Clinical Significance Of Incidental Findings Research Articles

Incidental findings on MRI for the evaluation of endometriosis: prevalence and clinical significance.

This study aimed to analyze the prevalence and clinical significance of incidental findings on MRI for endometriosis. Differences between patients with and without evidence of deep infiltrating endometriosis on MRI were to be examined. This was a retrospective, descriptive cross-sectional single-center study. All patients who received a pelvic MRI for endometriosis between April 2021 and February 2023 were included. The presence and frequency of incidental findings were noted after review of all MR images and radiology reports. The potential clinical significance of the findings was analyzed. Differences in the frequency of incidental findings between patients with and without evidence of deep infiltrating endometriosis on MRI were evaluated, utilizing the Chi-square test, Fisher's exact test and Mann-Whitney U-test. 303 consecutive patients (mean age, 33.4 years ± 8.3) were evaluated. Incidental findings were noted in 299/303 (98.7%) patients. Most frequently, ossification of the hip acetabular rim and degenerative changes of the lumbar spine were noted. In 25/303 (8.3%) patients, incidental findings had high clinical significance. For specific incidental findings, significantly higher prevalences were found in patients with than in patients without evidence of deep infiltrating endometriosis on MRI (hip acetabular rim ossification, p = 0.041; annulus fibrosus fissures, p = 0.006; gallstones, p = 0.042). Incidental findings are very common on pelvic MRI for endometriosis. The detection of incidental findings can lead to the diagnosis of relevant diseases and thus enable early treatment. On the other hand, many incidental findings have no, only minor, or uncertain consequences.

Prevalence and clinical significance of incidental findings in chest and abdominopelvic CT scans of trauma patients; A cross-sectional study

BackgroundImaging may inadvertently reveal pathologies unrelated to their performing purpose, known as incidental findings (IF). This study aimed to assess the prevalence, clinical significance, and documentation of IFs in chest and abdominopelvic computed tomography (CT) scans of trauma patients. MethodsThis observational study was conducted at two urban level-1 trauma centers from March 2019 through April 2022. Official radiology reports of trauma patients who underwent chest and/or abdominopelvic CT scans at the emergency department (ED) were explored, and IF were extracted. Predictive factors of the presence of IFs and their documenting were investigated. ResultsOut of 656 chest and 658 abdominopelvic CT scans, 167 (25.37%) and 212 (32.31%) scans harbored at least one IF, respectively. Patients with IFs tended to be of higher age and female in both chest (age: 48 [IQR: 35–62] vs. 34 [IQR: 25–42.5]; female: 31.14% vs 14.66%, p < 0.001 for both) and abdominopelvic CT scans (age: 41 [IQR: 30–57.5] vs 33 [IQR: 25–43], female: 26.42% vs. 13.96%, p < 0.001 for both). As for documentation of significant IFs, only 49 of 112 chest IFs (43.8%) and 55 of 176 abdominopelvic IFs (31.3%) were documented. Investigating factors associated with documentation of clinically significant IFs, shorter length of hospital stay (1.5 (IQR: 0–4) vs. 3 (IQR: 2–8), p = 0.003), and discharging by ED physicians (documentation rate: 13.2% vs 42.6%, p < 0.001) were associated with poorer documentation of IFs only in abdominopelvic scans. ConclusionCT imaging in ED trauma patients often reveals incidental findings, especially in older patients. Over 50% of these findings are clinically significant, yet they are frequently ignored and not documented. Physicians need to be more vigilant in recognizing and documenting these incidental findings and informing patients of the need for further evaluation.

Frequency and Clinical Significance of Incidental Findings on CBCT Imaging: a Retrospective Analysis of Full-Volume Scans.

This retrospective study aims to identify incidental findings in cone-beam computed tomography scans of patients irradiated for preoperative evaluation for implant placement and obtained using the same imaging unit as well as the same field of view. The incidence of each incidental finding, as well as the overall incidence, were calculated and the findings were ranked according to their clinical significance. A total of 741 cone-beam computed tomography (CBCT) examinations with extended field of view (15 x 15 cm) were retrospectively evaluated for incidental findings (IFs). These were identified, recorded, classified as to their location, and ranked according to their clinical significance. The vast majority of CBCT examinations presented at least one IF, resulting in a surprisingly high prevalence in total. If extreme anatomical variants are considered (nasal septum deviation, sinus septations etc.), the cumulative prevalence exceeds 99%. IFs of major significance, that may require immediate attention, are beyond 10% in frequency. We found high prevalence of incidental findings on cone-beam computed tomography examinations performed for preoperative evaluation for implant placement (99.5% if anatomical variants included). Most incidental findings were of minor significance. Although the number of incidental findings that require immediate attention is relatively low, there is a considerable number of cases that need periodic evaluation and/or referral.

