Malignant incidental extracardiac findings on cardiac CT: Systematic review and meta-analysis

Nicola Flor, Giovanni Di Leo, Silvia Amaryllis Claudia Squarza, Silvia Tresoldi, Eliana Rulli, Gianpaolo Cornalba, Francesco Sardanelli

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

OBJECTIVE. The objective of our study was to systematically review the evidence on incidental extracardiac findings on cardiac CT with a focus on previously unknown malignancies. MATERIALS AND METHODS. A systematic search was performed (PubMed, EMBASE, Cochrane databases) for studies reporting incidental extracardiac findings on cardiac CT. Among 1099 articles initially found, 15 studies met the inclusion criteria. The references of those articles were hand-searched and 14 additional studies were identified. After review of the full text, 10 articles were excluded. Nineteen studies including 15,877 patients (64% male) were analyzed. A three-level analysis was performed to determine the prevalence of patients with incidental extracardiac findings, the prevalence of patients with major incidental extracardiac findings, and the prevalence of patients with a proven cancer. Heterogeneity was explored for multiple variables. Pooled prevalence and 95% CI were calculated. RESULTS. The prevalence of both incidental extracardiac findings and major incidental extracardiac findings showed a high heterogeneity (I2 > 95%): The pooled prevalence was 44% (95% CI, 35-54%) and 16% (95% CI, 14-20%), respectively. No significant explanatory variables were found for using or not using contrast material, the size of the FOV, and study design (I2 > 85%). The pooled cancer prevalence for 10 studies including 5082 patients was 0.7% (95% CI, 0.5-1.0%), with an almost perfect homogeneity (I2 <0.1%). Of 29 reported malignancies, 21 (72%) were lung cancers; three, thyroid cancers; two, breast cancers; two, liver cancers; and one, mediastinal lymphoma. CONCLUSION. Although the prevalence of reported incidental extracardiac finding at cardiac CT was highly variable, a homogeneous prevalence of previously unknown malignancies was reported across the studies, for a pooled estimate of 0.7%; more than 70% of these previously unknown malignancies were lung cancers. Extracardiac findings on cardiac CT require careful evaluation and reporting.

Original languageEnglish
Pages (from-to)555-564
Number of pages10
JournalAmerican Journal of Roentgenology
Volume201
Issue number3
DOIs
Publication statusPublished - Sep 2013

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Incidental Findings
Meta-Analysis
Neoplasms
Lung Neoplasms
Liver Neoplasms
Thyroid Neoplasms
PubMed
Contrast Media
Lymphoma
Cross-Sectional Studies
Databases
Breast Neoplasms

Keywords

  • Cardiac CT
  • Incidental extracardiac findings
  • Meta-analysis
  • Systematic review

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Malignant incidental extracardiac findings on cardiac CT : Systematic review and meta-analysis. / Flor, Nicola; Di Leo, Giovanni; Squarza, Silvia Amaryllis Claudia; Tresoldi, Silvia; Rulli, Eliana; Cornalba, Gianpaolo; Sardanelli, Francesco.

In: American Journal of Roentgenology, Vol. 201, No. 3, 09.2013, p. 555-564.

Research output: Contribution to journalArticle

Flor, Nicola ; Di Leo, Giovanni ; Squarza, Silvia Amaryllis Claudia ; Tresoldi, Silvia ; Rulli, Eliana ; Cornalba, Gianpaolo ; Sardanelli, Francesco. / Malignant incidental extracardiac findings on cardiac CT : Systematic review and meta-analysis. In: American Journal of Roentgenology. 2013 ; Vol. 201, No. 3. pp. 555-564.
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abstract = "OBJECTIVE. The objective of our study was to systematically review the evidence on incidental extracardiac findings on cardiac CT with a focus on previously unknown malignancies. MATERIALS AND METHODS. A systematic search was performed (PubMed, EMBASE, Cochrane databases) for studies reporting incidental extracardiac findings on cardiac CT. Among 1099 articles initially found, 15 studies met the inclusion criteria. The references of those articles were hand-searched and 14 additional studies were identified. After review of the full text, 10 articles were excluded. Nineteen studies including 15,877 patients (64{\%} male) were analyzed. A three-level analysis was performed to determine the prevalence of patients with incidental extracardiac findings, the prevalence of patients with major incidental extracardiac findings, and the prevalence of patients with a proven cancer. Heterogeneity was explored for multiple variables. Pooled prevalence and 95{\%} CI were calculated. RESULTS. The prevalence of both incidental extracardiac findings and major incidental extracardiac findings showed a high heterogeneity (I2 > 95{\%}): The pooled prevalence was 44{\%} (95{\%} CI, 35-54{\%}) and 16{\%} (95{\%} CI, 14-20{\%}), respectively. No significant explanatory variables were found for using or not using contrast material, the size of the FOV, and study design (I2 > 85{\%}). The pooled cancer prevalence for 10 studies including 5082 patients was 0.7{\%} (95{\%} CI, 0.5-1.0{\%}), with an almost perfect homogeneity (I2 <0.1{\%}). Of 29 reported malignancies, 21 (72{\%}) were lung cancers; three, thyroid cancers; two, breast cancers; two, liver cancers; and one, mediastinal lymphoma. CONCLUSION. Although the prevalence of reported incidental extracardiac finding at cardiac CT was highly variable, a homogeneous prevalence of previously unknown malignancies was reported across the studies, for a pooled estimate of 0.7{\%}; more than 70{\%} of these previously unknown malignancies were lung cancers. Extracardiac findings on cardiac CT require careful evaluation and reporting.",
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AU - Flor, Nicola

