Detection of Cardiac Incidental Findings on Routine Chest CT: The Impact of Dedicated Training in Cardiac Imaging |
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| Affiliation: | 1. Harvard Medical School, Boston, Massachusetts;2. Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts;1. Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee;2. Vanderbilt University School of Medicine, Nashville, Tennessee;3. Medical University of South Carolina, Charleston, South Carolina;4. Division of Abdominal Imaging & Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;5. Department of Radiology, University of Washington, Seattle, Washington;6. Harvard Medical School, Boston, Massachusetts;1. Department of Radiology, Mercy Fitzgerald Hospital, Darby, Pennsylvania;2. Cleveland Clinic, Cleveland, Ohio;1. Beth Israel Deaconess Medical Center, Boston, Massachusetts;2. Emory University School of Medicine, Atlanta, Georgia;3. NYU Langone Medical Center, New York, New York;4. Doctors Imaging Group, Gainesville, Florida;1. Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia;2. Emory University School of Medicine, Atlanta, Georgia;3. Department of Radiology, Children’s Healthcare of Atlanta (Egleston), Atlanta, Georgia;1. Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;2. University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina;3. Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina |
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| Abstract: | PurposeRoutine chest CT and cardiac CT angiography (CTA) both image the heart, albeit with different precision and intent. The aim of this study was to evaluate the diagnostic ability of radiologists with different levels of cardiac training to identify cardiac findings on chest CT without electrocardiographic gating compared with a reference standard of electrocardiographically gated cardiac CTA.MethodsElectrocardiographically gated cardiac CT angiographic studies performed between January 2005 to January 2010 in patients with routine chest CT within six months were retrospectively identified. Fourteen radiologists at four stages of training (stage 1, residents with no cardiac training [n = 4]; stage 2, residents who had completed at least one dedicated rotation of cardiac imaging [n = 3]; stage 3, radiologists without cardiac training [n = 3]; and stage 4, radiologists with formal cardiac fellowship training [n = 4]) performed blinded, anonymized cardiac readings of chest CT images. Findings were categorized (coronary arterial, noncoronary vessel, cardiac chamber, myocardial, pericardial, and valve findings) with cardiac CTA as a reference standard.ResultsOverall, 140 cardiac CT angiographic findings were reported in 63 of 77 patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of nongated CTA were 43.6%, 96.8%, 83.0%, 81.6%, and 81.8%, respectively, for all readers. Increasing training was associated with higher sensitivity (30.3%, 35.7%, 45.7%, and 61.2% from stages 1 to 4) but similar specificity (96.4%, 96.7%, 96.3%, and 97.6% from stages 1 to 4). Frequently missed findings categories were coronary arterial, myocardial, and cardiac chamber findings.ConclusionsIncreasing cardiac imaging training correlates with increased sensitivity and stable specificity to detect cardiac findings on routine chest CT without electrocardiographic gating. Cardiac findings should be noted on chest CT when observed, and cardiac training should be encouraged. |
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| Keywords: | Incidental findings cardiac CTA chest CT coronary artery ECG gated CT |
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