Sverzellati Nicola, Arcadi Teresa, Salvolini Luca, Dore Roberto, Zompatori Maurizio, Mereu Manuela, Battista Giuseppe, Martella Ilenia, Toni Francesco, Cardinale Luciano, Maffei Erica, Maggi Fabio, Cademartiri Filippo, Pirronti Tommaso
Section of Diagnostic Imaging, Department of Surgical Sciences, University of Parma, Padiglione Barbieri, University Hospital of Parma, V. Gramsci 14, 43100, Parma, Italy.
Department of Radiology, SDN Foundation, IRCCS, Naples, Italy.
Radiol Med. 2016 Mar;121(3):190-9. doi: 10.1007/s11547-015-0595-0. Epub 2015 Oct 30.
It is unclear whether (and, to what extent) radiologists look at and report cardiovascular abnormalities on non-cardio-synchronized standard chest computed tomography (CT). In this study, the frequency and the reporting rate of cardiovascular findings in chest CT examinations were retrospectively assessed.
This study was approved by the institutional review board of each participating center. Four academic centers provided data on 447 subjects who underwent non-ECG-synchronized chest CT examinations for evaluating pulmonary fibrosis (161/447, 36 %), suspected pulmonary embolism (140/447, 31.3 %), or lung cancer staging (146/447, 32.7 %). A total of 220/447 (53.7 %) and 227/447 CT (46.3 %) examinations were evaluated and reported by junior and senior chest radiologists, respectively. Two radiologists with training in cardiac imaging reviewed the same chest CT images looking for the presence of incidental cardiovascular abnormalities using a preformatted score sheet. Inter-observer agreement was assessed using the kappa coefficient of agreement (k).
Inter-observer agreement between the study reviewers was moderate to good (0.4-0.73) for most of the incidental cardiovascular findings. At least one incidental cardiovascular finding not documented in the original report was identified by the study reviewers in 225/409 (55 %) of chest CT examinations. A total of 168/266 (63.2 %) potentially clinically significant cardiovascular findings were unreported in the original reports of 177/447 (39.6 %) subjects (p < 0.0001). Senior radiologists tended to more frequently report coronary artery calcification (p = 0.0006), cardiac valves calcification (p = 0.0003), and ascending aorta enlargement (p = 0.01) compared to junior radiologists.
Several cardiovascular abnormalities can be reliably identified on standard chest CT. Yet, they are often under-reported, even when they might be relevant to the patient's work-up.
尚不清楚放射科医生是否（以及在何种程度上）会查看并报告非心脏同步标准胸部计算机断层扫描（CT）上的心血管异常情况。在本研究中，我们对胸部CT检查中心血管发现的频率及报告率进行了回顾性评估。
本研究经各参与中心的机构审查委员会批准。四个学术中心提供了447名接受非心电图同步胸部CT检查患者的数据，这些患者的检查目的分别为评估肺纤维化（161/447，36%）、疑似肺栓塞（140/447，31.3%）或肺癌分期（146/447，32.7%）。胸部CT检查中，初级和高级胸部放射科医生分别评估并报告了220/447（53.7%）和227/447（46.3%）的检查。两名接受过心脏成像培训的放射科医生使用预先格式化的评分表，对相同的胸部CT图像进行查看，以寻找是否存在偶然发现的心血管异常。观察者间一致性通过一致性kappa系数（k）进行评估。
对于大多数偶然发现的心血管情况，研究审查者之间的观察者间一致性为中等至良好（0.4 - 0.73）。研究审查者在225/409（55%）的胸部CT检查中发现了至少一项原始报告中未记录的偶然心血管发现。在177/447（39.6%）名受试者的原始报告中，共有168/266（63.2%）潜在具有临床意义的心血管发现未被报告（p < 0.0001）。与初级放射科医生相比，高级放射科医生更频繁地报告冠状动脉钙化（p = 0.0006）、心脏瓣膜钙化（p = 0.0003）和升主动脉增宽（p = 0.01）。
在标准胸部CT上可以可靠地识别出几种心血管异常情况。然而，即使这些异常可能与患者的检查相关，它们也常常未被充分报告。
