Incidental findings on routine preoperative noncontrast chest computed tomography and chest radiography prior to cardiac surgery in the multicenter randomized controlled CRICKET study

Wiebe G. Knol, Annemarie M. den Harder, Linda M. de Heer, Kálmán Benke, Pál Maurovich-Horvat, Tim Leiner, Béla Merkely, Gabriel P. Krestin, Ad J.J.C. Bogers, Ricardo P.J. Budde*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective: To describe the prevalence and consequences of incidental findings when implementing routine noncontrast CT prior to cardiac surgery. Methods: In the multicenter randomized controlled CRICKET study, 862 adult patients scheduled for cardiac surgery were randomized 1:1 to undergo standard of care (SoC), which included a chest-radiograph, or an additional preoperative noncontrast chest CT-scan (SoC+CT). In this subanalysis, all incidental findings detected on the chest radiograph and CT-scan were analyzed. The influence of smoking status on incidental findings was also evaluated, adjusting for sex, age, and group allocation. Results: Incidental findings were observed in 11.4% (n = 49) of patients in the SoC+CT group and in 3.7% (n = 16) of patients in the SoC-group (p < 0.001). The largest difference was observed in findings requiring follow-up (SoC+CT 7.7% (n = 33) vs SoC 2.3% (n = 10), p < 0.001). Clinically relevant findings changing the surgical approach or requiring specific treatment were observed in 10 patients (1.2%, SoC+CT: 1.6% SoC: 0.7%), including lung cancer in 0.5% of patients (n = 4) and aortic dilatation requiring replacement in 0.2% of patients (n = 2). Incidental findings were more frequent in patients who stopped smoking (OR 1.91, 1.03–3.63) or who actively smoked (OR 3.91, 1.85–8.23). Conclusions: Routine CT-screening increases the rate of incidental findings, mainly by identifying more pulmonary findings requiring follow-up. Incidental findings are more prevalent in patients with a history of smoking, and preoperative CT might increase the yield of identifying lung cancer in these patients. Incidental findings, but not specifically the use of routine CT, are associated with delay of surgery. Key Points: • Clinically relevant incidental findings are identified more often after a routine preoperative CT-scan, when compared to a standard of care workup, with some findings changing patient management. • Patients with a history of smoking have a higher rate of incidental findings and a lung cancer rate comparable to that of lung cancer screening trials. • We observed no clear delay in the time to surgery when adding routine CT screening.

Original languageEnglish
Pages (from-to)294-301
Number of pages8
JournalEuropean Radiology
Volume33
Issue number1
Early online date19 Jul 2022
DOIs
Publication statusPublished - 1 Jan 2023

Bibliographical note

Funding Information:
The authors of this manuscript declare relationships with the following companies: The Department of Radiology, UMCU, receives research support from Philips Healthcare and the Department of Radiology, Erasmus MC, receives institutional support from Siemens, both outside the submitted work. Dr. Merkely reports grants from Boston Scientific, grants and personal fees from Medtronic and Abbott, and personal fees from Biotronik, outside the submitted work.

Funding Information:
This work was supported by the Dutch Organization for Health Research and Development [837001403].

Publisher Copyright:
© 2022, The Author(s).

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