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Incidentaloma: Overview and Frequency Imaging Pearls - Educational Tools | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ Incidentaloma ❯ Overview and Frequency

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  • “Ideally, once a patient leaves the ED or hospital with an understanding of the AIF and the need for follow-up, the patient will take a proactive role in arranging that follow-up as appropriate, typically through a primary care physician. However, if a patient is not notified, forgets, does not understand, does not have access to a primary physician, or otherwise does not complete recommended follow-up, it raises the issue of who should be responsible for “closing the loop” to ensure that appropriate follow-up has occurred. This is especially important when the follow-up interval is extended (ie, 12 months). We sought consensus on best practices at the systems level, including the importance and potential reimbursement for follow-up of incidental findings.”
    White Paper: Best Practices in the Communication and Management of Actionable Incidental Findings in Emergency Department Imaging
    Christopher L. Moore et al.
    J Am Coll Radiol 2023;20:422-430.
  • “Although a system such as this does involve investment on the part of the hospital or overall health care system in both automated tracking, communication, and electronic health record infrastructure and personnel, the benefit of identifying malignancies earlier, avoiding the morbidity and mortality of a delayed diagnosis and the resultant litigation, should far outweigh the cost. Likewise, the revenue generated from the follow-up imaging and subsequent care in the system should a malignancy be identified should cover the cost of the program. A recent initiative focused specifically on ED patients with AIFs was able to contact subjects after their visits and/or confirm follow-up in more than 95% of cases.”
    White Paper: Best Practices in the Communication and Management of Actionable Incidental Findings in Emergency Department Imaging
    Christopher L. Moore et al.
    J Am Coll Radiol 2023;20:422-430.
  • TAKE-HOME POINTS
    - Actionable incidental findings are common in emergency department imaging and present unique challenges in reporting, communication, and ensuring appropriate follow-up.
    - Reporting of actional incidental findings can be enhanced by ensuring key elements are routinely included in appropriate parts of the report.
    - Appropriate and standard practices for communication between clinicians and patients and among clinicians are important when actionable incidental findings occur in emergency department imaging.
    - Ultimately the appropriate communication and follow-up of actionable incidental findings in emergency department imaging represent a systems issue that can be enhanced through use of informatics and tracking systems.
    White Paper: Best Practices in the Communication and Management of Actionable Incidental Findings in Emergency Department Imaging
    Christopher L. Moore et al.
    J Am Coll Radiol 2023;20:422-430.
  • RESULTS: Of screening tests with a SIF detected, 12 228 (89.1%) had a SIF considered reportable to the RC, with a higher proportion of reportable SIFs among those with a positive screen result for lung cancer (7632 [94.1%]) compared with those with a negative screen result (4596 [81.8%]). The most common SIFs reported included emphysema (8677 [43.0%] of 20 156 SIFs reported), coronary artery calcium (2432 [12.1%]), and masses or suspicious lesions (1493 [7.4%]). Masses included kidney (647 [3.2%]), liver (420 [2.1%]), adrenal (265 [1.3%]), and breast (161 [0.8%]) abnormalities.
    CONCLUSIONS AND RELEVANCE This case series study found that SIFs were commonly reported in the LDCT arm of the National Lung Screening Trial, and most of these SIFs were considered reportable to the RC and likely to require follow-up. Future screening trials should standardize SIF reporting.
    Significant Incidental Findings in the National Lung Screening Trial
    Ilana F. Gareen et al
    JAMA Intern Med. doi:10.1001/jamainternmed.2023.1116
  • Question What were the types of significant incidental findings (SIFs) detected on low-dose computed tomography screening examinations in the National Lung Screening Trial?
    Findings In this case series study of 26 455 participants who underwent screening with low-dose computed tomography in the National Lung Screening Trial, 8954 (33.8%) had a SIF reported. Most screening tests with a SIF (12 228 [89.1%]) had at least 1 abnormality considered reportable to the referring clinician; the most common SIFs included emphysema (8677 of 20 156 [43.0%]), coronary artery calcium (2432 [12.1%]), and masses (1493 [7.4%]).
