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Objectives <p>To evaluate the prevalence and clinical implications of extra-coronary findings in a large cohort of patients undergoing coronary computed tomography angiography (CCTA).</p> Materials and methods <p>This retrospective study analyzed data from 3295 consecutive CCTA examinations at a single tertiary center. Radiology reports were reviewed for potentially significant extra-coronary findings. Three-year follow-up evaluation was performed via hospital records. Prevalences of confirmed significant findings were determined and extrapolated to patients lost to follow-up.</p> Results <p>Extra-coronary findings were reported in 92.7% (3053/3295) of patients. Potentially significant non-cardiovascular findings were found in 25.3% (833/3295), including potentially malignant findings in 8.5% (281/3295) and significant non-malignant findings in 19.3% (637/3295). Among patients with potentially malignant findings, 40.2% (113/281) underwent follow-up, with confirmed malignancy in 28.3% (32/113). Extrapolation suggests a malignancy prevalence of up to 2.4% (95% CI: 1.8–3.2%) within the CCTA field of view, with a minimum of 1.0% if all patients lost to follow-up were assumed to have no malignancy. The most frequent significant non-malignant finding was pulmonary emphysema (10.7%; 352/3295), with extrapolated prevalence rates of 4.2% (95% CI: 2.6–5.9% for COPD and 1.8% (95% CI: 0.8–3.4%) for asthma or obstructive sleep apnea. Liver steatosis was present in 4.5% (147/3295), with an estimated prevalence of 3.1% (95% CI: 1.6–4.2%) for metabolic dysfunction-associated steatotic liver disease and 1.3% (95% CI: 0.3–2.9%) for alcohol-related liver disease.</p> Conclusion <p>Extra-coronary findings are common in CCTA and carry important clinical implications. Careful management is necessary, and additional screening protocols may benefit high-risk patients.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis> <i>How frequently do extra-coronary findings occur in coronary CT angiography, and what is their clinical impact in patients undergoing cardiac evaluation?</i></p> <p><Emphasis Type="BoldItalic">Findings</Emphasis> <i>Clinically significant extra-coronary non-cardiovascular findings were identified in 25.3% of patients, including unsuspected malignancies and relevant pulmonary and hepatic comorbidities.</i></p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis> <i>Extra-coronary findings on coronary CT angiography are common and often clinically relevant, warranting structured assessment to support timely diagnosis and multidisciplinary patient care.</i></p> Graphical Abstract <p></p>

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Beyond the heart: prevalence and implications of extra-coronary findings in coronary CT angiography: a retrospective study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月5日

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  • David A. Gloor,
  • Inga Todorski,
  • Alan Peters,
  • Benedikt Wagner,
  • Tobias Gassenmaier,
  • Justus Roos,
  • Andreas Christe,
  • Lukas Ebner,
  • Adrian T. Huber

摘要

Objectives

To evaluate the prevalence and clinical implications of extra-coronary findings in a large cohort of patients undergoing coronary computed tomography angiography (CCTA).

Materials and methods

This retrospective study analyzed data from 3295 consecutive CCTA examinations at a single tertiary center. Radiology reports were reviewed for potentially significant extra-coronary findings. Three-year follow-up evaluation was performed via hospital records. Prevalences of confirmed significant findings were determined and extrapolated to patients lost to follow-up.

Results

Extra-coronary findings were reported in 92.7% (3053/3295) of patients. Potentially significant non-cardiovascular findings were found in 25.3% (833/3295), including potentially malignant findings in 8.5% (281/3295) and significant non-malignant findings in 19.3% (637/3295). Among patients with potentially malignant findings, 40.2% (113/281) underwent follow-up, with confirmed malignancy in 28.3% (32/113). Extrapolation suggests a malignancy prevalence of up to 2.4% (95% CI: 1.8–3.2%) within the CCTA field of view, with a minimum of 1.0% if all patients lost to follow-up were assumed to have no malignancy. The most frequent significant non-malignant finding was pulmonary emphysema (10.7%; 352/3295), with extrapolated prevalence rates of 4.2% (95% CI: 2.6–5.9% for COPD and 1.8% (95% CI: 0.8–3.4%) for asthma or obstructive sleep apnea. Liver steatosis was present in 4.5% (147/3295), with an estimated prevalence of 3.1% (95% CI: 1.6–4.2%) for metabolic dysfunction-associated steatotic liver disease and 1.3% (95% CI: 0.3–2.9%) for alcohol-related liver disease.

Conclusion

Extra-coronary findings are common in CCTA and carry important clinical implications. Careful management is necessary, and additional screening protocols may benefit high-risk patients.

Key Points

Question How frequently do extra-coronary findings occur in coronary CT angiography, and what is their clinical impact in patients undergoing cardiac evaluation?

Findings Clinically significant extra-coronary non-cardiovascular findings were identified in 25.3% of patients, including unsuspected malignancies and relevant pulmonary and hepatic comorbidities.

Clinical relevance Extra-coronary findings on coronary CT angiography are common and often clinically relevant, warranting structured assessment to support timely diagnosis and multidisciplinary patient care.

Graphical Abstract