Published online Jan 28, 2019. doi: 10.4329/wjr.v11.i1.10
Peer-review started: October 24, 2018
First decision: December 10, 2018
Revised: January 1, 2019
Accepted: January 10, 2019
Article in press: January 10, 2019
Published online: January 28, 2019
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.
To analyse the frequency of EVIF identified on computed angiography (CT) of the upper limb.
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.
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.
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.
Core tip: We retrospectively analysed 79 upper limb computer tomography angiographys for extravascular incidental findings (EVIFs). These were grouped into 3 categories based on clinical significance, category A (immediate), category B (indeterminate) and category C (no clinical significance). A total of 153 EVIFs were reported in 52 patients. Of these 13 EVIFs (8.4%) were Category A, 50 EVIFs (32.3%) were Category B, while 91 EVIFs (59.5%) were Category C. One index case of malignancy (1.3%) and four cases of new disseminated metastatic disease (5.4%) were identified. This highlights the importance for both the reporting radiologist and the referring physician to recognize the frequency of EVIFs.