    Meaning The results of this case series study suggest that SIFs should be reported in a consistent manner and that SIF management should follow established guidelines to potentially minimize costs to patients, clinicians, and the health care system.
    Significant Incidental Findings in the National Lung Screening Trial
    Ilana F. Gareen et al
    JAMA Intern Med. doi:10.1001/jamainternmed.2023.1116
  • “In this case series study, slightly more than one-third of all NLST LDCT screening participants had a SIF detected. Most of these SIFs were classified as reportable to the RC for additional evaluation. This large number of potentially clinically important SIFs may be associated with a heavy burden of follow-up care and testing, with implications for patients, clinicians, and the health care system. At the same time, the discovery of these SIFs can potentially present an opportunity for early detection of non– lung cancer conditions in a high-risk population.”  
    Significant Incidental Findings in the National Lung Screening Trial
    Ilana F. Gareen et al
    JAMA Intern Med. doi:10.1001/jamainternmed.2023.1116
  • Purpose: The frequency of computed tomography (CT) imaging of trauma patients has given rise to an increase in the discovery of incidental findings. The purpose of this study was to evaluate the frequency and documentation of follow-up recommendations of incidental findings during the initial trauma evaluation. Secondarily, trauma patients with and without incidental findings were compared. We hypothesized that there would be a high rate of incidental findings in trauma patients and that these findings would be poorly documented.
    Results: Of the 1573 CT scans performed, 478 (30.4%) revealed incidental findings. The abdomen/pelvis had the highest rate of incidental findings (61.7%). Of the 416 patients, 295 (70.9%) had a total of 858 incidental findings, with an average of 3 findings per patient. Follow-up was required for 24 (2.8%) incidental findings, and admission/immediate intervention was required for 6 (0.7%) findings. Only 12 (1.4%) incidental findings were documented in the discharge note. Increasing age (p < 0.001), a higher body mass index (BMI) (p = 0.015), and receiving a pan-CT (p < 0.001) increased the odds of having an incidental finding.
    Incidental findings in blunt trauma patients: prevalence, follow-up documentation, and risk factors. 
    James MK et al.
    Emerg Radiol. 2017;24(4):347-353
  • Aim: Whole-body computed tomography (CT) for trauma occasionally reveals significant incidental findings not related to trauma, which require an adequate response. In this study, we examined the current state of incidental findings in trauma patients on whole-body CT and the effects of the feedback system.
    Results: During the study period, whole-body CT revealed incidental findings in 79 of 199 trauma patients (40.1%). The mean age of the 79 patients with incidental findings was 62.8 ± 19.5 years, and the mean injury severity score was 16.6 ± 10.0. No difference was observed in the severity of trauma, age, or length of hospital stay. The incidental findings were related to the liver/gallbladder in 22 patients, kidneys in 17, lungs in 14, and the intracranial area in 13. The recognition rate of incidental findings after the implementation of the feedback system increased from 23.3% to 32.6%.
    Incidental findings on whole-body computed tomography in trauma patients: the current state of incidental findings and the effect of implementation of a feedback system. 
    Kumada K et al.
    Acute Med Surg. 2019;6(3):274-278.
  • “Although CT is not considered the examination of choice for the detection and characterisation of adnexal diseases, adnexal masses may be incidentally detected during CT examination performed for other clinical indications. Most adnexal incidentalomas are benign, and therefore may not require further investigation, follow-up or intervention; however, few of them may prove malignant. Multidetector CT has improved the diagnostic performance of the technique in the detection and differentiation of adnexal mass lesions. Radiologists should be able to recognise the normal CT appearance of the ovaries and the CT characteristics of various adnexal incidentalomas. This may obviate unnecessary imaging evaluation and allow optimal treatment planning. Regarding the management of adnexal lesions incidentally found on CT, recommendations based on the collective experience of the members of the American College of Radiology Incidental Findings Committee II have recently been presented.”
    Adnexal incidentalomas on multidetector CT: how to manage and characterise.
    Tsili AC, Argyropoulou MI.
    Obstet Gynaecol. 2019;1-8.
