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Pasurka M, Statescu A, von Knebel Doeberitz P, Kubach J, Dally F, Gravius S, Betsch M. Incidental findings are frequent in shoulder CT and MRI scans and increase with age. J Orthop 2024; 56:161-166. [PMID: 38882230 PMCID: PMC11169079 DOI: 10.1016/j.jor.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 05/26/2024] [Indexed: 06/18/2024] Open
Abstract
Objectives CT and MRI scans of the shoulder can lead to the identification of incidental findings (IF), which can have a major impact on the further treatment of the patient. The aim of this retrospective study was to record the prevalence of IF, incidentalomas (IT) and malignant IT for CT and MRI examinations of the shoulder and to investigate the effect of patient characteristics on the statistical occurrence of IF, IT and malignant IT. Materials and methods A total of 903 shoulder examinations (415 CT, 488 MRI) were retrospectively analyzed for the presence of IF, subsequently categorized (harmless IF, IT requiring clarification, malignant IT) and analyzed regarding patient characteristics. The statistical analysis was carried out using independent t- and chi-square tests. A significance level of p < 0.05 was set. Results Among the 903 patients evaluated (436 female, 467 male), 153 (16.9%) patients experienced IF (harmless IF: 101 (11.2%) patients, IT: 94 (10.4%), malignant IT: 4 (0.4%). The average age of the patients without IF and IT was significantly lower compared to the patients with IF and IT (p < 0.001). While IF occurred in 31.1% of the CT, IF was only detected in 4.9% of the MRI (p < 0.001). Conclusion IF have a high prevalence (16.9%), especially in CT examinations of the shoulder, which increases with age. The exact detection and initiation of appropriate therapy is of great clinical importance, as early detection of life-threatening diseases enables more effective treatment and a potential gain in health and lifespan.
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Affiliation(s)
- Mario Pasurka
- Department of Trauma Surgery and Orthopaedics, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Adrian Statescu
- Department of Orthopaedic and Trauma Surgery, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, 68167, Mannheim, Germany
| | - Philipp von Knebel Doeberitz
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, 68167, Mannheim, Germany
| | - Joshua Kubach
- Department of Trauma Surgery and Orthopaedics, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Franz Dally
- Department of Orthopaedic and Trauma Surgery, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, 68167, Mannheim, Germany
| | - Sascha Gravius
- Department of Orthopaedic and Trauma Surgery, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, 68167, Mannheim, Germany
| | - Marcel Betsch
- Department of Trauma Surgery and Orthopaedics, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, 91054, Erlangen, Germany
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2
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Bintein F, Yannoutsos A, Chatellier G, Fontaine M, Damotte D, Paterlini-Bréchot P, Meyer G, Duchatelle V, Marini V, Schwering KL, Labrousse C, Beaussier H, Zins M, Salmeron S, Lajonchère JP, Priollet P, Emmerich J, Trédaniel J. Patients with atherosclerotic peripheral arterial disease have a high risk of lung cancer: Systematic review and meta-analysis of literature. JOURNAL DE MÉDECINE VASCULAIRE 2021; 46:53-65. [PMID: 33752847 DOI: 10.1016/j.jdmv.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 12/23/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Lung cancer and atherosclerosis share common risk factors. Literature data suggest that the prevalence of lung malignancy in patients with peripheral arterial disease (PAD) is higher than in the general population. Our goal was to determine, through a systematic literature review, the prevalence of lung cancer in patients with PAD. METHODS We consulted available publications in the Cochrane library, MEDLINE, PUBMED, EMBASE, and ClinicalTrials.gov. We included all articles, written in English or French, published between 1990 and 2020 reporting the prevalence of lung cancer in patients with PAD (atherosclerotic aortic aneurysm or peripheral occlusive diseases). Patients with coronary artery disease, cardiac valvulopathy or carotid stenosis were not included. We did not include case reports. We performed a critical analysis of each article. Data were collected from two independent readers. A fixed effect model meta-analysis allowed to estimate a summary prevalence rate. RESULTS We identified 303 articles, and selected 19 articles according to selection criteria. A total of 16849 patients were included (mean age 68.3 years, 75.1% of males). Aortic aneurysms were found in 29% of patients and atherosclerotic occlusive disease in 66% of patients. Lung cancer was identified in 538 patients, representing a prevalence of 3%. DISCUSSION Lung cancer is found in 3% of patients with atherosclerotic PAD. This prevalence is higher than that found in lung cancer screening programs performed in the general population of smokers and former smokers. These patients should be screened for lung cancer. Their selection may dramatically increase the benefit of lung cancer screening.
