McKenna David A, Laxpati Monish, Colletti Patrick M
Department of Radiology, Keck School of Medicine, University of Southern California, USA.
Open Cardiovasc Med J. 2008;2:20-5. doi: 10.2174/1874192400802010020. Epub 2008 Apr 2.
OBJECT OR PURPOSE OF STUDY: As the field of view of cardiac magnetic resonance imaging (CMR) includes the thorax and upper abdomen, it is not surprising that these studies can reveal incidental extra-cardiac abnormalities. The purpose of this study is to determine the prevalence of these incidental findings.
MATERIALS, METHODS AND PROCEDURES: 132 volunteer participants with a mean age of 74.2 years (range, 61-89 years; 127 males and 5 females) had CMR with 7 sequences. All images were retrospectively reviewed by a radiologist, specifically assessing for non-cardiac findings. Visualized abnormalities were noted and categorized according to significance. Clinically significant findings were defined as those requiring further clinical or radiological work-up, with moderately significant findings defined as those that may affect patient care depending on medical history or symptoms. Remaining findings were considered clinically insignificant.
Within the group, 107 participants (81%) had extra-cardiac findings, with 63 (48%) having multiple findings. A total of 224 incidental findings were visualized, with at least one clinically significant and moderately significant finding found in 23 (17%) and 43 (33 %) of the subjects, respectively. Potentially clinically significant findings included pulmonary nodules, solid or complex lesions of the solid abdominal viscera and thyroid, and aortic pathology including aneurysm. The most prevalent incidental findings were however benign appearing, including renal and hepatic cysts, hemangiomas, and atelectasis. The SSFP coronal localizer, SSFP axial localizer, and short axis SSFP cine oblique sequences were most sensitive at detecting incidental findings (p = 0.013 vs four other sequences) with 47%, 46%, and 41% detection respectively, with no significant difference between these three multislice sequences (p = 0.369).
In total, 81% of our volunteers had extra-cardiac findings, of which 17% were potentially clinically significant, necessitating further work up. We believe that these numbers appear high compared to prior similar studies performed at Cardiac CT. This may be related to the relatively older cohort examined here. In conclusion it is important to look beyond the heart when reviewing cardiac MRI studies and carefully assess the entire field of view for abnormalities.
研究目的：由于心脏磁共振成像（CMR）的视野包括胸部和上腹部，这些研究能揭示偶然发现的心脏外异常并不奇怪。本研究的目的是确定这些偶然发现的发生率。
材料、方法和步骤：132名平均年龄74.2岁（范围61 - 89岁；127名男性和5名女性）的志愿者接受了7个序列的CMR检查。所有图像均由一名放射科医生进行回顾性审查，特别评估非心脏方面的发现。记录可视化的异常情况并根据其重要性进行分类。具有临床意义的发现被定义为那些需要进一步临床或放射学检查的情况，中度具有意义的发现被定义为那些可能根据病史或症状影响患者治疗的情况。其余发现被认为临床意义不大。
在该组中，107名参与者（81%）有心脏外发现，其中63名（48%）有多项发现。总共可视化了224个偶然发现，分别在23名（17%）和43名（33%）受试者中发现至少一项具有临床意义和中度具有意义的发现。潜在具有临床意义的发现包括肺结节、实性腹部脏器和甲状腺的实性或复杂性病变以及包括动脉瘤在内的主动脉病变。然而，最常见的偶然发现表现为良性，包括肾囊肿、肝囊肿、血管瘤和肺不张。稳态自由进动（SSFP）冠状位定位像、SSFP轴位定位像和短轴SSFP电影斜位序列在检测偶然发现方面最敏感（与其他四个序列相比，p = 0.013），检测率分别为47%、46%和41%，这三个多层序列之间无显著差异（p = 0.369）。
总体而言，我们的志愿者中有81%有心脏外发现，其中17%可能具有临床意义，需要进一步检查。我们认为与之前在心脏CT上进行的类似研究相比，这些数字看起来较高。这可能与这里检查的队列年龄相对较大有关。总之，在审查心脏MRI研究时，除了心脏之外查看并仔细评估整个视野中的异常情况很重要。