  • “The increasing use of computed tomography (CT) scans in the evaluation of trauma patients has led to increased detection of incidental radiologic findings. Incidental findings (IFs) of the abdominal viscera are among the most commonly discovered lesions and can carry a risk of malignancy. Despite this, patient notification regarding these findings is often inadequate.”

    Improving patient notification of solid abdominal viscera incidental findings with a standardized protocol.
    J Trauma Manag Outcomes. 2015 Feb 4;9(1):1
    Collins CE et al.
  • “We identified patients who underwent abdominopelvic CTs as part of their trauma evaluation during a recent 1-year period (9/2011-8/2012). Patients with IFs of the kidneys, liver, adrenal glands, pancreas and/or ovaries had their charts reviewed for documentation of the lesion in their discharge paperwork or follow-up. A quality improvement project was initiated where patients with abdominal IFs were verbally informed of the finding, it was noted on their discharge summary and/or were referred to specialists for evaluation. Nine months after the implementation of the IF protocol, a second chart review was performed to determine if the rate of patient notification improved.”

    Improving patient notification of solid abdominal viscera incidental findings with a standardized
    protocol.
    Collins CE et al
    J Trauma Manag Outcomes. 2015 Feb 4;9(1):1
  • “Of 1,117 trauma patients undergoing abdominopelvic CT scans during the 21 month study period, 239 patients (21.4%) had 292 incidental abdominal findings. Renal lesions were the most common (146 patients, 13% of all patients) followed by hepatic (95/8.4%) and adrenal (38/3.4%) lesions. Pancreatic (10/0.9%) and ovarian lesions (3/0.3%) were uncommon. Post-IF protocol implementation patient notification regarding IFs improved by over 80% (32.4% vs. 17.7% pre-protocol, p = 0.02).”

    Improving patient notification of solid abdominal viscera incidental findings with a standardized protocol.
    Collins CE et al
    J Trauma Manag Outcomes. 2015 Feb 4;9(1):1
  • “IFs of the solid abdominal organs are common in trauma patients undergoing abdominopelvic CT scan. Patient notification regarding these lesions is often inadequate. A systematic approach to the documentation and evaluation of incidental radiologic findings can significantly improve the rate of patient notification.”

    Improving patient notification of solid abdominal viscera incidental findings with a standardized protocol.
    Collins CE et al
    J Trauma Manag Outcomes. 2015 Feb 4;9(1):1
  • “Important IF occurred in 12.7% of non-enhanced CT scans performed for suspected renal colic in the emergency department and are more common in older individuals. Prospective studies that use radiographic recommendations to characterize IF and examine the outcome and cost of their workup are encouraged.”

    Incidental Findings on CT for Suspected Renal Colic in Emergency Department Patients: Prevalence and Types in 5,383 Consecutive Examinations.
    Samim M et al.
    J Am Coll Radiol. 2015 Jan;12(1):63-9. 
  • PURPOSE:
    This study aimed to determine the prevalence, importance, and types of incidental findings (IF) in non-enhanced CT scans performed for suspected renal colic, based on ACR white papers and other accepted radiographic recommendations.
    METHODS:
    Retrospective review of 5,383 consecutive finalized reports of nonenhanced CT using renal colic protocol performed on adult patients at 2 emergency departments over a 5.5-year period. IF were defined as those unrelated to symptoms (as opposed to alternate causes of symptoms) and were categorized as "important" if follow-up was recommended based on recently published consensus recommendations.”

    Incidental Findings on CT for Suspected Renal Colic in Emergency Department Patients: Prevalence and Types in 5,383 Consecutive Examinations.
    Samim M et al.
    J Am Coll Radiol. 2015 Jan;12(1):63-9. 
  • “Important IF were identified in 12.7% (95% confidence interval [CI]: 11.8%-13.6%) of scans. Prevalence of important IF increased with age: important IF in individuals age >80 years were 4 times more common than for those aged 18-30 years: 28.9% (95% CI: 22.4%-36.4%) versus 6.9% (95% CI: 5.5%-8.6%), respectively, P ≤ .05. Women had a higher prevalence of important IF compared with men: 13.4% (95% CI: 12.2%-14.7%) versus 11.9% (95% CI: 10.7%-13.2%), but the difference was not statically significant (P = .09).”

