Beyond the heart: prevalence and implications of extra-coronary findings in coronary CT angiography: a retrospective study

OBJECTIVES: To evaluate the prevalence and clinical implications of extra-coronary findings in a large cohort of patients undergoing coronary computed tomography angiography (CCTA). MATERIALS AND METHODS: This retrospective study analyzed data from 3295 consecutive CCTA examinations at a single tertiary center. Radiology reports were reviewed for potentially significant extra-coronary findings. Three-year follow-up evaluation was performed via hospital records. Prevalences of confirmed significant findings were determined and extrapolated to patients lost to follow-up. RESULTS: Extra-coronary findings were reported in 92.7% (3053/3295) of patients. Potentially significant non-cardiovascular findings were found in 25.3% (833/3295), including potentially malignant findings in 8.5% (281/3295) and significant non-malignant findings in 19.3% (637/3295). Among patients with potentially malignant findings, 40.2% (113/281) underwent follow-up, with confirmed malignancy in 28.3% (32/113). Extrapolation suggests a malignancy prevalence of up to 2.4% (95% CI: 1.8-3.2%) within the CCTA field of view, with a minimum of 1.0% if all patients lost to follow-up were assumed to have no malignancy. The most frequent significant non-malignant finding was pulmonary emphysema (10.7%; 352/3295), with extrapolated prevalence rates of 4.2% (95% CI: 2.6-5.9% for COPD and 1.8% (95% CI: 0.8-3.4%) for asthma or obstructive sleep apnea. Liver steatosis was present in 4.5% (147/3295), with an estimated prevalence of 3.1% (95% CI: 1.6-4.2%) for metabolic dysfunction-associated steatotic liver disease and 1.3% (95% CI: 0.3-2.9%) for alcohol-related liver disease. CONCLUSION: Extra-coronary findings are common in CCTA and carry important clinical implications. Careful management is necessary, and additional screening protocols may benefit high-risk patients. KEY POINTS: Question How frequently do extra-coronary findings occur in coronary CT angiography, and what is their clinical impact in patients undergoing cardiac evaluation? Findings Clinically significant extra-coronary non-cardiovascular findings were identified in 25.3% of patients, including unsuspected malignancies and relevant pulmonary and hepatic comorbidities. Clinical relevance Extra-coronary findings on coronary CT angiography are common and often clinically relevant, warranting structured assessment to support timely diagnosis and multidisciplinary patient care.