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Affiliation(s)
- F Bintein
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France.
| | - A Yannoutsos
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France; Inserm UMR 1153 Center of Research in Epidemiology and Statistics, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - G Chatellier
- Hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | | | - D Damotte
- Hôpital Cochin, AP-HP, 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Unité Inserm U1138, centre de recherche des Cordeliers, Paris, France
| | | | - G Meyer
- Hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - V Duchatelle
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - V Marini
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | | | - C Labrousse
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - H Beaussier
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - M Zins
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - S Salmeron
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - J-P Lajonchère
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - P Priollet
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - J Emmerich
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France; Inserm UMR 1153 Center of Research in Epidemiology and Statistics, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - J Trédaniel
- Hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Unité Inserm UMR-S 1124, toxicologie, pharmacologie et signalisation cellulaire, Paris, France
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3
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Beller E, Ammermann F, Busse A, Heller T, Thierfelder KM, Weinrich M, Neumann A, Weber MA, Meinel FG. Extravascular findings on run-off MR angiography: frequency, location and clinical significance. Clin Imaging 2020; 69:172-178. [PMID: 32861128 DOI: 10.1016/j.clinimag.2020.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/03/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this study was to analyze the prevalence, location and clinical relevance of extravascular findings (EVFs) on magnetic resonance angiography (MRA) of the run-off vasculature. METHODS In this retrospective study, we analyzed run-off MRAs of 194 consecutive patients (45 women and 149 men, median age 68 years, IQR 58-74 years). Our patient cohort consisted predominantly of individuals with known (n = 165, 85%) or suspected (n = 15, 8%) peripheral artery disease (PAD). All MRA examinations were performed between 2012 and 2018 on a 3 Tesla MRI scanner using a standardized protocol. Two radiologists re-evaluated the MRA images to identify EVFs, which were classified into findings with major (category I), moderate (category II) and minor (category III) clinical significance. RESULTS A total of 501 EVFs were found in 172 of the 194 patients (89%). Twenty-seven findings (5%) were assigned to category I, 189 (38%) to category II and 285 (57%) to category III. 23 of 194 patients (12%) had at least one EVF with major clinical relevance (category I). Most of the 27 category I EVFs were observed in the soft tissues (n = 13, 48%). The remaining category I EVFs were found in the musculoskeletal (n = 7, 26%), urogenital (n = 4, 15%), lymphatic (n = 2, 7%) and gastrointestinal (n = 1, 4%) system. The majority of the category I EVFs were infectious (n = 14, 52%) or neoplastic (n = 10, 37%) pathologies. CONCLUSIONS Clinically relevant EVF can be encountered frequently on run-off MRA examinations. These results illustrate the importance of evaluating all organ systems when reporting MRA examinations, despite the clinical focus being the patients' vascular status.