Prevalence and Clinical Significance of Incidental Findings in the Maxillofacial Complex of Adolescent Orthodontic Patients: A Retrospective Cone Beam Computed Tomography Analysis.

The aim of this study was to determine the prevalence and severity of incidental findings in the maxillofacial complex of orthodontic patients imaged with cone beam computed tomography (CBCT) and assign those findings an appropriate clinical significance. Incidental findings (IF) were identified in 250 CBCT scans of adolescent orthodontic patients (aged 13-18 years) with a large field-of-view and categorized based on their anatomic location and placed into one of six subgroups based on anatomic region: i) sino-nasal, ii) dentoalveolar, iii) nasooropharyngeal airway, iv) temporomandibular joint, v) neck, vi) calcifications, and vi) miscellaneous findings. Additionally, findings were assigned a clinical significance score based on severity on a scale of mild, moderate and severe. Mild IF was defined as an IF that does not require any further investigation or referral. Moderate IF was defined as an IF that has the tendency to become clinically significant and should be observed periodically. IFs that warrant further investigation and/or intervention were designated as severe. The percentage of IFs in sino-nasal and dento-alveolar regions were 44.7% and 19.1% respectively. The percentage of IFs with mild, moderate, and severe clinical significance were 27%, 72%, and 1%, respectively. Out of the IFs involving calcifications, 80.8% were stylohyoid calcifications and <1% were cranial cavity IFs such as petroclinoid calcifications and falx cerebri calcifications. Among the sino-nasal findings, 1.2% were identified as severe. The sino-nasal region had the highest frequency of IFs. Understanding the prevalence of incidental findings and its clinical relevance is important for clinicians to allow for appropriate monitoring and timely treatment of patients.

Variation in Reporting of Incidental Findings on Initial Lung Cancer Screening and Associations With Clinician Assessment

PurposeThe aim of this study was to quantify the distribution, frequency, and clinical significance of incidental findings (IFs) on initial lung cancer screening (LCS) and the association of report characteristics with subsequent assessment. MethodsHealth records of patients undergoing initial LCS from 2015 to 2018 in the Minneapolis VA Health Care System were retrospectively reviewed for demographics, Lung CT Screening Reporting & Data System coding, IFs, and subsequent clinical assessment. IFs were considered potentially significant if they were likely to require any follow-up. High-risk significant IFs (SIFs) were potentially malignant. The primary outcome was the SIF being addressed. Outcomes were analyzed using a mixed-effects model. ResultsPatients (n = 901) were primarily male (94.1%) smokers (62.1%) with a mean age of 65.2 years. IFs were extremely common (93.9%), with an average of 2.6 IFs per scan (n = 2,296). Seven hundred eighty-six IFs (34.2%) were deemed likely SIFs, of which 58 (7.4%) were high risk. Two hundred twenty-two (28.2%) were addressed by clinicians, of which 104 (13.2%) underwent testing. Reporting of SIFs varied among radiologists, with at least one SIF in the impression in 24% to 78% of low-dose CT studies with the S modifier, used to indicate the presence of a SIF, applied to 0% to 51% of reports. In the mutually adjusted model, radiologist recommendation (adjusted odds ratio [OR], 4.67; 95% confidence interval [CI], 2.23-9.76), high-risk finding (adjusted OR, 4.35; 95% CI, 1.81-10.45), and reporting in the impression (adjusted OR, 2.58; 95% CI, 1.28-5.18) were associated with increased odds of the SIF’s being addressed. ConclusionsRadiologists vary in their reporting of IFs on LCS. Further standardization of reporting of SIFs may improve this process, with the simultaneous goals of generating appropriate testing when needed and minimizing low-value care.

Prevalence of extra-hepatic incidental findings on ultrasound screening for hepatocellular carcinoma.

