title: Lumbar Transforaminal Epidural Steroid Injections: Incidental Extraspinal Findings on Planning Imaging.
abstract: OBJECTIVE
  Planning imaging performed during CT-guided procedures may occasionally contain important incidental findings. The purpose of this study was to identify and characterize by clinical relevance the extraspinal findings detected on planning imaging for CT-guided lumbar transforaminal epidural steroid injections (TFESIs).
  
  
  METHODS
  Four radiologists retrospectively evaluated the planning scout views and CT studies for 488 consecutive CT-guided lumbar TFESIs performed in 400 patients over a 1-year period. Incidental extraspinal findings were identified and used to characterize patients by the need for follow-up using the CT Colonography Reporting and Data System (C-RADS), a classification scheme originally developed to characterize incidental findings on CT colonography. Patients with C-RADS E4 findings have potentially important findings that should be communicated to the referring physician; patients with C-RADS E3 findings have findings that are likely unimportant, but workup may be indicated. All previously unknown C-RADS E3 and E4 findings discovered in the course of this research were reported to referring physicians for appropriate patient follow-up.
  
  
  RESULTS
  Ten of 400 (2.5%) patients were classified as C-RADS E4; the most common C-RADS E4 finding was vascular aneurysm or stenosis (4/400, 1.0%). Thirteen of 400 (3.3%) patients were classified as C-RADS E3; the most common C-RADS E3 finding was hepatomegaly (4/400, 1.0%). Of 22 patients with C-RADS E3 and E4 findings unknown to clinicians, the finding for only one (4.5%) was communicated to clinicians at the time of the procedure.
  
  
  CONCLUSIONS
  Clinically important incidental extraspinal findings were identified in 5.8% of patients on the planning imaging performed for CT-guided lumbar TFESIs. Communication of clinically important findings was poor (4.5%).
authors.affiliation: 1 Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, 2nd Fl, East Wing, Ste 200, Pittsburgh, PA 15213.
authors.forename: Gerritt M
authors.initials: GM
authors.lastname: Lagemann
authors.affiliation: 1 Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, 2nd Fl, East Wing, Ste 200, Pittsburgh, PA 15213.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Aldred
authors.affiliation: 1 Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, 2nd Fl, East Wing, Ste 200, Pittsburgh, PA 15213.
authors.forename: Amir A
authors.initials: AA
authors.lastname: Borhani
authors.affiliation: 1 Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, 2nd Fl, East Wing, Ste 200, Pittsburgh, PA 15213.
authors.forename: Anish
authors.initials: A
authors.lastname: Ghodadra
authors.affiliation: 1 Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, 2nd Fl, East Wing, Ste 200, Pittsburgh, PA 15213.
authors.forename: Vikas
authors.initials: V
authors.lastname: Agarwal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D023881:Colonography, Computed Tomographic / Q000706:statistics & numerical data; D005260:Female; D006529:Hepatomegaly / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D033162:Incidental Findings; D007268:Injections, Epidural / Q000706:statistics & numerical data*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D015641:Radiography, Interventional / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013256:Steroids / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014652:Vascular Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D013256:Steroids
keywords: CT Colonography Reporting and Data System (C-RADS); incidental finding; nerve root block (NRB); transforaminal epidural steroid injection (TFESI)