University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16SUF, UK.
Edinburgh Imaging facility QMRI, University of Edinburgh, Edinburgh, UK.
Eur Radiol. 2018 Jun;28(6):2639-2646. doi: 10.1007/s00330-017-5181-5. Epub 2018 Jan 2.
Noncardiac findings are common on coronary computed tomography angiography (CCTA). We assessed the clinical impact of noncardiac findings, and potential changes to surveillance scans with the application of new lung nodule guidelines.
This substudy of the SCOT-HEART randomized controlled trial assessed noncardiac findings identified on CCTA. Clinically significant noncardiac findings were those causing symptoms or requiring further investigation, follow-up or treatment. Lung nodule follow-up was undertaken following the 2005 Fleischner guidelines. The potential impact of the 2015 British Thoracic Society (BTS) and the 2017 Fleischner guidelines was assessed.
CCTA was performed in 1,778 patients and noncardiac findings were identified in 677 (38%). In 173 patients (10%) the abnormal findings were clinically significant and in 55 patients (3%) the findings were the cause of symptoms. Follow-up imaging was recommended in 136 patients (7.6%) and additional clinic consultations were organized in 46 patients (2.6%). Malignancy was diagnosed in 7 patients (0.4%). Application of the new lung nodule guidelines would have reduced the number of patients undergoing a follow-up CT scan: 68 fewer with the 2015 BTS guidelines and 78 fewer with the 2017 Fleischner guidelines; none of these patients subsequently developed malignancy.
Clinically significant noncardiac findings are identified in 10% of patients undergoing CCTA. Application of new lung nodule guidelines will reduce the cost of surveillance, without the risk of missing malignancy.
• Clinically significant noncardiac findings occur in 10% of patients undergoing CCTA. • Noncardiac findings may be an important treatable cause of chest pain • Further imaging investigations for noncardiac findings were recommended in 8% of patients after CCTA. • New lung nodule follow-up guidelines will result in cost savings.
冠状动脉 CT 血管造影（CCTA）常发现非心脏性病变。本研究评估了非心脏性病变的临床影响，以及新的肺结节指南应用后对监测扫描的潜在改变。
SCOT-HEART 随机对照试验的子研究评估了 CCTA 上发现的非心脏性病变。有临床意义的非心脏性病变是指引起症状或需要进一步检查、随访或治疗的病变。肺结节随访遵循 2005 年 Fleischner 指南。评估了 2015 年英国胸科学会（BTS）和 2017 年 Fleischner 指南的潜在影响。
1778 例患者进行了 CCTA，其中 677 例（38%）发现非心脏性病变。173 例（10%）患者的异常发现具有临床意义，55 例（3%）患者的发现是症状的原因。136 例（7.6%）患者建议进行随访成像，46 例（2.6%）患者安排了额外的门诊会诊。7 例（0.4%）患者诊断为恶性肿瘤。应用新的肺结节指南将减少接受随访 CT 扫描的患者数量：2015 年 BTS 指南减少 68 例，2017 年 Fleischner 指南减少 78 例；这些患者均未随后发生恶性肿瘤。
CCTA 检查的患者中有 10%发现有临床意义的非心脏性病变。应用新的肺结节指南将降低监测成本，而不会增加漏诊恶性肿瘤的风险。
• CCTA 检查的患者中有 10%发现有临床意义的非心脏性病变。• 非心脏性病变可能是胸痛的重要可治疗原因。• CCTA 后，8%的患者建议进一步进行非心脏性病变的影像学检查。• 新的肺结节随访指南将节省成本。