Abdominal ultrasound is a cost-effective method for screening for hepatocellular carcinoma (HCC) in high-risk individuals. Currently, at many institutions the protocol for obtaining HCC screening ultrasounds includes a traditional examination of the right upper quadrant, including the pancreas and right kidney. There is no consensus on the role of imaging of extra-hepatic structures and there are limited data describing the frequency and clinical significance of incidental findings discovered during HCC screening. The purpose of this retrospective study is to assess the prevalence and significance of extra-hepatic incidental findings during HCC screening ultrasounds. A single-center retrospective review of all right upper quadrant HCC screeningultrasounds identified 432 HCC screening ultrasounds performed on 294 adults over a 2.5-year period. Findings in all organs evaluated were recorded. Any incidental finding was classified as minor, moderate, or major clinical significance. At least one extra-hepatic finding was documented in 57.4% of examinations. The most common extra-hepatic findings occurred in the gallbladder (40.3%), most commonly gallstones (25.4%). Four moderate clinically significant incidental findings were recorded (0.9%). Only one of these incidental findings required specific imaging follow up (0.2%). No major clinical significance incidental findings were identified. Potentially clinically significant incidental findings during ultrasound HCC screenings are rare. Incidental findings identified on HCC screening did not result in significant additional follow-up imaging or interventions.

Incidental Findings in Low-Dose Full-Body Imaging Taken for Total Hip and Knee Arthroplasty

AbstractDetection of incidental findings (IFs) in preoperative imaging for total joint arthroplasty (TJA) patients may lead to additional testing, cost, and surgical delay. The purpose of this study is to identify the incidence and clinical significance of IFs on preoperative low-dose full-body imaging (LFI) in the total joint population. Furthermore, we aim to determine whether these findings lead to additional imaging, delay, or cancelation in TJA cases. A retrospective review of 2,183 patients planned for total hip arthroplasty or total knee arthroplasty, who had preoperative LFI imaging obtained from 2013 to 2020 was conducted. LFI radiographic reports were reviewed to identify any flagged radiographs. Flagged IFs were divided into thoracic, spinal, lower limb, and abdominal IFs. Charts were reviewed to identify if any additional imaging was completed, the case was delayed or canceled, or a new pathology requiring continued follow-up or treatment was discovered. Of the 2,183 LFI images taken prior to TJA, 41 cases qualified as having IF (1.9%, 41/2,183), 18 thoracic, 11 spinal, 11 lower limb, and 1 abdominal. Overall, 15 (0.7%, 15/2,183) IF cases were clinically determined to require at least one additional form of imaging. Two had a significant finding; a schwannoma near the distal femoral shaft and a squamous cell carcinoma of the lung. Three TJA cases were delayed, and no cases were cancelled due to the IFs. The possible increase in IF detection by preoperative LFI does not greatly impact TJA case completion. Though rare, providers should pay close attention as clinically significant IFs can be discovered and lead to early treatment. This was a retrospective cohort study with level III evidence.

588 Incidence and Clinical Significance of Incidental Findings in Major Trauma Patients

Abstract Aim This study aimed to characterise and demonstrate the clinical importance of incidental findings (IF) for patients presenting to a Major Trauma Centre (MTC). Method A prospective review of 941 consecutive patients who were imaged and subsequently admitted to hospital as Major Trauma. IF unrelated to the trauma were analysed from radiological imaging reports and documented management was reviewed. Results 594 patients (63.1%) received a pan/trauma CT, 225 (23.9%) had isolated CT scans and 122 (13%) had X-Rays only. 365 (38.7%) patients had a total of 647 IF. Of these: 15 (2.3%) were suggestive of malignancy (e.g., colon mass, liver tumour). 41 (6.3%) represented acute pathology requiring urgent intervention (e.g., pulmonary embolism, consolidation). 148 (22.9%) represented likely benign pathology but required further investigation or routine follow-up (e.g., pulmonary nodules, pancreatic cysts). 443 (68.5%) represented benign or chronic pathology not requiring any specific follow-up (e.g., hiatus hernia, diverticular disease). The reporting radiologist advised further investigation or review in 61 (6.5%) cases. This was actioned and documented in 44 (72.1%) cases by the MTC clinician as part of the tertiary survey. 9 patients still lacked adequate documentation, 2 were transferred to a different hospital, 1 self-discharged and 5 were never reviewed by the major trauma team. Conclusion The common utilisation of pan/trauma CT scanning in Major Trauma identifies a high volume of IF. Over a quarter represented potentially clinically significant findings that require onward investigation. MTC should ensure they have appropriate systems to capture and document IF including actioning further investigation and follow up.

