Title : Beyond the Heart in Cardiovascular Magnetic Resonance Imaging: Prevalence and Clinical Significance of Incidental Extracardiac Findings
Abstract:
Cardiovascular magnetic resonance (CMR) imaging provides comprehensive tissue characterization and plays a central role in the evaluation of a broad spectrum of cardiovascular diseases. Because routine CMR acquisition also includes portions of the thorax and upper abdomen, incidental extracardiac findings (IECFs) are frequently encountered and may have clinical consequences beyond the primary cardiac indication. This single-center retrospective study evaluated 597 consecutive patients who underwent clinically indicated CMR between 2021 and 2025. The prevalence, anatomical distribution, and clinical significance of IECFs were assessed using a structured three-tier risk-stratification model: Tier 1, benign or normal variants; Tier 2, potentially significant findings; and Tier 3, clinically significant findings requiring prompt evaluation or management.
IECFs were identified in 204 patients (34.2%). Among the total cohort, 98 patients (16.4%) had Tier 1 findings, 87 (14.6%) had Tier 2 findings, and 19 (3.2%) had Tier 3 findings. Overall, 106 patients (17.8%) met the actionable threshold defined by Tier 2 or Tier 3 findings, and 61 patients (10.2% of the total cohort) underwent downstream diagnostic imaging, subspecialty consultation, or therapeutic management. The liver/biliary system (9.5%) and lungs/pleura (7.0%) were the most frequently involved anatomical regions. Although less common overall, mediastinal and lung/pleural lesions showed the highest proportions of Tier 3 abnormalities, at 21.4% and 19.0%, respectively. In multivariable logistic regression, advancing age (OR 1.29 per decade, 95% CI 1.13–1.48; p<0.001) and referral indications other than
cardiomyopathy, myocarditis, or ischemia (OR 2.20, 95% CI 1.33–3.64; p=0.002) independently predicted actionable findings.
These findings demonstrate that systematic review of the extracardiac field of view during routine CMR can provide clinically meaningful additional information. A tiered reporting approach may help prioritize relevant abnormalities, support appropriate downstream care, and reduce unnecessary investigations of benign findings
