Prevalence and clinical significance of incidental extracardiac findings in cardiac magnetic resonance imaging

Introduction
Incidental pathological findings are frequently found outside the investigated cardiovascular system in cardiac magnetic resonance (CMR) imaging. Some of these findings might have clinical importance.

Aim
To evaluate the prevalence and significance of extracardiac findings (ECFs) in patients referred for CMR. The CMR has the ability to depict ECFs in the visualized thorax and upper abdomen. These incidental lesions can often present a challenge to physicians.

Material and methods
A total of 192 CMR reports were retrospectively reviewed for extracardiac findings. ECFs were classified as benign, indeterminate, or of clinical significance at the time of image evaluation. Benign findings were those considered to be of little clinical significance with no follow-up needed. Indeterminate findings were those deemed of potential clinical importance, requiring correlation of the patient history or a follow-up study. Clinically significant findings were those felt to be of definite clinical importance requiring immediate evaluation or intervention.

Results
A total of 56 (29.2%) ECFs were found in 192 (29.2%) patients. Of those, 21 (37.5%) were considered benign, 23 (41%) indeterminate, and 12 (21.4%) clinically significant findings. In the clinically significant group, the most common findings were liver and pulmonary masses. Five malignancies were observed with certainty at CMR. All of them had been incidentally diagnosed on CMR for the first time, and the patients’ management was subsequently changed.

Conclusions
Extracardiac findings in clinically indicated CMR are common in the present study (about 29.2%). Radiologists and cardiologists should be aware of relevant extracardiac findings that might require additional diagnostics or treatment.