Prevalence and clinical significance of incidental findings on CT attenuation correction for myocardial perfusion imaging

BackgroundThe appropriate clinical approach to incidentally detected lesions (IDLs) on CT attenuation correction (CTAC) images in myocardial perfusion imaging (MPI) remains uncertain. We sought to establish their prevalence and clinical significance in a large cohort and compared to previous studies to help provide further clarity and guide future clinical practice. Methods and ResultsA total of 3758 MPI studies were reviewed retrospectively. IDLs of potential clinical significance—not known before MPI - were reported in 245 (6.5%) of these cases. Following appropriate further investigation/follow-up, these were of proven clinical significance in 30 (12.2%) cases with 14 patients (5.7%) harboring previously undiagnosed or progressive malignancies. The positive predictive value (PPV) for clinically significant incidental findings on CTAC images was 17.2% and the PPV value for incidental malignant findings was 8.0%. ConclusionAlthough incidental findings on CTAC images in MPI are common and often clearly insignificant at time of MPI reporting, many are clinically significant with a relatively high positive predictive value. This is especially so for malignancies. Our findings, therefore, in combination with previous studies as described here support routine reporting and appropriate further investigation of incidental CTAC findings in MPI.

Prevalence and clinical impact of incidental findings on the unenhanced CT images of PET/CT scan in patients with multiple myeloma: the value of radiological reporting in the multimodal hybrid imaging.

In the hybrid Positron Emission Tomography/Computed Tomography (PET/CT) method, the functional evaluation is integrated with the morphological information provided by co-registered CT, still performed for attenuation correction and lesion localization. However, co-registered CT images could provide additional diagnostic information that PET alone could underestimate. To optimize the diagnostic potential of this hybrid examination, we evaluated the prevalence and the clinical significance of incidental findings detected on co-registered CT images in a cohort of multiple myeloma (MM) patients. We evaluated 112 MM patients (mean age 65.8 y), who underwent [18F]FDG-PET/CT during their regular workup. All co-registered CT images were retrospectively reviewed by two expert radiologists and each non-myelomatous incidental finding (nM-IF) was collected and clinically graded according to a nM-IF Reporting and Data System (nM-RADS). In addition, nM-IFs were classified according to anatomic localization (skull, lung, mediastinum, abdomen, breast, gastrointestinal, genitourinary and cardiovascular system and muscle/soft tissue). 163 nM-IFs were detected in 94/112 patients (83.9%) (mean value: 1.5 IFs per patient). The most interested anatomic districts were the lung (n=33; 20.2%), genitourinary (n=33; 20.2%) and gastrointestinal (n=30; 18.4%) systems. Focusing on the clinically significant findings (nM3+nM4), 92/163 (56.4%) IFs could have been required further investigations, of which 38/163 (23.3%) were potentially important and detected in 33/112 (29.5%) patients. The high percentage of potentially clinically significant IFs detected in MM patients emphasizes that co-registered CT images hold precious information often missed. Giving more relevance to co-registered CT with tailored acquisition and reconstruction protocols and dedicated reporting could optimize the potentiality of this multimodality imaging method with impact on clinical management.

Whole-body magnetic resonance imaging (WB-MRI) with diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) in prostate cancer: Prevalence and clinical significance of incidental findings.

Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) is now recommended as a first-line staging modality in prostate cancer patients, and the widespread use of DWIBS may lead to an increased frequency of incidental findings. The aim of this study was to evaluate the prevalence and clinical significance of incidental findings on whole-body magnetic resonance imaging (WB-MRI) with DWIBS. Data from 124 patients with prostate cancer (age, 76.5 ± 5.6 years), who underwent 1.5 T WB-MRI with STIR, TSE-T2, TSE-T1, In/Out GRE, and DWIBS sequences, were retrospectively analyzed. Findings unrelated to prostate cancer were considered as incidental findings and categorized into two groups based on their clinical implications as follows: imaging follow-up or additional examinations was required (significant incidental findings) and no need to additional work-up (non-significant incidental findings). A chi-square test was performed to compare the differences in the prevalence of significant incidental findings based on age (≤75 and>75 years old). A total of 334 incidental findings were found with 8.1% (n = 27) as significant incidental findings. Significant incidental findings were more frequent in patients over 75 years old than those of 75 years old or younger (28.6% vs 11.1%, p = 0.018). Clinically significant incidental findings, which required imaging follow-up or additional examinations, were commonly observed in prostate cancer patients on WB-MRI/DWIBS. Some incidental findings were clinically significant that may lead to changes in treatment strategy. Checking the entire organ carefully for abnormalities and reporting any incidental findings detected are important.

