Incidental findings are common among healthy older adults who undergo cardiac multidetector row computed tomography (MDCT), according to a report in the April 14th issue of the Archives of Internal Medicine.

"Clinicians must be aware that incidental findings, especially pulmonary nodules, are common in cardiac MDCT for detection of coronary artery calcification in older healthy adults," Dr. Jeremy R. Burt, now at Johns Hopkins Hospital, Baltimore, told Reuters Health. "The net risks and benefits of acting on this information should be carefully weighed."

While at Stanford University School of Medicine, Dr. Burt and colleagues investigated the prevalence and type of incidental findings discovered during cardiac MDCT scanning that were recommended for clinical or radiological follow-up examination in a sample of 459 healthy men and women 60 to 69 years old without previously diagnosed cardiovascular disease.

Overall, 41 per cent of the participants had at least one incidental finding on cardiac MDCT, and 23 per cent had at least one incidental finding recommended for follow-up examination, the authors report.

Incidental findings were most commonly located in lung (31 per cent), liver (six per cent), heart (five per cent), hilum and "other" (four per cent each), mediastinum (three per cent), and spleen (one per cent).

The most common incidental finding recommended for follow-up examination was a noncalcified solid pulmonary nodule greater than two mm in diameter, the report indicates. This occurred in 15 per cent of participants.

Other common findings included benign-appearing hepatic cysts (five per cent of participants), enlarged, calcified lymph nodes in the mediastinum and hilum (six per cent), and pericardial effusion (three per cent).

"With the advent of even more sensitive 64- and 128-detector cardiac MDCT scanners for coronary artery calcium and noninvasive coronary angiography, it is likely that the prevalence of detected incidental findings will only increase over time," the investigators say.

"Our study highlights...the need for further data on the potential benefits, harms, and costs of searching for incidental findings during cardiac MDCT," the authors conclude.

A second segment of this study looked at clinical outcomes of those with incidental pulmonary nodules, Dr. Burt said. The results of this evaluation will be published in the American Journal of Medicine.


Arch Intern Med 2008;168:756-761