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

To assess the frequency and impact of incidental findings (IF) on CT during work-up for transcatheter aortic valve intervention (TAVI). 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 revi...

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Published in:	British journal of radiology Vol. 92; no. 1102; p. 20190344
Main Authors:	Hinton, Jonathan, Gough, Sam, Ahmed, Hanad, Gabara, Lavinia, Rawlins, John, Calver, Alison, Shah, Benoy N, Rakhit, Dhrubo, Shambrook, James, Harden, Stephen, Peebles, Charles, Abbas, Ausami, Curzen, Nick
Format:	Journal Article
Language:	English
Published:	England The British Institute of Radiology 01-10-2019
Subjects:	Aged Aged, 80 and over Clinical Decision-Making Cohort Studies Female Humans Incidental Findings Male Neoplasms - diagnostic imaging Preoperative Care Prevalence Retrospective Studies Risk Tomography, X-Ray Computed - statistics & numerical data Transcatheter Aortic Valve Replacement - statistics & numerical data United Kingdom United Kingdom
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Summary:	To assess the frequency and impact of incidental findings (IF) on CT during work-up for transcatheter aortic valve intervention (TAVI). 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. 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. 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. 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.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1
ISSN:	0007-1285 1748-880X
DOI:	10.1259/bjr.20190344