Preoperative computed tomography angiography (CTA) of the body in vascular patients: prevalence and significance of unsuspected extravascular findings

Abstract

Purpose Evaluation of the prevalence and significance of unsuspected extravascular findings on computed tomography angiography (CTA) of the body before endovascular or surgical treatment in vascular patients.

Materials and Methods This study was approved by the local institutional review board. Radiology reports of 806 patients who underwent CTA of the body during January 2004 until December 2014 before endovascular or surgical treatment of vascular diseases were retrospectively reviewed. All unexpected extravascular abnormalities were classified as clinically non-significant (requiring no follow-up) or clinically significant (requiring further follow-up/immediate treatment). The course of patients with significant extravascular findings was retrospectively evaluated.

Results Overall 806 patients were included in this study (592 men; mean age: 67 years). In 778 (96.5 %) of 806 patients 3293 incidental extravascular findings were diagnosed. There were 259 suspicious findings in 205 patients (25.4 %) that required further follow-up or immediate treatment. A previously unknown malignant tumor was diagnosed in 23 (2.9 %) patients. 10 patients (1.2 %) were diagnosed with lung cancer. Malignant tumors were detected more often in men than in women (3.5 % versus 0.9 %). Patients with an incidental tumor were significantly older than patients without a tumor (mean age: 72.3 vs. 67.5 years).

Conclusion Clinically significant unexpected extravascular findings are common in vascular patients. Especially noteworthy are malignant tumors of the lung.

Key points 

• Clinically relevant extravascular findings were detected in 25.4 % of the patients.

• The incidence of malignant tumors was 2.9 %.

• Lung cancer had the highest incidence among all malignancies (1.2 %).

Citation Format

• Turowski LS, Dollinger M, Wohlgemuth WA et al. Preoperative computed tomography angiography (CTA) of the body in vascular patients: prevalence and significance of unsuspected extravascular findings. Fortschr Röntgenstr 2019; 191: 716 – 724

Zusammenfassung

Ziel Evaluation der Prävalenz und Signifikanz von unerwarteten extravaskulären Befunden in Ganzkörper-computertomografischen Angiografie-Scans (CTA) vor endovaskulärer oder chirurgischer Behandlung von Gefäßpatienten.

Material und Methoden Diese Studie wurde von der örtlichen Ethikkommission genehmigt. Es wurden radiologische Befunde von Patienten, die eine Ganzkörper-CTA im Zeitraum zwischen Januar 2004 und Dezember 2014 vor endovaskulärer oder chirurgischer Therapie von Erkrankungen der Gefäße erhielten, retrospektiv aufgearbeitet. Alle unerwarteten extravaskulären Befunde wurden als klinisch nicht relevant (Verlaufskontrollen nicht indiziert) oder klinisch relevant (Verlaufskontrollen/sofortige Behandlung indiziert) klassifiziert. Der weitere Verlsauf von Patienten mit klinisch relevanten extravaskulären Befunden wurde retrospektiv evaluiert.

Ergebnisse Es wurden 806 Patienten in diese Studie eingeschlossen (592 Männer; Durchschnittsalter 67 Jahre). Bei 778 (96,5 %) von 806 Patienten wurden insgesamt 3293 extravaskuläre Zufallsbefunde festgestellt. Darunter befanden sich 259 suspekte Befunde bei 205 Patienten (25,4 %), die Verlaufskontrollen oder eine sofortige Behandlung erforderten. Ein bis dahin unbekanntes Malignom wurde bei 23 Patienten (2,9 %) diagnostiziert, darunter waren 10 Patienten (1,2 %) mit einem Lungenkarzinom. Bei Männern wurden mehr maligne Tumoren nachgewiesen als bei Frauen (3,5 % versus 0,9 %; p = 0,055; Fisher-Test). Patienten mit einem zufällig entdeckten malignen Tumor waren signifikant älter als Patienten ohne Tumorbefund (Durchschnittsalter 72,3 vs. 67,5 Jahre; p = 0,0432; t-test).

Fazit Klinisch relevante extravaskuläre Zufallsbefunde treten häufig auf bei Gefäßpatienten. Besonders beachtenswert sind maligne Tumoren der Lunge.

Kernaussagen 

• Bei 25,4 % der Patienten wurden klinisch relevante extravaskuläre Zufallsbefunde diagnostiziert.

• Die Inzidenz maligner Tumoren lag bei 2,9 %.

• Das Bronchialkarzinom hat unter den Malignomen die höchste Inzidenz (1,2 %).

Key words

CT-angiography - neoplasms - aorta

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