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Affiliation(s)
- Ebba Beller
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany.
| | - Felix Ammermann
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Anke Busse
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Thomas Heller
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Kolja M Thierfelder
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Malte Weinrich
- Department of General, Thoracic, Vascular and Transplantation Surgery, Rostock University Medical Center, Rostock, Germany
| | - Andreas Neumann
- Department of General, Thoracic, Vascular and Transplantation Surgery, Rostock University Medical Center, Rostock, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Felix G Meinel
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
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Nourzaie R, Das J, Abbas H, Thulasidasan N, Gkoutzios P, Ilyas S, Monzon L, Sabharwal T, Moser S, Diamantopoulos A. Extravascular findings during upper limb computed tomographic angiography focusing on undiagnosed malignancy. World J Radiol 2019; 11:10-18. [PMID: 30705743 PMCID: PMC6354083 DOI: 10.4329/wjr.v11.i1.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/01/2019] [Accepted: 01/10/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Computer tomography angiography (CTA) has been an established method for diagnostic vascular disease of lower limbs. Recently, the method is widely used for diagnosis of vascular pathologies in the upper limbs too. It also has increased the possibilities of this scans being reviewed by no specially trained radiologists. This increases the risk of incidental non vascular findings to be missed or misinterpreted. The study is focusing in the frequency of extravascular incidental finding (EVIF) and highlights the importance for both the reporting radiologist and the referring physician recognizing the frequency of EVIFs.
AIM To analyse the frequency of EVIF identified on computed angiography (CT) of the upper limb.
METHODS A total of 1383 CT angiographic studies of the peripheral arterial system were performed between August 2015 and August 2017. All upper limb CTAs (n = 79) were retrospectively reviewed for the presence of non-vascular incidental findings within the chest, abdomen/pelvis, musculoskeletal system or head and neck. These EVIFs were subsequently grouped into 3 categories based on clinical significance. EVIFs of immediate clinical relevance were included in category A, findings considered indeterminate but most likely benign were placed in category B, while incidental findings of no clinical significance were included in category C.
RESULTS Complete imaging datasets were available in 74/79 (93.7%). Patient demographics included 39 (52.7%) females and 35 (47.2%) males with a mean age of 59 ± 19.5 years (range 19-93 years). A total of 153 EVIFs were reported in 52 patients (70.3%). Of these, 44 EVIFs (28.7%) were found in the chest, 83 (54.2%) in the abdomen, 14 (9.2%) in the musculoskeletal system and 9 (5.8%) in the head and neck. Thirteen EVIFs (8.4%) identified in 11 patients were noted to be of immediate clinical significance (Category A), 50 EVIFs (32.3%) were identified in 20 patients and were considered indeterminate but most likely benign, while the remaining 91 EVIFs (59.5%) identified in 21 patients were determined to be of no clinical significance (Category C). One index case of malignancy (1.3%) and four cases of new disseminated metastatic disease (5.4%) were identified.
CONCLUSION Our study of upper limb CTA examinations demonstrated a frequency of 8.4% for extravascular incidental findings of immediate clinical significance. We highlight the importance for both the reporting radiologist and the referring physician of the need to recognize the frequency with which EVIFs are identified in the upper limb peripheral arterial system and of the necessity for further clinical and imaging work-up.