    Incidental Findings on CT for Suspected Renal Colic in Emergency Department Patients: Prevalence and Types in 5,383 Consecutive Examinations.
    Samim M et al.
    J Am Coll Radiol. 2015 Jan;12(1):63-9. 
  • “Significant noncardiac findings are common in patients referred to routine preprocedural DSCT for planning TAVI (17.1%).”
    Prevalence of noncardiac findings in computed tomography angiography before transcatheter aortic valve replacement.
    Staab W et al.
    J Cardiovasc Comput Tomogr. 2014 May-Jun;8(3):222-9
  • “In 60 of 204 DSCT examinations (29.4%) no noncardiac findings were observed. Of the remaining 144 examinations (70.6%), 260 had noncardiac findings; 35 of 204 patients (17.1%) had a total of 37 clinically significant noncardiac findings. Eight malignancies were detected; 5 of them were incidentally diagnosed on DSCT and changed patient management. A total of 223 nonsignificant findings were observed in 116 of 204 patients (56.9%; group A), the most frequent findings were pleural effusions or colorectal diverticulosis. The prevalence of incidental and significant findings on DSCT before TAVI increased with patient age (r(2) = 0.69; P = .01).”
    Prevalence of noncardiac findings in computed tomography angiography before transcatheter aortic valve replacement.
    Staab W et al.
    J Cardiovasc Comput Tomogr. 2014 May-Jun;8(3):222-9
  • “In 60 of 204 DSCT examinations (29.4%) no noncardiac findings were observed. Of the remaining 144 examinations (70.6%), 260 had noncardiac findings; 35 of 204 patients (17.1%) had a total of 37 clinically significant noncardiac findings. Eight malignancies were detected; 5 of them were incidentally diagnosed on DSCT and changed patient management. A total of 223 nonsignificant findings were observed in 116 of 204 patients (56.9%; group A), the most frequent findings were pleural effusions or colorectal diverticulosis.”
    Prevalence of noncardiac findings in computed tomography angiography before transcatheter aortic valve replacement.
    Staab W et al.
    J Cardiovasc Comput Tomogr. 2014 May-Jun;8(3):222-9
  • “ Of the remaining 144 examinations (70.6%), 260 had noncardiac findings; 35 of 204 patients (17.1%) had a total of 37 clinically significant noncardiac findings. Eight malignancies were detected; 5 of them were incidentally diagnosed on DSCT and changed patient management..”
    Prevalence of noncardiac findings in computed tomography angiography before transcatheter aortic valve replacement.
    Staab W et al.
    J Cardiovasc Comput Tomogr. 2014 May-Jun;8(3):222-9
  • “This study highlights the importance to assess the noncardiac anatomy on DSCT images in patients planned for TAVI, because a total number of 260 noncardiac findings were observed in 144 of 204 patients (70.6%). Significant noncardiac findings that required follow-up examinations or noncardiac findings with a demand for clinical treatment, including 8 malignancies (3.9%), were detected in 35 patients. The prevlence of incidental and significant findings on DSCT before TAVI increases with patient age.”
    Prevalence of noncardiac findings in computed tomography angiography before transcatheter aortic valve replacement.
    Staab W et al.
    J Cardiovasc Comput Tomogr. 2014 May-Jun;8(3):222-9
  • “ The white paper led 560 radiologists (51%) to recommend additional imaging less often and 33 radiologists (3%) to recommend imaging more often.”
    ACR Members’ Response to JACR White Paper on the Management of Incidental Abdominal CT Findings
    Berland LL et al.
    J Am Coll Radiol 2014;11:30-35
  • “ Radiologists who read the white paper were more likely to report an incidental finding that was highly likely benign as “likely benign”, whereas those who had not read the paper were more likely to recommend additional imaging.”
    ACR Members’ Response to JACR White Paper on the Management of Incidental Abdominal CT Findings
    Berland LL et al.
    J Am Coll Radiol 2014;11:30-35
  • “ Nineteen studies including 15,877 patients (64% male) were analyzed. A three level analysis was performed to determine the prevalence of patients with incidental extracardiac findings, the prevalence of patients with major incidental extracardiac findings, and the prevalence of patients with a proven cancer.”
