol, UK.|Department of Surgical, Microsurgical and Medical Sciences, Institute of Radiological Sciences, University of Sassari, Sassari, Italy.
authors.forename: Antonio Matteo
authors.initials: AM
authors.lastname: Amadu
authors.affiliation: Cardiovascular Magnetic Resonance Unit, NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Bristol, UK.|Department of Cardiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Baritussio
authors.affiliation: Cardiovascular Magnetic Resonance Unit, NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Bristol, UK.|Department of Cardiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK.
authors.forename: Amardeep Ghosh
authors.initials: AG
authors.lastname: Dastidar
authors.affiliation: Department of Clinical Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK.
authors.forename: Nathan E
authors.initials: NE
authors.lastname: Manghat
authors.affiliation: Cardiovascular Magnetic Resonance Unit, NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Bristol, UK. C.Bucciarelli-Ducci@bristol.ac.uk.|Department of Cardiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK. C.Bucciarelli-Ducci@bristol.ac.uk.
authors.forename: Chiara
authors.initials: C
authors.lastname: Bucciarelli-Ducci
mesh_terms: D000072096:Cardiologists; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging*; D002983:Clinical Competence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033162:Incidental Findings; D008279:Magnetic Resonance Imaging; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results
keywords: CMR; Cardiovascular Magnetic Resonance; Extra-cardiac findings; Extra-cardiac pathology; Incidental findings