Clinical significance of incidentally detected lead perforations by computed tomography.

Computed tomography (CT) has an established role in detecting perforation of implanted pacemaker and defibrillator leads. The clinical significance of incidental finding of delayed lead perforation remains unclear. The aim of this study was to assess the prevalence of lead perforation as detected by CT in a cohort of patients undergoing transvenous laser lead extraction and characterize the association between finding of incidental lead perforation with periprocedural outcomes. Consecutive patients that underwent chest CT and lead extraction were retrospectively assessed for presence of lead perforation. A total of 143 patients and 348 leads were assessed. The finding of lead perforation was correlated with findings from peri-procedural transesophageal echocardiography (TEE) and outcomes of the lead extraction procedure. Lead perforations (including perforations<5mm and ≥5mm) were detected in 66 (46%) patients and 73 (21%) leads. Lead perforation ≥5mm were less common and detected in 13 (9%) of patients and 14 (4%) of leads. There was no significant difference in the rates of peri-procedural death, cardiac avulsion, cardiac tamponade or post-extraction pericardial effusion in patients with and without lead perforation. Incidental delayed lead perforations detected by CT are common and do not correlate with significant TEE findings or adverse peri-procedural outcomes in patients undergoing lead extraction. Larger studies are needed to further characterize the frequency and safety of these findings.

23. Incidental findings on XON array: Our experience over the last two years

Exon-level copy number variation (CNV) can be difficult to assess using whole-exome sequencing (WES) or whole-genome SNP microarray (CMA). The clinical implementation of the CytoScan XON array has allowed for the evaluation of exon-level CNVs that previously were either difficult to identify or missed entirely by preceding testing methods. Increasing the resolution of detection has not only aided in diagnosis of recessive disorders in which exome analysis identified a single variant within a candidate gene, but has also been useful in the diagnosis of dominant disorders in cases for which exome and/or CMA is negative. Furthermore, the increased resolution of detection in the assessment of exon-level CNVs has led to the discovery of significant incidental findings in a select few cases. In this report, we assess the prevalence and clinical significance of incidental findings detected by clinical XON array analysis over the last two years at the Greenwood Genetic Center. To illustrate our findings, four cases have been selected from approximately 300 to date with various clinical indications including: abnormal prenatal screening, hearing loss accompanied by developmental delay, and two cases with multiple congenital anomalies. For each case presented, previous testing was unremarkable and XON array analysis of phenotype-driven genes was negative. However, further analysis of the unmasked XON array data identified a potential causative aberration in each patient (e.g. exonic CNVs involving: CDH23, ARSA, PKD1 and ARID1A). This collection of cases not only demonstrates the utility and potential of the XON array in the context of complicated cases with unknown genetic etiology for which WES and CMA is negative, but provides further evidence for the importance of incidental findings in exon-level analysis.

Nature and clinical significance of incidental findings in maxillofacial cone-beam computed tomography: a systematic review.

This systematic review was conducted to assess the types, potential clinical significance, and treatment implications of incidental findings (IFs) in CBCT diagnostic imaging of the maxillofacial region. The authors searched several electronic databases and grey literature without time restriction for studies on the IFs in maxillofacial CBCT. Studies that classified the IFs based on their potential clinical significance were included. The methodological quality of the included studies was evaluated by the STROBE criteria. The online searches of the electronic databases yielded 1323 records. Five articles were included in the final qualitative analysis. The methodological quality ranged from low to moderate risk of bias. Percentages of IFs with high (requiring intervention/referral), moderate (requiring monitoring), and low clinical significance ranged from 0.3 to 31.4%, 15.6 to 28.9%, and 43.46 to 71.1%, respectively. There was an inconsistency between the studies in the clinical significance of 58.8% of the IFs identified. Most IFs in maxillofacial CBCT are either normal variants or findings that do not require referral or treatment. There was no clear consensus on the recommended management of most common IFs. The lack of consensus on clinical significance emphasizes the importance of collaboration between medical and dental specialties to establish professional guidelines for the management of commonly encountered IFs in CBCT.

