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Incidental findings in CT angiography performed in acute stroke
patients and change of management: single center observation
Sabou TC., Höltje J., Bonk F, Pohlmann C., Urban P.P., Brüning R.
EP #72
Radiology and Neuroradiology,
Asklepios Klinik Barmbek, 22291 Hamburg, Germany
Purpose
In the diagnostic process of acute stroke in most centers computed
tomography (CT) is established as a combination of unenhanced
cranial CT, plus CT angiography and CT- based perfusion
measurements.
Aim of this retrospective evaluation was to evaluate the percentage
of incidental findings during this CTA scans (from aortic arch), and to
evaluate changes in therapy based on these observations.
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Materials and Methods
We have retrospectively selected from the PACS-Database 100
patients which underwent an unenhanced cranial CT examination
and a CT-Angiography between 20.3. and 06.08.2012 (median age
74y, 31y-95y; 52 males, 48 females).
CTA scan range was from the aortic arch to scull in all cases at an
injection of 80 - 130 cc contrast (body weight adapted).
The raw data (Philips Brilliance 40 and GE Optima 660) were
reconstructed in axial, sagittal and coronal planes with a 2-3 mm
slice thickness.
Image acquisition was followed by a consensual evaluation and
classification (resident and neuroradiologist) according to a
predefined score (e.g. in category 1 for pulmonary lesions)=
dissection, bronchial carcinoma, pulmonary embolism).
From the hospital’s SAP database a possible change of patient
management was retrospectively evaluated.
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Results
The following secondary findings were observed in a total of 73/100
patients:
• pulmonary section: 20% (for example pulmonary carcinoma,
pulmonary artery embolism);
• Vascular: 44% (i.e. dissection, figure 1),
• intracranial findings: 19% (for example hypophyseal adenoma)
• musculoskeletal findings: 11% (for example epidural hemaotma
in the cervical spine, figure 3):
• ENT-section: 5%.
Secondary findings which altered the treatment strategy such
as central pulmonary embolism, acute pulmonary edema (figure 2a)
or lung carcinoma (figure 2c) were observed in 14 patients.
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Figure 1
86 years old female patient: the CT angiography shows a Stanford B
aortic dissection with a partially thrombosed lumen (1a- 1c).
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Figure 2
In the partially depicted, apical lung segments one could see
secondary findings such as pulmonary edema (2a), pleural effusion
with pneumonic infiltration (2b) and a lesion suspected to be tumor
(2c),
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Figure 3
In an 68 year old patient the CT scan revealed a space occupying
lesion in the cervical spinal canal (3a, arrow); with suspicion of
epidural hematoma in the MRI study next morning (3b)
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Pulmonary Vessels
Pulmonary
1 Aneurysm
embolism
Pulmonary mass 1 dissection
(ACI/Stanford B)
Intracranial
3 Lymphoma
3 Meningeoma
Lymph nodes
mediastinal
1 Stenosis of internal
3 Cavernoma
carotid artery (NASCET
<49% 1) or subclavian
artery
Pleural effusion 6 Cerebral sinus or vein 1 DVA
thrombosis
Pulmonary
edema
2
Intrapolmonary 3
noduloes
Emphysema
4
Pulmonary
inflammation
4
Lymphoma
Adenoma
Chronic subdural
hematma
ICB, SAB
Hemorhagic
transformation
Posttraumatic bleeding
Skelettal
Neck
1 Disc herniation 1 Enlarged
2
lymph nodes
2 Fractures
1 Tumor ENT
1
1 Fracture
1 Thyroid
3
enlargement
1 Spinal canal
5 Mass other
stenosis > Kang
I
1 Ventro-lithesis 1
1
1 Compression 1
fracture
1 Neuroforamina 3
l stenosis
9 Osseous lesion 1
1
2
TOTAL
73
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Literature
1.William B. Hall, MD; Sherstin G. Truitt, MD; Leslie P. Scheunemann, MD; Sidharth A. Shah, MD;
M. Patricia Rivera, MD; Leonard A. Parker, MD; Shannon S. Carson, MD; The Prevalence of
Clinically Relevant Incidental Findings on Chest Computed Tomographic Angiograms Ordered to
Diagnose Pulmonary Embolism. Arch Intern Med. 2009;169(21):1961-1965.
doi:10.1001/archinternmed.2009.360;
2.Hoffstetter P1, Herold T, Daneschnejad M, Zorger N, Jung EM, Feuerbach S, Schreyer AG. Nontrauma-associated additional findings in whole-body CT examinations in patients with multiple
trauma. Rofo. 2008 Feb;180(2):120-6. Epub 2007 Nov 16. Broderick JP, Palesch YY, Demchuk
AM, et.al.;
3.von Kalle T, Fabig-Moritz C, Heumann H, Winkler P. Incidental findings in paranasal sinuses
and mastoid cells: a cross-sectional magnetic resonance imaging (MRI) study in a pediatric
radiology department. Rofo. 2012 Jul;184(7):629-34. doi: 10.1055/s-0032-1312861. Epub
2012 May 22.
4.Weber C, Grzyska U, Lehner E, Adam G. Clinical relevance of cranial CT under emergency
conditions--basic neuroradiologic investigations. Rofo. 2003 May;175(5):654-62.
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Conclusion
A high number of examination in acute stroke patients yielded
incidental findings within the examined region.
In our single center analysis, in 14% patients had an alternative
treatment strategy based on CT findings, especially chest findings.
For questions please contact [email protected]
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