title: Prevalence and clinical significance of extravascular incidental findings in patients undergoing CT cervico-cerebral angiography.
abstract: BACKGROUND
  CT cervico-cerebral angiography (CTCCA) is now the first line diagnostic imaging modality for the majority of vascular pathologies of the head and neck with diagnostic value comparable to or better than traditional angiographic techniques. The aim of this study was to assess the prevalence, clinical significance and management of extravascular incidental findings detected on CTCCA.
  
  
  METHODS
  A retrospective review of the CTCCA reports of 302 consecutive patients from 2009 to 2013 was undertaken. Extravascular incidental findings were classified, according to an adaptation of the CT colonography data and reporting system (CRADS), as EV1-EV4. EV1=no incidental findings, EV2=clinically insignificant incidental finding, EV3=incidental finding of intermediate clinical significance, EV4=highly clinically significant finding. Follow up of the electronic medical records of patients with EV3 or EV4 findings was undertaken to determine subsequent management.
  
  
  RESULTS
  Potentially clinically significant findings were demonstrated in 14.2% of patients with 8.6% of patients having a highly clinically significant finding. 4 incidental findings were confirmed to be malignant lesions and 5 required acute intervention. In addition 19% of patients with highly clinically significant incidental findings did not receive appropriate follow up.
  
  
  CONCLUSIONS
  This study has demonstrated the presence of clinically important incidental findings in a significant proportion of patients undergoing CTCCA with a significant minority of these patients not receiving follow up. A standardised method of reporting incidental findings, such as that used in this paper, would aid radiologists and referring physicians in recording and communicating these findings.
authors.affiliation: Department of Radiology, Mater Misercordiae University Hospital, Dublin, Ireland. Electronic address: crockettmt@gmail.com.
authors.forename: Matthew Thomas
authors.initials: MT
authors.lastname: Crockett
authors.affiliation: Department of Radiology, Mater Misercordiae University Hospital, Dublin, Ireland. Electronic address: blathnaidmurphy@hotmail.com.
authors.forename: Blathnaid
authors.initials: B
authors.lastname: Murphy
authors.affiliation: Department of Radiology, Mater Misercordiae University Hospital, Dublin, Ireland. Electronic address: jennifer.js.smith@gmail.com.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Smith
authors.affiliation: Department of Radiology, Mater Misercordiae University Hospital, Dublin, Ireland. Electronic address: kavanaghec@gmail.com.
authors.forename: Eoin Carl
authors.initials: EC
authors.lastname: Kavanagh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography / Q000379:methods*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D009333:Neck; D015995:Prevalence; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014652:Vascular Diseases / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: CT angiography; CT cervico-cerebral angiography; Head and neck; Incidental findings; Neuroradiology