학술대회 안내 사전등록 안내 초록등록 안내 초록등록/관리 숙박및교통 안내


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Non-cardiac Findings on 64-slice Cardiac MDCT comparison between Single Cardiac CT and additional Chest CT protocol: a double-edged sword?
서울대학교 의과대학 내과학 교실, 서울대학교병원 순환기 내과¹ 분당서울대학교병원 심장센터² 분당서울대학교병원 진단방사선과³
최의근¹, 장성아¹ 전은주³ 최상일³ 장혁재² 조영석² 정우영² 채인호² 최동주²
OBJECTIVES 64-slice MDCT is becoming more common as a diagnostic tool for cardiac diseases. MDCT is also known to detect significant number of non-cardiac findings during cardiac work-up. However, significant non-cardiac findings might be missed when we limit field-of-view (FOV) to cardiac structure. The objective of this study was to estimate the prevalence of non-cardiac findings and risk and benefit of cardiac MDCT according to protocols.METHODS We enrolled 1,194 consecutive subjects (49.4±9.7 years, 62.5% men) underwent coronary artery disease screening with 64-slice MDCT. First, patients were scanned using ECG-gated coronary CT Angiography technique from the level of pulmonary arteries through the base of heart (cardiac FOV) and then additional chest scan was performed using non-gated chest CT technique from the level of thoracic inlet through kidney (thoracic FOV). We compared the frequency of non-cardiac findings and the exposed radiation dose between single cardiac CT (cardiac FOV) and additional chest CT protocol (thoracic FOV).RESULTS In additional chest CT protocol, total of 1,461 incidental non-cardiac findings were identified in 851 patients (71.3%). A total of 75 patients (6.2%) had clinically significant findings, requiring further diagnostic work-up: 42, non-calcified nodule < 10mm; 2, non-calcified nodule ≥ 10mm; 5, pulmonary infiltrates; 14, mass other than lung; and 12, other lesions. Four cases (0.3%) of malignancy were detected at surgically treatable stage except one case. In single cardiac CT protocol, 29 patients (38.7%) with significant lesions were missed including 3 cases of malignancy. The mean effective dose of radiation in single cardiac CT protocol (14.0 ± 2.2 mSv) was less than that for additional chest CT protocol (20.2 ± 2.0 mSv). The expected lifetime risk of cancer increased to 0.03% by additional scan (0.07% vs. 0.10%).CONCLUSIONS In a population referred for cardiac MDCT, significant non-cardiac findings (6.2%) were detected by additional chest CT protocol. Considering significant number of non-cardiac findings and acceptable radiation hazard risk, protocol with extended FOV is preferred in patient with suspected cardiac disease.


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