Monday, November 30, 2009

Cardiac CT incidentalomas

Although screening for lung cancer with CT is not highly evidence based or widely advocated, many incidental nodules (as well as occasional non-neoplastic incidental abnormalities) are picked up on cardiac CT imaging. A recent paper in JACC reported high cost and low yield, and reached the following conclusions regarding such incidentalomas:

Although noncardiac IF are common, clinically significant or indeterminate IF are less prevalent. Rates of death were similar in patients with and without IF, and IF was not an independent predictor of noncardiac death. The investigation of IF is not without cost or risk. Larger studies are required to assess the potential mortality benefit of identifying IF.

This raises important questions. What should be done with the information? Should radiologists even over-read the non-cardiac portion of cardiac scans as is customarily done?

A fundamental question is: if information is there why let it go down the drain?

Another consideration is driven by anecdotal experience. I am aware of one or two cases in which incidental information was life saving.

Finally, external factors in our culture which drive defensive medicine will always place pressure on the clinician to chase down the lesion. A reasonable compromise might be to let the patient make an informed decision.

Via and Heart of the Matter.

1 comment:

#1 Dinosaur said...

A reasonable compromise might be to let the patient make an informed decision.

Not really. Tough as it may be, this is something doctors are really going to have to pull together on to make substantive recommendations.