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Affiliation(s)
- Romman Nourzaie
- Department of Interventional Radiology, Guys’ and St. Thomas’ NHS Foundation Trust, London SE17EH, United Kingdom
| | - Jeeban Das
- Department of Interventional Radiology, Guys’ and St. Thomas’ NHS Foundation Trust, London SE17EH, United Kingdom
| | - Hiba Abbas
- Department of Interventional Radiology, Guys’ and St. Thomas’ NHS Foundation Trust, London SE17EH, United Kingdom
| | - Narayanan Thulasidasan
- Department of Interventional Radiology, Guys’ and St. Thomas’ NHS Foundation Trust, London SE17EH, United Kingdom
| | - Panos Gkoutzios
- Department of Interventional Radiology, Guys’ and St. Thomas’ NHS Foundation Trust, London SE17EH, United Kingdom
| | - Shahzad Ilyas
- Department of Interventional Radiology, Guys’ and St. Thomas’ NHS Foundation Trust, London SE17EH, United Kingdom
| | - Leo Monzon
- Department of Interventional Radiology, Guys’ and St. Thomas’ NHS Foundation Trust, London SE17EH, United Kingdom
| | - Tarun Sabharwal
- Department of Interventional Radiology, Guys’ and St. Thomas’ NHS Foundation Trust, London SE17EH, United Kingdom
| | - Steven Moser
- Department of Interventional Radiology, Guys’ and St. Thomas’ NHS Foundation Trust, London SE17EH, United Kingdom
| | - Athanasios Diamantopoulos
- Department of Interventional Radiology, Guys’ and St. Thomas’ NHS Foundation Trust, London SE17EH, United Kingdom
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Dhillon PS, Butt MW, Pollock G, Kirk J, Bungay P, De Nunzio M, Thurley P. Incidental extravascular findings in CT angiograms in patients post endovascular abdominal aortic aneurysm repair: clinical relevance and frequency. CVIR Endovasc 2018. [PMCID: PMC6966401 DOI: 10.1186/s42155-018-0016-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background To evaluate the incidence and clinical relevance of extravascular incidental findings (EVIF), particularly malignancies, in planning and follow-up CT angiograms (CTA) of the abdominal aorta in patients who underwent endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm. Retrospective study of 2203 planning and follow-up CTAs of 418 patients who underwent EVAR in a single tertiary centre between 2006 and 2015. CTA reports were scrutinized for EVIFs, which were classified according to clinical relevance, into (I) immediate, (II) potential and (III) no clinical relevance. Clinical follow-up and management were reviewed for significant findings. Follow-up CTAs of patients with incidental malignancies were re-reviewed by two consultant radiologists to evaluate if early missed malignant findings on previous CTAs were present. Results In total, 950 EVIFs were noted in 418 patients [31 females (7.4%), 387 males (92.6%); age range 63–93, mean age 79.0 years]. The number of patients with findings in each category were; Category I (115), Category II (165), Category III (304). Incidental malignant findings were reported in 51 patients (12.2%), of which 27 were noted on the initial CTA (6.5%) and 24 on follow-up CTAs (5.7%). Of the 24 patients with malignancies on follow-up CTAs, 13 had early malignant findings missed or misinterpreted on previous CTAs, while 11 had no significant abnormality even on retrospective review. Conclusion A high number of significant EVIFs, particularly incidental malignancies, can be identified in follow-up CTAs of patients who undergo EVAR. Specific ‘review areas’ when reporting surveillance CTAs can be recommended based on the findings of our study.
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Behbahani S, Mittal S, Patlas MN, Moshiri M, Menias CO, Katz DS. "Incidentalomas" on abdominal and pelvic CT in emergency radiology: literature review and current management recommendations. Abdom Radiol (NY) 2017; 42:1046-1061. [PMID: 27695953 DOI: 10.1007/s00261-016-0914-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The purpose of this article is to familiarize radiologists and clinicians with a subset of common and uncommon incidental findings on abdominal and pelvic computed tomography examinations, including hepatic, splenic, renal, adrenal, pancreatic, aortic/iliac arterial, gynecological, and a few other miscellaneous findings, with an emphasis on "incidentalomas" discovered in the emergency setting. In addition, we will review the complex problem of diagnosing such entities, and provide current management recommendations. Representative case examples, which we have encountered in our clinical practices, will be demonstrated.
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Affiliation(s)
- Siavash Behbahani
- Department of Radiology, Winthrop-University Hospital, 259 First Street, Mineola, NY, 11501, USA.