Frequency and Clinical Significance of Incidental Findings Detected in Internal Acoustic Canal Magnetic Resonance Imaging of Patients with Audiovestibular Symptoms.

ObjectivesRetrocochlear pathology associated with audiovestibular symptoms is detected in very few of the patients, and most of the internal acoustic canal magnetic resonance imaging examinations (IAC-MRIs) are either completely normal or include accompanying incidental findings (IFs). The aim of our study is to reveal the presence and frequency of IFs in IAC-MRIs, together with retrocochlear lesions. In addition, we intend to emphasize the clinical importance of these IFs.MethodsA retrospective analysis of 374 serial IAC-MRI scans.ResultsGender distribution: 201 males and 173 females. Age range: 2–82 years. Seventy-two scans (19.25%) were totally normal. Fifteen scans (4.01%) demonstrated only pontocerebellar angle findings (PCAFs). The presence of PCAF and IF was together in 57 scans (15.24%). In 230 (61.50%) of the scans, only IFs were present. The incidence of IFs in all IAC-MRIs was 76.74% (287 of 374). Critical findings that may require clinical further evaluation and examination were present in 34 scans (9.09%). IFs that did not require further examination were observed in 253 scans (67.65%).ConclusionVarious IFs can be detected with IAC-MRI that may cause similar symptoms with PCAF. And unfortunately, some of these IFs may be of very high clinical importance. All referral clinicians should know well that these audiovestibular symptoms can appear as IFs anywhere in the auditory pathway, and how they should be followed in their clinical approach.

Clinical significance of incidental findings on coronary CT angiography: Insights from a randomized controlled trial

BackgroundThe effect of incidental findings from coronary computed tomography angiography (CCTA) on management has not been rigorously investigated. This study uses a control group to explore this relationship. MethodsAnalysis of data from a randomized controlled trial of acute chest pain patients admitted to telemetry was performed. Patients were randomized to undergo either CCTA (n = 200) or radionuclide myocardial perfusion imaging (MPI) (n = 200). Incidental findings were determined from imaging reports. Records were reviewed to determine subsequent management and imaging during and after hospitalization. Comparisons were performed using Fischer’s exact tests. Results386 incidental findings were found among 187 CCTA studies. No extra-cardiac incidental findings were noted in the MPI arm, which served as an effective control group. There were significantly more non-coronary medical workups during admission in the CCTA group compared to the MPI group [20% (39) vs. 12% (23), P = 0.038]. CCTA patients underwent significantly more resting echocardiography during the inpatient workup compared to the MPI group [38% (75) vs. 18% (55), P = 0.042]. CCTA patients underwent significantly more non-contrast chest CT exams in the year following admission compared to MPI patients [14% (27) vs. 7% (13) P = 0.029]. ConclusionsIncidental findings on inpatient CCTAs performed for chest pain have a significant impact on treatment and imaging during and following hospital admission.

Prevalence and clinical significance of incidental findings on multiparametric prostate MRI.

To assess the prevalence and clinical significance of incidental findings (IFs) detected at multiparametric prostate MRI examination. Multiparametric prostate MRIs of 647 consecutive patients (mean age 67.1 ± 8.0 years) were retrospectively evaluated by two radiologists recording the presence of all extra-prostatic IFs. Findings were classified as related to or not related to genitourinary system and divided into three classes, according to their clinical significance, as follows: group 1, not significant or scarcely significant; group 2, moderately or potentially significant; and group 3, significant. Differences in distribution of IFs between patients ≤ 65years old and patients > 65years old were assessed using Pearson's χ2 or Fisher's exact test. Statistical significance level was set at p < 0.05. Incidental findings (n = 461) were present in 341 (52.7%) patients, while 306 (47.3%) patients did not have any extra-prostatic IF. Overall, IFs were significantly more common in patients > 65years old (n = 225, 57.0%) compared to patients ≤ 65years old (n = 116, 46.0%, p = 0.007). There were 139 (30.2%) IFs related to genitourinary system and 322 (69.8%) IFs not related to genitourinary system. Group 3 IFs were almost exclusively present in patients > 65years old (2.8%, p = 0.034) and included 7 (1.1%) bladder carcinomas, 3 (0.5%) testicle tumors, 2 (0.3%) rectal cancers. Twenty-seven (4.2%) of the 647 patients underwent surgical treatment for IFs not directly related to prostate cancer. IFs not related to prostate cancer may be frequently encountered on multiparametric prostate MRI, and they are significantly more common in patients > 65years old.

