Abstract
Purpose: To assess prevalence and significance of extra cardiac findings (ECF) in clinical routine cardiovascular magnetic resonance (CMR) studies reported by cardiologists alone versus cardiologist and radiologist working together. Methods: One-thousand-seventy-four consecutive patients presenting at our institution for CMR work-up of multiple cardiovascular disease entities were enrolled retrospectively in two groups (cardiologists reading alone vs. cardiologists and radiologist reading together). Results: In 1,074 routine CMR studies a total of 357 ECF’s were identified in 235 patients yielding a prevalence of 21.9 %. Of these 357 ECF’s more than one-third were previously known. In the remaining 223 previously unknown findings 118 (52.9 %) were considered as major ECF’s (92 patients), and 105 (47.1 %) were considered as minor ECF’s (69 patients). Cardiologists reading alone reported 23 previously unknown ECF’s in 23 patients, versus 200 previously unknown ECF in 138 patients by cardiologists and radiologists working together, p < 0.0001. Nevertheless, highly significant ECF’s with major prognostic implications, such as the initial diagnosis of malignancy in an individual with no history of cancer, are extremely rare (n = 3, 0.3 %). Cardiologists alone, as well as cardiologists and radiologists working together seem to do well with reporting of such extremely important ECF’s. Conclusions: The prevalence of all ECF’s was 21.9 %, and 14.9 % of previously unknown ECF’s, respectively. However, the prevalence of highly significant ECF’s was low. Joint reading with cardiologists and radiologists may increase the number of ECF’s detected in CMR studies, but it remains unclear if this could result in an improved long-term outcome of patients undergoing routine CMR.
Similar content being viewed by others
Abbreviations
- ECF:
-
Extra cardiac finding
- CMR:
-
Cardiovascular magnetic resonance
- SSFP:
-
Steady state free precession
- LGE:
-
Late gadolinium enhancement
- IR-GRE:
-
Inversion recovery gradient echo
- CT:
-
Computed tomography
References
Bruder O, Schneider S, Nothnagel D, Dill T, Hombach V, Schulz-Menger J, Nagel E, Lombardi M, van Rossum AC, Wagner A et al (2009) EuroCMR (European Cardiovascular Magnetic Resonance) registry: results of the German pilot phase. J Am Coll Cardiol 54:1457–1466
Bruder O, Wagner A, Lombardi M, Schwitter J, van Rossum A, Pilz G, Nothnagel D, Steen H, Petersen S, Nagel E et al (2013) European Cardiovascular Magnetic Resonance (EuroCMR) registry–multi national results from 57 centers in 15 countries. J Cardiovasc Magn Reson 15:9
Schwitter J, Arai AE (2011) Assessment of cardiac ischaemia and viability: role of cardiovascular magnetic resonance. Eur Heart J 32:799–809
Onuma Y, Tanabe K, Nakazawa G, Aoki J, Nakajima H, Ibukuro K, Hara K (2006) Noncardiac findings in cardiac imaging with multidetector computed tomography. J Am Coll Cardiol 48:402–406
Horton KM, Post WS, Blumenthal RS, Fishman EK (2002) Prevalence of significant noncardiac findings on electron-beam computed tomography coronary artery calcium screening examinations. Circulation 106:532–534
Sosnouski D, Bonsall RP, Mayer FB, Ravenel JG (2007) Extracardiac findings at cardiac CT: a practical approach. J Thorac Imaging 22:77–85
Lee CI, Tsai EB, Sigal BM, Plevritis SK, Garber AM, Rubin GD (2010) Incidental extracardiac findings at coronary CT: clinical and economic impact. AJR Am J Roentgenol 194:1531–1538
Sohns C, Sossalla S, Vollmann D, Luethje L, Seegers J, Schmitto JD, Zabel M, Obenauer S (2011) Extra cardiac findings by 64-multidetector computed tomography in patients with symptomatic atrial fibrillation prior to pulmonal vein isolation. Int J Cardiovasc Imaging 27:127–134
Bendix K, Jensen JM, Poulsen S, Mygind N, Norgaard BL (2011) Coronary dual source multi detector computed tomography in patients suspected of coronary artery disease: prevalence of incidental extra-cardiac findings. Eur J Radiol 80:109–114
Schragin JG, Weissfeld JL, Edmundowicz D, Strollo DC, Fuhrman CR (2004) Non-cardiac findings on coronary electron beam computed tomography scanning. J Thorac Imaging 19:82–86
Wyttenbach R, Medioni N, Santini P, Vock P, Szucs-Farkas Z (2012) Extracardiac findings detected by cardiac magnetic resonance imaging. Eur Radiol 22:1295–1302
Khosa F, Romney BP, Costa DN, Rofsky NM, Manning WJ (2011) Prevalence of noncardiac findings on clinical cardiovascular MRI. AJR Am J Roentgenol 196:W380–W386
Chan PG, Smith MP, Hauser TH, Yeon SB, Appelbaum E, Rofsky NM, Manning WJ (2009) Noncardiac pathology on clinical cardiac magnetic resonance imaging. JACC Cardiovasc Imaging 2:980–986
Irwin RB, Newton T, Peebles C, Borg A, Clark D, Miller C, Abidin N, Greaves M, Schmitt M (2013) Incidental extra-cardiac findings on clinical CMR. Eur Heart J Cardiovasc Imaging 14:158–166
McKenna DA, Laxpati M, Colletti PM (2008) The prevalence of incidental findings at cardiac MRI. Open Cardiovasc Med J 2:20–25
Kramer CM, Barkhausen J, Flamm SD, Kim RJ, Nagel E (2008) Standardized cardiovascular magnetic resonance imaging (CMR) protocols, society for cardiovascular magnetic resonance: board of trustees task force on standardized protocols. J Cardiovasc Magn Reson 10:35
Simonetti OP, Kim RJ, Fieno DS, Hillenbrand HB, Wu E, Bundy JM, Finn JP, Judd RM (2001) An improved MR imaging technique for the visualization of myocardial infarction. Radiology 218:215–223
Mahrholdt H, Wagner A, Holly TA, Elliott MD, Bonow RO, Kim RJ, Judd RM (2002) Reproducibility of chronic infarct size measurement by contrast-enhanced magnetic resonance imaging. Circulation 106:2322–2327
Klem I, Heitner JF, Shah DJ, Sketch MH Jr, Behar V, Weinsaft J, Cawley P, Parker M, Elliott M, Judd RM, Kim RJ (2006) Improved detection of coronary artery disease by stress perfusion cardiovascular magnetic resonance with the use of delayed enhancement infarction imaging. J Am Coll Cardiol 47:1630–1638
Atalay MK, Prince EA, Pearson CA, Chang KJ (2011) The prevalence and clinical significance of noncardiac findings on cardiac MRI. AJR Am J Roentgenol 196:W387–W393
Kirkpatrick JN, St John Sutton MG (2012) Non-cardiac findings: now you see them. J Am Soc Echocardiogr 25:558–560
Acknowledgments
This work was funded in part by the Robert Bosch Foundation (KKF-10-4-R, KKF-11-18, KKF-13-2).
Conflict of interest
The authors declare that they have no competing interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Greulich, S., Backes, M., Schumm, J. et al. Extra cardiac findings in cardiovascular MR: Why cardiologists and radiologists should read together. Int J Cardiovasc Imaging 30, 609–617 (2014). https://doi.org/10.1007/s10554-014-0368-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10554-014-0368-1