Extracardiac findings on coronary computed tomography angiography in patients without significant coronary artery disease.
OBJECTIVE
To analyse extracardiac findings in patients without significant coronary artery disease (CAD) in general and in symptomatic patients in particular.


METHODS
We searched the Radiology Information System database for coronary computed tomography angiographies (CTA) performed from 2000-2014 and retrospectively enrolled 3,898 patients without significant CAD (coronary stenosis < 50%) in CTA. In 2,330 symptomatic patients, we analysed the spectrum of extracardiac findings and identified pathologies potentially explaining chest pain. Finally, we investigated variables affecting the number of extracardiac findings detected in CTA.


RESULTS
Overall extracardiac findings were found in 1,177 patients (30.2%; 95%CI, 28.8-31.7%). 94 patients (2.4%; 95%CI, 2.0-2.9%) had extracardiac findings with a recommendation for follow-up, sixteen patients (0.4%; 95%CI, 0.3-0.7%) had incidental urgent, and another three patients (0.1%; 95%CI, 0.1-0.2%) had incidental malignant extracardiac findings. 185 of 2,330 symptomatic patients (7.9%; 95%CI, 6.9-9.1%) revealed extracardiac findings potentially explaining chest pain after exclusion of significant CAD. The number of extracardiac findings increased significantly with patient age (p < 0.001) and the cumulative experience of the CT reader (p < 0.001).


CONCLUSION
30.2% of patients undergoing CTA for exclusion of CAD had ECF, and 7.9% of symptomatic patients without significant CAD on their examination had findings that could potentially explain their symptoms.


KEY POINTS
• Of patients undergoing CTA, 2.8% have relevant incidental extracardiac findings. • CTA could identify the differential diagnosis of chest pain when excluding significant CAD. • Patient age and reader's professional experience influence the number of detected ECFs.
['Karius|Philipp|P|', 'Lembcke|Alexander|A|', 'Sokolowski|Felix C|FC|', 'Gandara|Ivan Dario Perez|IDP|', 'Rodríguez|Alejandra|A|', 'Hamm|Bernd|B|', 'Dewey|Marc|M|http://orcid.org/0000-0002-4402-2733']
D000368:Aged D002637:Chest Pain D000072226:Computed Tomography Angiography D017023:Coronary Angiography D003324:Coronary Artery Disease D003937:Diagnosis, Differential D005260:Female D006801:Humans D033162:Incidental Findings D008297:Male D008875:Middle Aged D011873:Radiology Information Systems D012189:Retrospective Studies
Chest pain Angina pectoris Coronary angiography Incidental findings Tomography, x-ray computed