    Malignant Incidental Extracardiac Findings on Cardiac CT: Systematic Review and Meta-Analysis
    Flor N et al.
    AJR 2013; 201:555-564
  • “ Although the prevalence of reported incidental extracardiac finding at cardiac CT was highly variable, a homogeneous prevalence of previously unknown malignancies was reported across the studies, for a pooled estimate of 0.7%; more than 70% of the previously unknown malignancies were lung cancer.”
    Malignant Incidental Extracardiac Findings on Cardiac CT: Systematic Review and Meta-Analysis
    Flor N et al.
    AJR 2013; 201:555-564
  • “ Abdominal contrast-enhanced CT for initial staging of prostate cancer shows a considerable prevalence of incidental vascular events and synchronous cancers, with kidney cancers being the most common. Notably, 71.5% of these malignancies were at early stage. Our results show an incremental value of CT in prostate cancer staging, with an emphasis on focused evaluation of the kidneys.”
    Incidental Findings at Initial Imaging Workup of Patients with Prostate Cancer: Clinical Signiificance
    Elmi A et al.
    AJR 2012; 199:1305-1311
  • “ Overall 292 of the 355 patients (82.3%) had one or more incidental findings, as summarized in Tables 1 and 2. Colonic diverticulitis was the most common finding (42.5%), followed by renal (41.6%) and liver (25.6%) cysts. All these prevalent findings were classified as having low importance except for the two complex cysts that underwent MRI for further characterization.”
    Incidental Findings at Initial Imaging Workup of Patients with Prostate Cancer: Clinical Signiificance
    Elmi A et al.
    AJR 2012; 199:1305-1311
  • “ Seventy five potentially significant findings were noted in 73 patients (20.6%), which were mostly indeterminate masses in the kidneys, adrenal glands, pancreas, colon, liver and bladder. In addition lymphadenopathy at the sites uncoomon for prostate cancer metastases was noted in 18 cases, of which five showed non-prostate cancer malignant infiltration.”
    Incidental Findings at Initial Imaging Workup of Patients with Prostate Cancer: Clinical Signiificance
    Elmi A et al.
    AJR 2012; 199:1305-1311
  • “ Histopathologic examination was performed in 33 patients and confirmed malignancy in 21 cases (renal cell carcinoma (n=7), lymphoma (n=4), pancreatic cancer (n=3),colorectal(n=3), transitional cell carcinoma of the bladder (n=2), gastric cancer (n=1), hepatocellular carcinoma (n=1).”
    Incidental Findings at Initial Imaging Workup of Patients with Prostate Cancer: Clinical Signiificance
    Elmi A et al.
    AJR 2012; 199:1305-1311
  • “One potential advantage of the incidental diagnosis of tumors is identifying disease in the preclinical stage when treatment could be reasonably more effective leading to better survival.Notably, 85.7% of our patients were at early stages at the time of diagnosis (N0M0 cancers) and only three patients (14.3%) had evidence of distant metastases of the second cancer.”
    Incidental Findings at Initial Imaging Workup of Patients with Prostate Cancer: Clinical Signiificance
    Elmi A et al.
    AJR 2012; 199:1305-1311
  • “ Abdominal contrast enhanced CT for initial staging of prostate cancer shows a considerable prevalence of incidental vascular events and synchronous cancers, with kidney cancers being the most common. Notably 71.5% of these malignancies were at early stage. Our results show an incremental value of CT in prostate cancer staging, with an emphasis on focused evaluation of the kidneys.”
    Incidental Findings at Initial Imaging Workup of Patients With Prostate Cancer: Clinical Significance and Outcomes
    Elmi A et al.
    AJR 2012; 199:1305-1311
  • “ We found 779 incidental findings in 292 patients (82.3%) of which 75 findings in 73 patients (20.6%) were potentially significant. Indeterminate masses were the most prevalent significant finding (n=62). Synchronous malignancy was detected in 21 patients(5.9%). Kidney cancer (n=7 (1.97%) was the most common malignancy, followed by lymphoma (n=4(1.13%). Staging of the cancers revealed that 15 patients including all those with renal cancer had N0M0 disease.”
