Extracardiac findings on coronary CT angiography: A systematic review

Coronary computed tomography angiography (CCTA) is of growing importance in noninvasive diagnosis of coronary artery diseases. The CT data allow evaluation not only of coronary arteries but also of adjacent anatomical territories. Our objective was to review, to analyze, and to quantify the spectrum and the prevalence of extracardiac findings (ECF) in CCTA. Therefore, we searched MEDLINE, EMBASE, and ISI Web of Science. Prior to quantitative analysis, we categorized the ECF of all included studies into clinically significant and clinically non-significant findings. First, we calculated the average prevalences of ECF and clinically significant ECF performing a meta-analysis for proportions using the double arcsine transformation. Second, we analyzed the spectrum and location of clinically significant ECF. Third, we identified ECF of acutely life-threatening potential as well as malignancies and calculated their prevalences. Thirteen studies with a total of 11,703 patients were found to meet the inclusion criteria. The average prevalence of overall ECF was 41.0% (95% confidence interval [95% CI]: 27, 56; P < .0001) and 16.0% (95% CI (9, 24; P < .0001) for clinically significant ECF. Clinically significant ECF were most commonly detected in the lungs (50.2%), the abdomen (26.7%), the vessels (13.1%), the mediastinum (3.6%), and in other adjacent anatomical territories (6.4%). The prevalence of acutely life-threatening and malignant ECF accounted for 2.2% (95% CI: 1.9, 2.5; P < .0001) and 0.3% (95% CI: 0.2-0.4; P < .0001), respectively. In conclusion, clinically significant and acutely life-threatening ECF are common. Reading CCTA for ECF may lead to earlier detection of relevant disease.ConclusionClinically significant and acutely life-threatening ECF are common. Reading CCTA for ECF may lead to earlier detection of relevant disease.