Inzidentelle Befunde in der onkologischen Staging-CT-Untersuchung

Abstract

Incidental findings are frequently detected in modern cross sectional imaging in up to 73 % of all radiological examinations with an increasing incidence. Especially clinically relevant findings, such as thromboembolisms, inflammation or therapy associated findings can be found in staging examinations of oncological patients. Those findings should be categorized according to their clinical relevance.

Inzidentelle Befunde sind häufig in der modernen Schnittbildgebung: Sie werden in bis zu 73 % aller radiologischen Untersuchungen gefunden – mit zunehmender Inzidenz. Insbesondere bei Staging-Untersuchungen onkologischer Patienten können sich klinisch relevante Befunde wie Thromboembolien oder therapieassoziierte Veränderungen zeigen. Diese Befunde sollten anhand ihrer klinischen Relevanz klassifiziert werden, wie in diesem Beitrag dargestellt.

Schlüsselwörter

Zufallsbefund - Computertomografie - Staging-CT

Key words

incidental finding - computed tomography - staging CT

• Literatur

• 1 Jacobs PC, Mali WP, Grobbee DE. et al. Prevalence of incidental findings in computed tomographic screening of the chest: a systematic review. J Comput Assist Tomogr 2008; 32: 214-221
• 2 Lumbreras B, Donat L, Hernandez-Aguado I. Incidental findings in imaging diagnostic tests: a systematic review. Br J Radiol 2010; 83: 276-289
• 3 Furtado CD, Aguirre DA, Sirlin CB. et al. Whole-body CT screening: spectrum of findings and recommendations in 1192 patients. Radiology 2005; 237: 385-394
• 4 Orme NM, Fletcher JG, Siddiki HA. et al. Incidental findings in imaging research: evaluating incidence, benefit, and burden. Arch Intern Med 2010; 170: 1525-1532
• 5 Lumbreras B, Gonzalez-Alvarez I, Gomez-Saez N. et al. Management of patients with incidental findings in imaging tests: a large prospective single-center study. Clin Imaging 2014; 38: 249-254
• 6 Lumbreras B, Gonzalez-Alvarez I, Lorente MF. et al. Unexpected findings at imaging: predicting frequency in various types of studies. Eur J Radiol 2010; 74: 269-274
• 7 Kroczek EK, Wieners G, Steffen I. et al. Non-traumatic incidental findings in patients undergoing whole-body computed tomography at initial emergency admission. Emerg Med J 2017; 34: 643-646
• 8 Pooler BD, Kim DH, Pickhardt PJ. Potentially important extracolonic findings at screening CT colonography: incidence and outcomes data from a clinical screening program. Am J Roentgenol 2016; 206: 313-318
• 9 Samim M, Goss S, Luty S. et al. Incidental findings on CT for suspected renal colic in emergency department patients: prevalence and types in 5383 consecutive examinations. J Am Coll Radiol 2015; 12: 63-69
• 10 Surov A, Bach AG, Tcherkes A. et al. Non-osseous incidental findings in low-dose whole-body CT in patients with multiple myeloma. Br J Radiol 2014; 87: 20140185
• 11 Surov A, Bach AG, Schramm D. Clinically relevant cardiovascular findings detected on staging computed tomography in patients with several malignancies. Angiology 2016; 67: 630-637
• 12 Choy G, Kröpil P, Scherer A. et al. Pertinent reportable incidental cardiac findings on chest CT without electrocardiography gating: review of 268 consecutive cases. Acta Radiol 2013; 54: 396-400
• 13 Bach AG, Schmoll HJ, Beckel C. et al. Pulmonary embolism in oncologic patients: frequency and embolus burden of symptomatic and unsuspected events. Acta Radiol 2014; 55: 45-53
• 14 Bach AG, Beckel C, Schurig N. et al. Imaging characteristics and embolus burden of unreported pulmonary embolism in oncologic patients. Clin Imaging 2015; 39: 237-242
• 15 den Exter PL, van der Hulle T, Hartmann IJ. et al. Reliability of diagnosing incidental pulmonary embolism in cancer patients. Thromb Res 2015; 136: 531-534
• 16 Uhrig M, Simons D, Schlemmer HP. Incidental pulmonary emboli in stage IV melanoma patients: Prevalence in CT staging examinations and improved detection with vessel reconstructions based on dual energy CT. PLoS One 2018; 13: e0199458
• 17 Sebro R, Aparici CM, Pampaloni MH. Frequency and clinical implications of incidental new primary cancers detected on true whole-body 18F-FDG PET/CT studies. Nucl Med Commun 2013; 34: 333-339
• 18 Ozsoy O, Fioretta G, Ares C. et al. Incidental detection of synchronous primary tumours during staging workup for prostate cancer. Swiss Med Wkly 2010; 140: 233-236
• 19 Sato K, Ozaki K, Fujiwara S. et al. Incidental carcinomas detected by PET/CT scans in patients with malignant lymphoma. Int J Hematol 2010; 92: 647-650
• 20 Surov A, Fiedler E, Wienke A. et al. Intramammary incidental findings on staging computer tomography. Eur J Radiol 2012; 81: 2174-2178
• 21 Emmanouilides C, Glaspy J. Opportunistic infections in oncologic patients. Hematol Oncol Clin North Am 1996; 10: 841-860
• 22 Wong PS, Lau WF, Worth LJ. et al. Clinically important detection of infection as an “incidental” finding during cancer staging using FDG-PET/CT. Intern Med J 2012; 42: 176-183
• 23 Elmi A, Tabatabaei S, Talab SS. et al. Incidental findings at initial imaging workup of patients with prostate cancer: clinical significance and outcomes. Am J Roentgenol 2012; 199: 1305-1311
• 24 Meyer HJ, Uhlig J, Schramm D. et al. Radiological findings on irradiation-CT in patients with non metastatic breast cancer. Br J Radiol 2017; 90: 20170162
• 25 Li L, Mok H, Jhaveri P. et al. Anticancer therapy and lung injury: molecular mechanisms. Expert Rev Anticancer Ther 2018; 18: 1041-1057
• 26 Bruzzi JF, Truong MT, Marom EM. et al. Incidental findings on integrated PET/CT that do not accumulate 18F-FDG. Am J Roentgenol 2006; 187: 1116-1123