AU - Di Leo, Giovanni

AU - Squarza, Silvia Amaryllis Claudia

AU - Tresoldi, Silvia

AU - Rulli, Eliana

AU - Cornalba, Gianpaolo

AU - Sardanelli, Francesco

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N2 - OBJECTIVE. The objective of our study was to systematically review the evidence on incidental extracardiac findings on cardiac CT with a focus on previously unknown malignancies. MATERIALS AND METHODS. A systematic search was performed (PubMed, EMBASE, Cochrane databases) for studies reporting incidental extracardiac findings on cardiac CT. Among 1099 articles initially found, 15 studies met the inclusion criteria. The references of those articles were hand-searched and 14 additional studies were identified. After review of the full text, 10 articles were excluded. Nineteen studies including 15,877 patients (64% male) were analyzed. A three-level analysis was performed to determine the prevalence of patients with incidental extracardiac findings, the prevalence of patients with major incidental extracardiac findings, and the prevalence of patients with a proven cancer. Heterogeneity was explored for multiple variables. Pooled prevalence and 95% CI were calculated. RESULTS. The prevalence of both incidental extracardiac findings and major incidental extracardiac findings showed a high heterogeneity (I2 > 95%): The pooled prevalence was 44% (95% CI, 35-54%) and 16% (95% CI, 14-20%), respectively. No significant explanatory variables were found for using or not using contrast material, the size of the FOV, and study design (I2 > 85%). The pooled cancer prevalence for 10 studies including 5082 patients was 0.7% (95% CI, 0.5-1.0%), with an almost perfect homogeneity (I2 <0.1%). Of 29 reported malignancies, 21 (72%) were lung cancers; three, thyroid cancers; two, breast cancers; two, liver cancers; and one, mediastinal lymphoma. CONCLUSION. Although the prevalence of reported incidental extracardiac finding at cardiac CT was highly variable, a homogeneous prevalence of previously unknown malignancies was reported across the studies, for a pooled estimate of 0.7%; more than 70% of these previously unknown malignancies were lung cancers. Extracardiac findings on cardiac CT require careful evaluation and reporting.

AB - OBJECTIVE. The objective of our study was to systematically review the evidence on incidental extracardiac findings on cardiac CT with a focus on previously unknown malignancies. MATERIALS AND METHODS. A systematic search was performed (PubMed, EMBASE, Cochrane databases) for studies reporting incidental extracardiac findings on cardiac CT. Among 1099 articles initially found, 15 studies met the inclusion criteria. The references of those articles were hand-searched and 14 additional studies were identified. After review of the full text, 10 articles were excluded. Nineteen studies including 15,877 patients (64% male) were analyzed. A three-level analysis was performed to determine the prevalence of patients with incidental extracardiac findings, the prevalence of patients with major incidental extracardiac findings, and the prevalence of patients with a proven cancer. Heterogeneity was explored for multiple variables. Pooled prevalence and 95% CI were calculated. RESULTS. The prevalence of both incidental extracardiac findings and major incidental extracardiac findings showed a high heterogeneity (I2 > 95%): The pooled prevalence was 44% (95% CI, 35-54%) and 16% (95% CI, 14-20%), respectively. No significant explanatory variables were found for using or not using contrast material, the size of the FOV, and study design (I2 > 85%). The pooled cancer prevalence for 10 studies including 5082 patients was 0.7% (95% CI, 0.5-1.0%), with an almost perfect homogeneity (I2 <0.1%). Of 29 reported malignancies, 21 (72%) were lung cancers; three, thyroid cancers; two, breast cancers; two, liver cancers; and one, mediastinal lymphoma. CONCLUSION. Although the prevalence of reported incidental extracardiac finding at cardiac CT was highly variable, a homogeneous prevalence of previously unknown malignancies was reported across the studies, for a pooled estimate of 0.7%; more than 70% of these previously unknown malignancies were lung cancers. Extracardiac findings on cardiac CT require careful evaluation and reporting.

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KW - Incidental extracardiac findings

KW - Meta-analysis

KW - Systematic review

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