    Incidental Findings at Initial Imaging Workup of Patients With Prostate Cancer: Clinical Significance and Outcomes
    Elmi A et al.
    AJR 2012; 199:1305-1311
  • “Vascular anomalies are one important component that can be discovered incidentally on imaging. Early detection of the asymptomatic early process that could be managed with early intervention is paramount, particularly for aortic aneurysm management. We identified incidental abdominal aortic aneurysms requiring monitoring or surgical treatment in five cases.”
    Incidental Findings at Initial Imaging Workup of Patients with Prostate Cancer: Clinical Signiificance
    Elmi A et al.
    AJR 2012; 199:1305-1311
  • Moderate Importance CT Findings (Elmi et al)
    - Aortic aneurysm (8)
    - Inguinal hernia (30)
    - Hiatal hernia (19)
    - Ventral hernia (4)
    - Gallstones (39)
    - Renal calculi (30)
    - Hydronephrosis (17)
  • “ Age is an important factor in the likelihood of discovering incidental lesions. Therefore, we stratified the study population according to the age at the time of imaging to obtain more accurate estimates of age specific morbidities. In general there were no differences between the age groups in terms of incidence, but findings with important clinical relevance, such as vascular anomalies and the synchronous malignancies other than RCC, were more common in the older age group.”
    Incidental Findings at Initial Imaging Workup of Patients With Prostate Cancer: Clinical Significance and Outcomes
    Elmi A et al.
    AJR 2012; 199:1305-1311
  • “ Agreement is lacking, both across institutions and within departments, for the management of 6 commonly encountered incidental findings on body CT. Individual departments should develop internal guidelines to ensure consistent recommendations based on existing evidence.”
    Common Incidental Findings on MDCT: Survey of Radiologist Recommendations for Patient Management
    Johnson PT, Horton KM, Megibow AJ, Jeffrey RB, Fishman EK
    J Am Coll Radiol 2011;8:762-767
  • 12 Common Incidental CT Findings: What do you do?
    - Incidental 1 cm thyroid nodule
    - Incidental 5 mm non-calcified lung nodule
    - Incidental coronary artery calcification
    - Incidental 2 cm adrenal nodule (40 HU after IV)
    - Incidental 2 cm cystic lesion pancreas
    - Incidental 1 cm enhancing liver lesion in non-cirrhotic liver
    - Incidental high density renal lesion on contrast enhanced CT (30HU)
    - Incidental short segment jejunal intussusception
    - Incidental 1 cm low density/cystic splenic lesion
    - Incidental focal gallbladder wall calcifications
    - Incidental 3 cm ovarian cyst in post-menpausal female
    - Incidental 3 cm cyst in premenopausal female
  • 12 Common Incidental CT Findings: What do you do?
    - Incidental 1 cm thyroid nodule
    - Incidental 5 mm non-calcified lung nodule
    - Incidental coronary artery calcification
    - Incidental 2 cm adrenal nodule (40 HU after IV)
    - Incidental 2 cm cystic lesion pancreas
    - Incidental 1 cm enhancing liver lesion in non-cirrhotic liver
  • 12 Common Incidental CT Findings: What do you do?
    - Incidental high density renal lesion on contrast enhanced CT (30HU)
    - Incidental short segment jejunal intussusception
    - Incidental 1 cm low density/cystic splenic lesion
    - Incidental focal gallbladder wall calcifications
    - Incidental 3 cm ovarian cyst in post-menpausal female
    - Incidental 3 cm cyst in premenopausal female
  • “ The prevalence of pancreatic cysts at single shot fast SE MR imaging-especially cysts with a diameter smaller than 10mm is similar to that of pancreatic cysts at autopsy and higher than that of pancreatic cysts at transabdominal ultrasonography.”
    Pancreatic Cysts: depiction on single-shot fast spin echo MR images
    Zhang XM et al.
    Radiology 2002; May 223(2):547-53
  • Incidentaloma: Definition
  • “ 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.”
    Incidence of Highly Important Extravascular Findings Detected on CT Angiography of the Abdominal Aorta an the Lower Extremities
    Naidu S et al.
