Incidental findings on MRI of the temporomandibular joint

Objectives:

The aim of this study was to determine the prevalence of incidental findings in MRI of the temporomandibular joint (TMJ).

Methods:

MRI reports of 730 patients were assessed. The reports were analysed by one consultant and one clinical lecturer in dental and maxillofacial radiology. The prevalence of intracranial and extracranial incidental findings was recorded and categorized.

Results:

There were 53 (7.3%) incidental findings, of which 11 (1.5%) were intracranial and 42 (5.7%) were extracranial (divided into paranasal sinuses, mastoid air cells, muscle hypertrophy, lymphadenopathy and salivary glands). A total number of eight intracranial findings needed further dedicated imaging and/or specialist clinical opinion. Only one tumour (a meningioma) was found and required surgical intervention.

Conclusions:

Incidental findings on TMJ MRI are rare but not unheard of. The clinical relevance of incidental findings can be significant, and it is therefore important to ensure that the full data set of images is inspected, including any scout slices. A close working relationship between the areas of dental and maxillofacial radiology and neuroradiology is essential in expediting a second opinion relating to intracranial findings. All incidental findings should be communicated to referring clinicians in a timely manner, based on their urgency and clinical significance.     

The prevalence and clinical importance of incidental soft-tissue findings in cervical CT scans of trauma population

Objectives:

To define the age-related prevalence of incidental soft-tissue findings in cervical CT scans of a trauma population and to investigate their clinical importance.

Methods:

The original diagnostic radiology reports and the CT images of the 357 patients with cervical trauma were retrospectively evaluated. Incidental soft-tissue findings were investigated. All findings were grouped according to age. The findings were classified based on their clinical importance into three categories: Category 1: no clinical importance, Category 2: possible clinical importance requiring further investigation and Category 3: obvious clinical importance. In addition, the medical records of the patients were investigated. The follow-up ratio of the pathologies mentioned in the original radiology report was recorded.

Results:

The most frequently encountered findings in Categories 2 and 3 were carotid artery calcification (n = 89, 24.9%) and tonsillolith (n = 115, 32.2%), respectively. The reporting ratio in the original reports of Categories 1, 2 and 3 findings was 1.1% (n = 4), 9% (n = 27) and 34.5% (n = 64), respectively. No further investigations and follow-up was accomplished for Category 1 lesions, whereas 11.1% of Category 2 and 35.9% of Category 3 lesions were subjected to further investigations and follow-up.

Conclusions:

The cervical CT scans of trauma patients reveal many clinically important soft-tissue incidental findings. Cervical region incidental findings may be followed up on an outpatient basis, rarely being of life-threatening value. The ratio of reporting and follow-up of incidental findings increases parallel to the clinical importance of the lesions.     

Peri- and post-menopausal incidental adnexal masses and the risk of sporadic ovarian malignancy: new insights and clinical management

Adnexal masses are common among peri- and post-menopausal women. Although ovarian cancer is a significant cause of mortality in menopausal women, large population-based studies demonstrate that the majority of adnexal masses are benign. Despite this, the appearance of an adnexal mass is a concern for the patient and an insight exercise for physicians. In most cases, an adnexal enlargement is an incidental finding, generally corresponding to a benign cyst and easily diagnosed by conventional ultrasound. Exceptionally an ovarian tumour may be malignant and should be treated as early as possible. When conventional ultrasound renders complex morphology other diagnostic tools must be used such as: colour Doppler and functional tumour vessel properties, serum CA 125 levels, nuclear magnetic resonance imaging and in some cases laparoscopy. Several new tumour markers are being studied for clinical application, although there are presently no clear recommendations. Adnexal masses with benign morphological and functional properties must be periodically monitored as an alternative to surgery since malignant transformation is exceptional.     

Patient-centered clinical impact of incidentally detected abnormalities on chest CT scans

Purpose

To demonstrate the spectrum of incidental findings on chest CT scans and to evaluate the clinical impact of significant different abnormalities on patient management.

Materials and methods

This retrospective study included incidental findings on chest CT scans from an adult patient population, performed at the University of Washington, within a 10 month period. After exclusion of repetitive findings, 113 patients (50 males and 63 females, age 18–96 years, mean = 57.3 years) demonstrated 163 uniquely different findings. We determined the clinical significance according to the need for further workup and/or therapy. The gold standard for diagnosis was either by pathologic proof, follow up CT, or other imaging modalities.