| | - Sameer Mittal
- Department of Radiology, Winthrop-University Hospital, 259 First Street, Mineola, NY, 11501, USA
| | - Michael N Patlas
- Department of Radiology, Hamilton General Hospital, McMaster University, 237 Barton St., East Hamilton, ON, L8L 2X2, Canada
| | - Mariam Moshiri
- Department of Radiology, University of Washington Medical Center, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Christine O Menias
- Department of Radiology, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Douglas S Katz
- Department of Radiology, Winthrop-University Hospital, 259 First Street, Mineola, NY, 11501, USA
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7
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Lee JY, Jung MJ, Lee JG, Lee SH. Prevalences of Incidental Findings in Trauma Patients by Abdominal and Pelvic Computed Tomography. JOURNAL OF TRAUMA AND INJURY 2016. [DOI: 10.20408/jti.2016.29.3.61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Jin Young Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Jae Jung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Gil Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hwan Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Preuß A, Schaafs LA, Werncke T, Steffen IG, Hamm B, Elgeti T. Run-Off Computed Tomography Angiography (CTA) for Discriminating the Underlying Causes of Intermittent Claudication. PLoS One 2016; 11:e0152780. [PMID: 27054846 PMCID: PMC4824428 DOI: 10.1371/journal.pone.0152780] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 03/19/2016] [Indexed: 12/21/2022] Open
Abstract
AIM To evaluate run-off computed tomography angiography (CTA) of abdominal aorta and lower extremities for detecting musculoskeletal pathologies and clinically relevant extravascular incidental findings in patients with intermittent claudication (IC) and suspected peripheral arterial disease (PAD). Does run-off CTA allow image-based therapeutic decision making by discriminating the causes of intermittent claudication in patients with suspected peripheral arterial disease PAD? MATERIAL AND METHODS Retrospective re-evaluation of CTAs performed in patients with acute or chronic intermittent claudication (i.e., Fontaine stages I to IIB) between January 2005 and October 2013. Allocation to one of three categories of underlying causes of IC symptoms: vascular, musculoskeletal (MSK) or both. Clinically relevant extravascular incidental findings were evaluated. Medical records were reviewed to verify specific therapies as well as main and incidental findings. RESULTS While focused on vascular imaging, CTA image quality was sufficient for evaluation of the MSK system in all cases. The underlying cause of IC was diagnosed in run-off CTA as vascular, MSK and a combination in n = 138 (65%), n = 10 (4%), and n = 66 (31%) cases, respectively. Specific vascular or MSK therapy was recorded in n = 123 and n = 9 cases. In n = 82, no follow-up was possible. Clinically relevant extravascular incidental findings were detected in n = 65 patients (30%) with neoplasia, ascites and pleural effusion being the most common findings. DISCUSSION Run-off CTA allows identification of vascular, MSK, and combined causes of IC in patients with suspected PAD and can guide specific therapy. CTA also allowed confident detection of crEVIF although detection did not necessarily trigger workup or treatment.
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Affiliation(s)
- Alexandra Preuß
- Department of Radiology, Charité-Universitätsmedizin, Berlin, Germany
| | - Lars-Arne Schaafs
- Department of Radiology, Charité-Universitätsmedizin, Berlin, Germany
| | - Thomas Werncke
- Institute for Radiology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Ingo G. Steffen
- Department of Radiology, Charité-Universitätsmedizin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité-Universitätsmedizin, Berlin, Germany
| | - Thomas Elgeti
- Department of Radiology, Charité-Universitätsmedizin, Berlin, Germany
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Crockett MT, Murphy B, Smith J, Kavanagh EC. Prevalence and clinical significance of extravascular incidental findings in patients undergoing CT cervico-cerebral angiography. Eur J Radiol 2015; 84:1569-1573. [PMID: 26047822 DOI: 10.1016/j.ejrad.2015.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/15/2015] [Accepted: 05/07/2015] [Indexed: 12/23/2022]
Abstract
INTRODUCTION CT cervico-cerebral angiography (CTCCA) is now the first line diagnostic imaging modality for the majority of vascular pathologies of the head and neck with diagnostic value comparable to or better than traditional angiographic techniques. The aim of this study was to assess the prevalence, clinical significance and management of extravascular incidental findings detected on CTCCA. MATERIALS AND METHODS A retrospective review of the CTCCA reports of 302 consecutive patients from 2009 to 2013 was undertaken. Extravascular incidental findings were classified, according to an adaptation of the CT colonography data and reporting system (CRADS), as EV1-EV4. EV1=no incidental findings, EV2=clinically insignificant incidental finding, EV3=incidental finding of intermediate clinical significance, EV4=highly clinically significant finding. Follow up of the electronic medical records of patients with EV3 or EV4 findings was undertaken to determine subsequent management. RESULTS Potentially clinically significant findings were demonstrated in 14.2% of patients with 8.6% of patients having a highly clinically significant finding. 4 incidental findings were confirmed to be malignant lesions and 5 required acute intervention. In addition 19% of patients with highly clinically significant incidental findings did not receive appropriate follow up. DISCUSSION This study has demonstrated the presence of clinically important incidental findings in a significant proportion of patients undergoing CTCCA with a significant minority of these patients not receiving follow up. A standardised method of reporting incidental findings, such as that used in this paper, would aid radiologists and referring physicians in recording and communicating these findings.