    AJR 2010 194:1630-1634
  • “ 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. Extravascular findings were classified into three groups-low, moderate and high importance-on the basis of clinical significance.”
    Incidence of Highly Important Extravascular Findings Detected on CT Angiography of the Abdominal Aorta an the Lower Extremities
    Naidu S et al.
    AJR 2010 194:1630-1634
  • “ 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 the kidney (n=9), lung (n=7) and liver (n=6).”
    Incidence of Highly Important Extravascular Findings Detected on CT Angiography of the Abdominal Aorta an the Lower Extremities
    Naidu S et al.
    AJR 2010’194:1630-1634
  • “ 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 the 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 coccidiomycosis.”
    Incidence of Highly Important Extravascular Findings Detected on CT Angiography of the Abdomonal Aorta an the Lower Extremities
    Naidu S et al.
    AJR 2010 194:1630-1634
  • “ 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 coccidiomycosis.”
    Incidence of Highly Important Extravascular Findings Detected on CT Angiography of the Abdomonal Aorta an the Lower Extremities
    Naidu S et al.
    AJR 2010 194:1630-1634
  • “ The prevalence of clinically important incidental extraurinary findings at MDCT urography performed for hematuria was 6.8%.”
    Incidental Clinically Important Extraurinary Findings at MDCT Urography for Hematuria Evaluation: Prevalence in 1209 Consecutive Examinations
    Song JH et al.
    AJR 2012; 199:618-622

  • “ There were 11 (0.9%) examinations with acute findings, of which acute inflammation of the gastrointestinal tract and pancreaticobiliary system were the most common. Seventy two (5.9%) examinations revealed 74 nonacute but important findings.”
    Incidental Clinically Important Extraurinary Findings at MDCT Urography for Hematuria Evaluation: Prevalence in 1209 Consecutive Examinations
    Song JH et al.
    AJR 2012; 199:618-622
  • “ In 82 of 1209 paatients (6.8%) 85 clinically important incidental extraurinary findings were identified. There were 11 (0.9%) examinations with acute findings, of which acute inflammation of the gastrointestinal tract and pancreaticobiliary system were the most common. Seventy two (5.9%) examinations revealed 74 nonacute but important findings.”
    Incidental Clinically Important Extraurinary Findings at MDCT Urography for Hematuria Evaluation: Prevalence in 1209 Consecutive Examinations
    Song JH et al.
    AJR 2012; 199:618-622
  • “ Lung nodules were the most prevalent, followed by intraabdominal aneurysms and cystic ovarian masses. There were five (1.4%) histologically proven malignant neoplasms.”
    Incidental Clinically Important Extraurinary Findings at MDCT Urography for Hematuria Evaluation: Prevalence in 1209 Consecutive Examinations
    Song JH et al.
    AJR 2012; 199:618-622
  • Patient Demographics
  • 5 Proven Incidental Carcinomas
    - 4 cases of bronchogenic carcinoma (3 were stage 1 and 1 had metastatic disease)
    - 1 case of lymphoma
  • “ In our study of 1209 MDCT urography examinations, 6.8% of patients had clinically important or potentially important incidental findings requiring further investigation. Of these clinically significant results proved uncommon with acute findings diagnosed in 0.9% of patients and extraurinary malignancy confirmed in 0.4%.”
    Incidental Clinically Important Extraurinary Findings at MDCT Urography for Hematuria Evaluation: Prevalence in 1209 Consecutive Examinations
    Song JH et al.
    AJR 2012; 199:618-622
  • “ In conclusion, the prevalence of clinically important incidental extraurinary findings at MDCT urography performed for hematuria was 6.8%. Lung nodules were the most common incidental finding and malignant extraurinary neoplasm was found in 0.4% of cases.”
    Incidental Clinically Important Extraurinary Findings at MDCT Urography for Hematuria Evaluation: Prevalence in 1209 Consecutive Examinations
    Song JH et al.
    AJR 2012; 199:618-622
  • What helps define the frequency of incidental findings?
    - Area of body scanned
    - Reason for doing study
    - Scanning protocol including use of oral and/or IV contrast
    - Age of the patient

 

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