Detection of Cardiac Incidental Findings on Routine Chest CT: The Impact of Dedicated Training in Cardiac Imaging

Daniel Verdini, Ashley M. Lee, Anand M. Prabhakar, Suhny Abbara, Brian Ghoshhajra

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Purpose: Routine 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. Methods: Electrocardiographically 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. Results: Overall, 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. Conclusions: Increasing 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.

Original languageEnglish (US)
JournalJournal of the American College of Radiology
DOIs
StateAccepted/In press - 2016

Fingerprint

Incidental Findings
Thorax
Sensitivity and Specificity
Reading
Computed Tomography Angiography
Radiologists

Keywords

  • Cardiac CTA
  • Chest CT
  • Coronary artery
  • ECG gated CT
  • Incidental findings

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Detection of Cardiac Incidental Findings on Routine Chest CT : The Impact of Dedicated Training in Cardiac Imaging. / Verdini, Daniel; Lee, Ashley M.; Prabhakar, Anand M.; Abbara, Suhny; Ghoshhajra, Brian.

In: Journal of the American College of Radiology, 2016.

Research output: Contribution to journalArticle

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title = "Detection of Cardiac Incidental Findings on Routine Chest CT: The Impact of Dedicated Training in Cardiac Imaging",
abstract = "Purpose: Routine 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. Methods: Electrocardiographically 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. Results: Overall, 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. Conclusions: Increasing 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.",
keywords = "Cardiac CTA, Chest CT, Coronary artery, ECG gated CT, Incidental findings",
author = "Daniel Verdini and Lee, {Ashley M.} and Prabhakar, {Anand M.} and Suhny Abbara and Brian Ghoshhajra",
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language = "English (US)",
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T1 - Detection of Cardiac Incidental Findings on Routine Chest CT

T2 - The Impact of Dedicated Training in Cardiac Imaging

AU - Verdini, Daniel

AU - Lee, Ashley M.

AU - Prabhakar, Anand M.

AU - Abbara, Suhny

AU - Ghoshhajra, Brian

PY - 2016

Y1 - 2016

N2 - Purpose: Routine 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. Methods: Electrocardiographically 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. Results: Overall, 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. Conclusions: Increasing 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.

AB - Purpose: Routine 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. Methods: Electrocardiographically 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. Results: Overall, 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. Conclusions: Increasing 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.

KW - Cardiac CTA

KW - Chest CT

KW - Coronary artery

KW - ECG gated CT

KW - Incidental findings

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