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Affiliation(s)
| | - Blathnaid Murphy
- Department of Radiology, Mater Misercordiae University Hospital, Dublin, Ireland.
| | - Jennifer Smith
- Department of Radiology, Mater Misercordiae University Hospital, Dublin, Ireland.
| | - Eoin Carl Kavanagh
- Department of Radiology, Mater Misercordiae University Hospital, Dublin, Ireland.
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Preuß A, Elgeti T, Hamm B, Werncke T. Extravascular incidental findings in run-off CT angiography in patients with acute limb ischaemia: incidence and clinical relevance. Clin Radiol 2015; 70:622-9. [PMID: 25819627 DOI: 10.1016/j.crad.2015.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/07/2015] [Accepted: 02/20/2015] [Indexed: 12/21/2022]
Abstract
AIM To evaluate the incidence and clinical relevance of extravascular incidental findings (EVIFs) in CT angiography of the abdominal aorta and lower extremities (run-off CTA) in patients presenting with acute limb ischaemia (ALI). MATERIALS AND METHODS In this institutional review board-approved, retrospective study, 141 run-off CTA examinations conducted between 2005 and 2013 of patients (67 women, mean age 80 years; 74 men, mean age 69 years) presenting with clinical symptoms of ALI were re-evaluated by two radiologists (2 and 7 years of experience in interpreting run-off CTA). Imaging was conducted using 16- and 64-section CT systems. Image acquisition ranged from the costodiaphragmatic recess to the forefoot. The medical history form of each patient served as the standard of reference for assessment of incidence of EVIFs. CT morphology was assessed to assign EVIFs to one of three categories of clinical relevance: (I) immediate, (II) potential, and (III) no clinical relevance. RESULTS Thirty-eight patients had category I findings, including four patients (2.8%) with previously unknown malignancy and 67 patients with category II EVIFs. In total 473 extravascular EVIFs were found in 141 patients: 52 category I, 163 category II and 258 category III. CONCLUSION EVIFs with immediate clinical relevance are very common in run-off CTA in patients presenting with acute peripheral artery disease. Therefore, it is important to evaluate all body regions included in a CT examination carefully, even if the clinical focus is on vascular evaluation. The adequate classification of these EVIFs is required to avoid possible unnecessary diagnostic work-up with associated risks and costs.