Frequency, Cost, and Clinical Significance of Incidental Findings on Preoperative Planning Images for Computer-Assisted Total Joint Arthroplasty

BackgroundThe frequency of incidental findings with computer-assisted total joint arthroplasty (CA TJA) preoperative imaging and their clinical significance are currently unknown. MethodsWe reviewed 573 patients who underwent primary CA TJA requiring planning imaging. Incidental findings were defined as reported findings excluding those related to the planned arthroplasty. Secondary outcomes were additional tests or a delay in surgery. Associated charges were obtained from our institution’s website. Charge and incidence data were combined with TJA volumes obtained from the 2016 National Inpatient Sample to model costs to the healthcare system. ResultsOverall, 262 patients (45.7%) had at least 1 incidental finding, 144 patients (25.1%) had 2, and 65 (11.3%) had 3. The most common finding types were musculoskeletal (MSK, 67.7%), digestive (19.5%), cardiovascular (4.9%), and reproductive (4.7%). Also, 9.3% of patients had at least 1 non-MSK incidental finding. Both MSK and non-MSK incidental findings were more common with total hip arthroplasty compared to total knee arthroplasty (67.9% vs 42.2%, P < .0001, and 15.4% vs 8.3%, P < .05, respectively). Further testing was required in 6 cases (1.0%); 1 case required delay in surgery (0.2%). Using the 2016 volume of TJA procedures and assuming a 10%, 15%, and 25%, utilization rate of image-based CA TJA, the annual cost of additional testing was $2.7 million (95% confidence interval, $1.1-$6.3 million), $4.1 million ($1.6-$9.5 million), and $6.9 million (95% confidence interval, $2.7-$15.8 million), respectively. ConclusionIncidental findings are relatively common on planning images. Stakeholders should be aware of the hidden costs of incidental findings given the increasing popularity of image-based CA TJA.

Computed tomography for suspected pulmonary embolism results in a large number of non-significant incidental findings and follow-up investigations

Computed tomographic pulmonary angiograms (CTPAs) are often ordered to evaluate pulmonary embolism (PE) in the emergency department (ED). The increase use of CTPA has led to an increase in incidental findings, often of low clinical significance. Our objectives were to (1) assess the prevalence and clinical significance of incidental findings identified in patients evaluated with CTPAs for PE in the ED, (2) evaluate follow-up investigations for these incidental findings, and (3) assess the utility of routine chest X-rays done prior to CTPA. This is a historical cohort study of adult patients, presenting to two tertiary care EDs from January-December 2015, evaluated with CTPA for possible PE. Two reviewers' extracted data from electronic CT records in a standardized fashion with inter-rater reliability reported using the kappa statistic. We measured the prevalence of PE and stratified non-PE findings according to alternative diagnoses and incidental findings. Data were reported as mean and standard deviation (SD). Univariate analyses were performed with t test for continuous variables. A total of 1708 studies were included (mean 62years (SD 16.7), 56.9% female). PE was found in 233 (13.6%) patients. A total of 223 (13.1%) patients had an incidental finding, the majority of which included pulmonary nodules (n = 83, 37.2%) and adenopathy (n = 26, 11.6%). Of the incidental findings, 197 (88.3%) were non-significant and led to no definitive diagnosis of cancer. In patients who underwent both CTPA and chest X-ray, X-ray reports revealed the same diagnosis in 77% of PE-negative patients without missing a clinically significant incidental finding. Incidental findings are as common as a diagnosis of PE in patients undergoing CTPA. They are rarely clinically significant. Chest radiograph remains a reasonable initial investigation as it can aid in identifying alternative diagnoses especially in the setting of a low pre-test probability for PE.

Incidental findings on routine brain MRI scans in preterm infants

ObjectiveMany neonatal intensive care units (NICUs) have adopted the practice of performing routine brain MRI in very low birth weight (VLBW) infants at term-equivalent age in order to better evaluate...