The aim of this study was to assess the incidence of extra-cardiac findings in patients undergoing clinical cardiac magnetic resonance imaging (CMRI) of the heart including surrounding structures and to determine the influence of those findings on patient's management.
N=854 patient studies (median age 58 ± 12 years, male 63%) were included and examined by 1.5 Tesla (T) MR to primarily analyze the cardiac anatomy and secondly the surrounding structures. Extra-cardiac findings were classified as significant (Group A) if they were recommended to additional diagnostics or therapeutical interventions and as non-significant if there was no influence on patient's management (Group B).
631 patient studies were free of any kind of extra-cardiac pathologies. In the remaining cases, 286 extra-cardiac findings were examined. There were ~0.33 extra-cardiac findings per patient. 49 were defined as significant (Group A) and 237 as nonsignificant findings (Group B). The most common Group A findings were suspicious pulmonary nodules or masses > 4 mm diameter (n=14) and aortic aneurysms (n=5). In Group B, most of the findings were hepatic cysts or hemangiomas (n=50), followed by renal cysts (n=47). 8 malignancies were certainly observed. The most frequent indication for CMRI was evaluation of cardiac stress ischemia (n=501, 59%).
Extra-cardiac findings in clinical CMRI are common in patients referred to CMRI (26%). Radiologists and cardiologists have to be aware of relevant extra-cardiac findings which might require additional diagnostics or treatment. There is an importance of paying appropriate attention to structures outside of the heart.
Figure 1. Gastric herniation and angiosarcoma primarily found at CMRI. In a 77 years old male, CMRI primarily detected a thoracic gastric herniation (white stars, A: transversal, Haste, TR 800, TE 46; B: coronal, Haste, TR 800, TE 46; and C: parasagittal, Haste, TR 800, TE 46). An angiosarcoma of the left pulmonary artery was seen in a contrast medium enhanced follow-up thoracic CT scan in the same patient (D: white arrow, axial, 64-slices CT). Recommendation for additional diagnostics was given. Findings were defined as "significant".
Figure 2. Lung cancer found at CMRI. In a 71 years old patient, CMRI incidentally detected a pulmonary lesion in the left upper lung which was visible on transversal (A: Haste, TR 800, TE 43) and coronal views (B: Haste, TR 650, TE 42). Magnifications are shown in the insets C and D. This "significant" finding was confirmed by a subsequent 18F-FDG PET/CT (E: coronar, F: axial). At histology a bronchial carcinoma was diagnosed and treated. Size 4 x 3 cm.