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Affiliation(s)
- A Preuß
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - T Elgeti
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - B Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - T Werncke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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Gufler H, Schulze CG, Wagner S. Incidental findings in computed tomographic angiography for planning percutaneous aortic valve replacement: advanced age, increased cancer prevalence? Acta Radiol 2014; 55:420-6. [PMID: 23966366 DOI: 10.1177/0284185113500164] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Increased age is linked with a higher cancer risk according to model calculations. Patients with severe atherosclerotic aortic stenosis are of old age, therefore, a high incidence of malignancies should be found. PURPOSE To evaluate the prevalence of clinically significant and potentially malignant incidental findings at computed tomographic angiography (CTA) performed in patients with severe aortic stenosis being assessed as to their suitability for transcatheter aortic valve replacement (TAVR). MATERIAL AND METHODS Between August 2008 and April 2010, CTA of the thoraco-abdominal aorta and the pelvic arterial vessels was performed in 131 patients. There were 62 women (47%) and 69 men (53%); the mean age was 81.6 years (range, 64-91 years). Incidental findings were recorded and categorized as potentially malignant, clinically significant, and clinically insignificant. Clinically significant findings were defined as those requiring immediate therapy, intervention or imaging, or follow-up examination. RESULTS Of the 131 study patients, 31 (23.7%) presented significant extravascular incidental findings, 19 (14.5%) in the thorax, and 12 (9.2%) in the abdomen. Five lesions (3.8%) were considered potentially malignant, three of them (2.3%) were new and highly suspicious for malignancies (two renal cell carcinomas and one hepatocellular carcinoma). In two patients (1.5%) mediastinal lymphadenopathy was found (recurrent malignant lymphoma und new metastases from known bladder cancer). CONCLUSION The prevalence of highly suspicious malignant incidental findings in patients undergoing TAVR is 3.8% with an average age of 81.6 years which is not high compared to prevalence in the literature dealing with patients aged <70 years.
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Affiliation(s)
- Hubert Gufler
- Department of Diagnostic and Interventional Radiology, University of Rostock, Rostock, Germany
| | - Christian G Schulze
- Department of Diagnostic and Interventional Radiology, University of Rostock, Rostock, Germany
| | - Sabine Wagner
- Department of Diagnostic and Interventional Radiology, University of Rostock, Rostock, Germany
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Yang RY, Jaskolka JD, Tan KT, Roche-Nagle G. Prevalence and significance of extravascular incidental findings on computed tomographic angiography and magnetic resonance angiography. Vascular 2013; 21:355–62. [DOI: 10.1177/1708538112473973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) are routinely used to evaluate patients with vascular disease. They have the ability to detect unexpected non-vascular pathology. The purpose of this study was to determine the prevalence and significance of extravascular incidental findings in patients undergoing CTA or MRA. A retrospective review of 737 patients who underwent CTA and 184 patients who underwent MRA during a five-year period was performed. Incidental findings were classified as low, moderate or high significance findings. For patients with high significance extravascular findings, assessment of the rates of appropriate follow-up was conducted. Among the CTA patients, 539 (73.1%) had incidental findings. Low, moderate and high significance findings were discovered in 514 (69.7%), 95 (12.9%) and 41 (5.6%) patients, respectively. Twenty (48.8%) patients with high significance findings received appropriate follow-up investigations. Among the MRA patients, 95 (51.6%) had extravascular findings. Low, moderate and high significance findings were present in 80 (43.5%), 27 (14.7%), and 3 (1.6%) patients, respectively. Two (66.7%) patients with high significance findings were properly followed up. In conclusion, incidental findings on CTA and MRA are very common. A small percentage of these findings could be serious and were not all adequately followed-up in our study population. Referring physicians should be aware of the potential for serious incidental findings and manage them appropriately.
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Affiliation(s)
- Roy Y Yang
- Division of Vascular Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
- Division of Vascular & Interventional Radiology, Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Jeffrey D Jaskolka
- Division of Vascular & Interventional Radiology, Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Kong T Tan
- Division of Vascular & Interventional Radiology, Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Graham Roche-Nagle
- Division of Vascular Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
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Belgrano M, Pozzi Mucelli F, Spadacci A, Pizzolato R, Zappetti R, Cova M. Prevalence of extravascular collateral findings during 64-slice CT angiography of the abdominal aorta and lower limbs. Radiol Med 2010; 115:983-96. [PMID: 20574706 DOI: 10.1007/s11547-010-0557-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 11/18/2009] [Indexed: 12/21/2022]
Abstract
PURPOSE The aim of this study was to assess the prevalence of extravascular collateral findings during 64-slice CT angiography of the abdominal aorta (AA-CTA) and lower limbs (LL-CTA). MATERIALS AND METHODS The images of 536 AA-CTA and LL-CTA examinations performed for suspected aortic and peripheral vascular disease in 500 patients were retrospectively reviewed. Two radiologists evaluated the 5-mm axial images independently using appropriate window settings for the area under investigation. Collateral findings were divided according to their clinical significance into significant, nonsignificant and meriting further investigation. RESULTS No collateral findings were identified in 97/500 patients (19.4%). In the remaining patients, 821 collateral findings were detected, of which 43 (5.24%) were classified as significant, 135 (16.44%) as meriting further investigation and 643 (78.32%) as nonsignificant. The findings indicative of the presence of a malignant lesion totalled 36 (4.5%). CONCLUSIONS AA-CTA and LL-CTA demonstrate a nonnegligible prevalence of collateral findings, many of them major. It therefore appears that the evaluation should focus not only on the image reconstructions to identify vascular disease, but also on the native axial images to detect incidental findings.