Results

38 different findings were judged clinically significant (10.4%) requiring further workup and/or therapy in 9.6% and 7.1%, respectively. The anatomic site of disease was: intra-thoracic (n = 27, 71.1%), extra-thoracic (n = 5, 13.1%), lower neck (n = 3, 7.9%), and upper abdomen (n = 3, 7.9%). They included 12 unique malignant pathologies (31.6%), and 26 non-malignant findings (68.4%).

Conclusion

The clinically significant different incidental abnormalities on chest CT scans represented 10.4% of all incidental findings, 3.3% were due to malignancies. The clinical impact of incidental abnormalities on chest CT may be of utmost importance on patient care.     

Incidental papillary microcarcinoma of the thyroid.

Papillary microcarcinoma (PMC) is a thyroid tumor measuring 10mm or less in maximum diameter and comprise up to 30% of all papillary thyroid cancers. Most of them are detected incidentally and defined as incidental papillary microcarcinoma (IPCincidental cancers found in surgical specimens of benign thyroid diseases is high. Although most PMC are incidental, all incidental papillary cancers cannot be classified as microcarcinoma, owing to their size that may be larger than 10mm. Not much is known about the biological behavior and clinical course of IPC相似文献   

无症状膀胱肿瘤27例临床分析

目的探讨无症状膀胱肿瘤的临床特征、诊治方法。方法对27例无症状膀胱肿瘤患者的临床资料进行回顾性分析,并与同期170例有症状就诊,诊断为膀胱肿瘤患者的临床资料进行比较。结果与有症状膀胱肿瘤相比,无症状膀胱肿瘤均为Ta~T1期肿瘤,多数病理分级低。结论超声检查对早期发现无症状膀胱肿瘤有重要作用。无症状膀胱肿瘤中膀胱癌多见,但恶性程度低,肿瘤表浅,预后良好,术后复发率低。     

Cáncer de vesícula biliar en un hospital comarcal

Objectives

To assess the management of gallbladder cancer (GBC) in our region.

Material and methods

Data on 372 patients who underwent cholecystectomy were identified from our database (January 2003 to February 2008) and 6 patients were found to have GBC.

Results

Four patients had incidental carcinoma, one case was preoperatively suspected, and one patient presented with jaundice and locally advanced neoplasia. The incidence was 2 per 100,000 inhabitants per year; incidental carcinoma in 1.1% of cholecystecomies. The ultrasonography showed multilithiasis in 2 patients, sludge and neoplasia in 1, gallstones more than 3 cm in 2, and tumor mass only in 1 case. T stage: 1 case of T0 (in situ), 1 of T1, 2 of T2 and one T4. Incidental carcinomas were reoperated on when a T2 was established: 2 underwent lymphadenectomy and cystic stump resection, 1 segmentectomy IVb-V and lymphadenectomy. In the preoperative suspected neoplasia a cholecystectomy, lymphadenectomy, and partial hepatic gallbladder bed resection was initially performed.

Conclusions

GBC has a low incidence but it will be found in 1% of cholecystectomies. There is no adjuvant treatment and T-based surgical treatment is the is the only opportunity to reach cure in those patients. A national GBC database would be helpful in the publication of national guidelines for this disease.     

膀胱癌根治术后患者前列腺偶发癌临床特征分析

异,以及比较具有临床意义和无临床意义的前列腺癌,两组之间膀胱癌分级分期、肿瘤特异性生存率等指标差异。结果:96例病例中,有14例(14.6%)发现合并前列腺偶发癌,且所有肿瘤分期均在pT2以内。Gleason 评分10例≤6分(71.4%),4例≥7分(28.6%)。合并前列腺偶发癌的患者年龄比未合并前列腺偶发癌患者的年龄更大,具有统计学意义。但两组的膀胱癌病理学特征差异无统计学意义。患者总体生存率取决于膀胱癌的分期和淋巴结是否转移,前列腺偶发癌不会降低膀胱癌根治术术后患者的总体存活率。结论:膀胱癌根治术术后无患者死于前列腺癌,可见前列腺偶发癌对膀胱癌患者总体生存率无明显影响,术后无需对前列腺癌进行检测与治疗。     

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.