Frequency and impact of incidental findings on computed tomography during work-up for transcatheter aortic valve implantation: single centre experience and review of the literature

Author:

Hinton Jonathan12,Gough Sam1,Ahmed Hanad1,Gabara Lavinia1,Rawlins John1,Calver Alison1,Shah Benoy N1,Rakhit Dhrubo1,Shambrook James3,Harden Stephen3,Peebles Charles3,Abbas Ausami3,Curzen Nick12

Affiliation:

1. Coronary Research Group, University Hospital Southampton NHS Foundation Trust, England

2. Faculty of Medicine, University of Southampton, England

3. Cardiothoracic Radiology, University Hospital Southampton NHS Foundation Trust, England

Abstract

Objective: To assess the frequency and impact of incidental findings (IF) on CT during work-up for transcatheter aortic valve intervention (TAVI). Methods: A consecutive cohort of patients referred for consideration of TAVI who underwent a CT scan between 2009 and 2018 were studied retrospectively. CT reports were reviewed for the presence of IFs and categorised based upon their clinical significance: (a) insignificant—findings that did not require specific treatment or follow-up; (b) intermediate—findings that did not impact on the decision-making process but required follow-up; (c) significant—findings that either required urgent investigation or meant that TAVI was clinically inappropriate. Results: A total of 652 patients were included, whose median age was 82 years. One or more insignificant IF was found in 95.6% of patients. Intermediate IFs were documented in 5.4%. 91 (14%) patients had at least one significant IF. These included possible malignancy in 67 (74%). The ultimate decision to offer aortic valve intervention was only changed by the presence of an IF in 3.5% of cases. Conclusion: Clinically significant IFs are detected in more than 1 in 10 of patients undergoing CT as part of a TAVI work-up, although just over half of these patients still receive aortic valve intervention. Advances in knowledge: This study is the largest UK cohort, which, when combined with a review of existing literature, provides a clear picture of the frequency and clinical impact of IFs found at CT for TAVI assessment.

Publisher

British Institute of Radiology

Subject

Radiology, Nuclear Medicine and imaging,General Medicine

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