title: Extravascular incidental findings in run-off CT angiography in patients with acute limb ischaemia: incidence and clinical relevance.
abstract: OBJECTIVE
  To evaluate the incidence and clinical relevance of extravascular incidental findings (EVIFs) in CT angiography of the abdominal aorta and lower extremities (run-off CTA) in patients presenting with acute limb ischaemia (ALI).
  
  
  METHODS
  In this institutional review board-approved, retrospective study, 141 run-off CTA examinations conducted between 2005 and 2013 of patients (67 women, mean age 80 years; 74 men, mean age 69 years) presenting with clinical symptoms of ALI were re-evaluated by two radiologists (2 and 7 years of experience in interpreting run-off CTA). Imaging was conducted using 16- and 64-section CT systems. Image acquisition ranged from the costodiaphragmatic recess to the forefoot. The medical history form of each patient served as the standard of reference for assessment of incidence of EVIFs. CT morphology was assessed to assign EVIFs to one of three categories of clinical relevance: (I) immediate, (II) potential, and (III) no clinical relevance.
  
  
  RESULTS
  Thirty-eight patients had category I findings, including four patients (2.8%) with previously unknown malignancy and 67 patients with category II EVIFs. In total 473 extravascular EVIFs were found in 141 patients: 52 category I, 163 category II and 258 category III.
  
  
  CONCLUSIONS
  EVIFs with immediate clinical relevance are very common in run-off CTA in patients presenting with acute peripheral artery disease. Therefore, it is important to evaluate all body regions included in a CT examination carefully, even if the clinical focus is on vascular evaluation. The adequate classification of these EVIFs is required to avoid possible unnecessary diagnostic work-up with associated risks and costs.
authors.affiliation: Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Preuß
authors.affiliation: Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Elgeti
authors.affiliation: Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Hamm
authors.affiliation: Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. Electronic address: werncke.thomas@mh-hannover.de.
authors.forename: T
authors.initials: T
authors.lastname: Werncke
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D033162:Incidental Findings; D007511:Ischemia / Q000000981:diagnostic imaging*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed