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Noncardiac Pathology on Clinical Cardiac Magnetic Resonance Imaging

Peter G. Chan, MD^_*,_*, Martin P. Smith, MD, Thomas H. Hauser, MD^_*, Susan B. Yeon, MD^_*, Evan Appelbaum, MD^_*, Neil M. Rofsky, MD, Warren J. Manning, MD^_*,

^_* Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

^_* Reprint requests and correspondence: Dr. Peter G. Chan, Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215 (Email: pchan{at}post.harvard.edu).

Objectives: We sought to determine the prevalence of noncardiac pathology in a large consecutive series of patients referred for clinical cardiac magnetic resonance (CMR) studies.

Background: The imaging field for many CMR sequences extends outside of the heart border. As a result, noncardiac pathology may be identified. These noncardiac findings have clinical significance because they often lead to subsequent imaging/testing and intervention. The prevalence of noncardiac findings on clinical CMR studies has not been well described.

Methods: The reports of all 1,534 (62% male, age 50 ± 15 years) clinical CMR studies performed at an academic medical center during calendar years 2002 to 2006 were reviewed. All studies had been interpreted by both a staff cardiologist (level III trained in CMR) and a board-certified radiologist (with fellowship training in CMR). For each study, sex, age, indication for CMR study, and reported noncardiac pathology were extracted. Follow-up for each major noncardiac pathology was evaluated by reviewing the patient's medical center electronic medical record. These noncardiac pathologies were then categorized as significant if an intervention or change in the patient's management ensued.

Results: A total of 116 (7.6%) studies had at least one noncardiac finding. These findings included 55 major findings (e.g., lymphadenopathy, lung abnormalities, mediastinal masses) in 48 distinct reports (prevalence of 3.1%) and 74 minor findings (e.g., small pleural effusions, liver cysts, renal cysts) in 70 distinct reports (prevalence of 4.6%). The majority (62%) of major findings were previously known, with only 8 findings in 6 (0.4%) of 1,534 reports ultimately deemed to be new and clinically important/significant. The age of those with noncardiac pathology was greater (54 ± 16 years vs. 49 ± 16 years, p < 0.001).

Conclusions: In this large series of consecutive clinical CMR studies interpreted by both staff cardiologists and radiologists, noncardiac pathology is uncommonly reported. When reported, the majority of major findings are previously known. New major findings were detected in <0.5% of reports.

Key Words: cardiac magnetic resonance • noncardiac pathology • thorax

Abbreviations and Acronyms   CCT = cardiac computed tomography   CMR = cardiac magnetic resonance   CT = computed tomography   MDCT = multidetector computed tomography   MR = magnetic resonance