Purpose The true prevalence of non-cardiac pathology on clinical cardiovascular magnetic resonance (CMR) imaging is not fully defined. While prior studies have shown few non-cardiac findings (NCFs) on CMR reports, this may be an underestimate. We sought to determine the prevalence of NCFs by using a second imaging review with specific attention to NCFs.
Materials and Methods The images from all 495 clinical CMR studies performed at our center in 2006 were independently reviewed by a radiologist for the presence of NCFs, defined as benign (e.g., pleural effusion, hiatal hernia), indeterminate (e.g. pleural effusion, enlarged lymph node), or worrisome (e.g. lung nodule, aortic dissection). Data were compared with NCFs listed in the subject’s clinical CMR report, which also included information as to whether a radiologist was physically present at the original reading session.
Results The initial clinical CMR reports included 105 NCFs (30 benign, 68 indeterminate, and 7 worrisome). On focused image review, 295 NCFs (144 [49%] benign, 137 [46%] indeterminate, 14 [5%] worrisome) were identified in 212/495 (43%) studies, with 113 studies (23%) containing indeterminate and/or worrisome NCFs. The vast majority (281/295, 95%) of NCFs were visible on either the initial scout images (186/295, 63%) or thoracic T1w axial fast spin echo images (176/295, 60%). Overall, 36% (105/295) of NCFs (21% of benign, 50% of indeterminate, and 50% of worrisome) detected on our image review were included in the original clinical CMR report. NCFs were reported more frequently when a radiologist was present for the joint CMR readout (42% 95/228;vs. 15% 10/67;, p=0.003).
Conclusion Indeterminate or worrisome NCFs are more common than previously reported, and involve nearly a quarter of clinical CMR studies. The vast majority of NCFs were visible on scout and T1w axial images. A joint reading session with cardiologists and radiologists improves the detection and reporting of NCFs. These data also highlight the importance of training CMR practitioners to identify NCFs.
A multi-band double-inversion radial fast spin-echo technique for T2 cardiovascular magnetic resonance mapping of the heart