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Affiliation(s)
- M Belgrano
- Unità Clinico Operativa di Radiologia, Università degli Studi di Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, Italy.
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Naidu SG, Hara AK, Brandis AR, Stone WM. Incidence of highly important extravascular findings detected on CT angiography of the abdominal aorta and the lower extremities. AJR Am J Roentgenol 2010; 194:1630-4. [PMID: 20489106 DOI: 10.2214/ajr.09.3538] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the frequency and significance of extravascular findings on CT angiography of the abdominal aorta and lower extremities. MATERIALS AND METHODS Reports of CT angiograms of the abdominal aorta and lower extremities for 275 patients (164 men and 111 women; mean age, 72 years) were retrospectively reviewed. Patients were scanned from the level of diaphragm to toes. Extravascular findings were classified into three groups-low, moderate, and high importance-on the basis of clinical significance. Low-importance findings were defined as those with little, if any, clinical significance. Moderate-importance findings were those that may not be clinically apparent but recognition of which could be beneficial at a later time. Highly important findings were defined as previously unknown results requiring further imaging or investigation. For highly important findings, electronic chart review determined the subsequent clinical course. RESULTS Highly important extravascular findings were found in 40 (15%) patients. Of 462 findings overall, 43 (9%) were of high importance, 77 (17%) were of moderate importance, and 342 (74%) were of low importance. The most common highly important findings were indeterminate lesions of kidney (n = 9), lung (n = 7), and liver (n = 6). Overall, eight (3%) of the 275 patients had findings of high clinical significance that resulted in medical therapy or surgical intervention, including lung carcinoma, renal cell carcinoma, colon carcinoma, cholangiocarcinoma, and pulmonary coccidioidomycosis. CONCLUSION Of patients undergoing CT angiography of the abdominal aorta and lower extremities, 15% had previously undiagnosed, highly important findings. Radiologists and referring clinicians should be aware of the frequency of these clinically significant extravascular findings at CT angiography.
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Affiliation(s)
- Sailen G Naidu
- Department of Radiology, Mayo Clinic, Scottsdale, AZ 85259, USA
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Katz DS. Response to: Extravascular incidental findings at multislice CT angiography of the abdominal aorta and lower extremity arteries. ABDOMINAL IMAGING 2008; 33:750-751. [PMID: 18784954 DOI: 10.1007/s00261-008-9459-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Venous Thromboembolism and Occult Malignancy: Simultaneous Detection During Pulmonary CT Angiography with CT Venography. AJR Am J Roentgenol 2008; 191:885-9. [DOI: 10.2214/ajr.07.3516] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Mahnken AH, Bruners P, Mommertz G, Mühlenbruch G, Jacobs MJ, Günther RW, Langer S. Carbon Dioxide Contrast Agent for CT Arteriography: Results in a Porcine Model. J Vasc Interv Radiol 2008; 19:1055-64. [DOI: 10.1016/j.jvir.2008.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2007] [Revised: 03/09/2008] [Accepted: 03/09/2008] [Indexed: 11/17/2022] Open
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