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Prevalence and Clinical Relevance of Extracardiac Findings in Cardiovascular Magnetic Resonance Imaging

Mantini, Cesare, MD, PhD*; Mastrodicasa, Domenico, MD*,†; Bianco, Francesco, MD*,‡; Bucciarelli, Valentina, MD*,‡; Scarano, Michele, MD§; Mannetta, Gianluca, MD*; Gabrielli, Daniela, MD, PhD*; Gallina, Sabina, MD*,‡; Petersen, Steffen E., MD, PhD, MPH∥,¶; Ricci, Fabrizio, MD‡,∥,#; Cademartiri, Filippo, MD, PhD**

doi: 10.1097/RTI.0000000000000360
Imaging in Cardiac Risk Prediction
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Purpose: To assess the prevalence of extracardiac findings (ECF) during cardiovascular magnetic resonance (CMR) examinations and their downstream effect on clinical management.

Materials and Methods: We retrospectively identified 500 consecutive patients. Trans-axial balanced steady-state free precession nongated images acquired from the upper thorax to the upper abdomen were evaluated independently by 2 radiologists. ECF were classified as nonsignificant (benign, with no need for further investigation), significant (mandatory to be reported/monitored), and major (clinically remarkable pathology, mandatory to be reported/investigated/treated). Fifteen-month clinical follow-up information was collected through hospital records.

Results: Of 500 patients, 108 (21.6%) showed a total of 153 ECF: 59 (11.8% of the entire study population; 38.5% of all ECF) nonsignificant, 76 (15.2%; 49.7%) significant, and 18 (3.6%; 11.8%) major ECF. The most frequent ECF were pleural effusion, hepatic cyst, renal cyst, and ascending aorta dilatation. Of 94 significant and major ECF, 46 were previously unknown and more common in older patients. Newly diagnosed major ECF (n=11, 2.2% of the entire study population, and 7.2% of all ECF)—including 5 tumors (1% of study population)—were confirmed by downstream evaluations and required specific treatment. Patients with major ECF were significantly older than patients without with major ECF. Newly diagnosed clinically significant and major ECF prompted downstream diagnostic tests in 44% and 100% of cases, respectively.

Conclusions: The detection of significant and major ECF is common during CMR reporting. The knowledge and the correct identification of most frequent ECF enable earlier diagnoses and faster treatment initiation of unknown extracardiac pathologies in patients referred to CMR imaging.

*Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University

Institute of Cardiology, “G. d’Annunzio” University, Chieti

§Emergency Department, Cardiology Unit, Hospital “Madonna del Soccorso”, San Benedetto del Tronto

**Cardiovascular Imaging Center, SDN IRCCS, Naples, Italy

Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC

William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London

Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, UK

#Department of Clinical Sciences, Lund University, Malmö, Sweden

Fabrizio Ricci and Filippo Cademartiri share senior authorship.

Steffen E. Petersen is a consultant to Circle Cardiovascular Imaging Inc. (Calgary, AB, Canada). Steffen E. Petersen wishes to acknowledge support from the NIHR Barts Biomedical Research Centre. The remaining authors declare no conflicts of interest.

Correspondence to: Domenico Mastrodicasa, MD, “G. d'Annunzio” University, Chieti 66100, Italy (e-mail: domenico.mastrodicasa@gmail.com).

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