Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Jan 28, 2019; 11(1): 10-18
Published online Jan 28, 2019. doi: 10.4329/wjr.v11.i1.10
Extravascular findings during upper limb computed tomographic angiography focusing on undiagnosed malignancy
Romman Nourzaie, Jeeban Das, Hiba Abbas, Narayanan Thulasidasan, Panos Gkoutzios, Shahzad Ilyas, Leo Monzon, Tarun Sabharwal, Steven Moser, Athanasios Diamantopoulos
Romman Nourzaie, Jeeban Das, Hiba Abbas, Narayanan Thulasidasan, Panos Gkoutzios, Shahzad Ilyas, Leo Monzon, Tarun Sabharwal, Steven Moser, Athanasios Diamantopoulos, Department of Interventional Radiology, Guys’ and St. Thomas’ NHS Foundation Trust, London SE17EH, United Kingdom
Author contributions: Nourzaie R performed the data collection and data analysis; Nourzaie R and Das J wrote the paper; Das J, Diamantopoulos A, Moser S and Abbas H revised and corrected the paper; Diamantopoulos A and Abbas H revised the data analysis; Thulasidasan N, Gkoutzios P, Ilyas S and Sabharwal T critically revised the manuscript for important intellectual content; Moser S and Diamantopoulos A designed the research and revised the final paper.
Institutional review board statement: Exempted due to retrospective nature of study.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: No conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Athanasios Diamantopoulos, MD, PhD, EBIR, Department of Interventional Radiology, Guys’ and St. Thomas’ NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom. athanasios.diamantopoulos@gstt.nhs.uk
Telephone: +44-271-887188-89482 Fax: +44-271-887188-89483
Received: October 24, 2018
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
Processing time: 96 Days and 20.8 Hours
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.

Keywords: Extravascular incidental findings; Computed angiography; Upper limbs; Arterial; Extravascular findings

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.