Incidental findings on cervical spine computed tomography scans: overlooked and unimportant?

PURPOSE: Imaging of the cervical spine for trauma or degenerative disease includes multiple areas of the head and neck that may harbor incidental findings. We sought to determine the incidence of common "incidentalomas" on cervical spine CT scans, their importance, and how often these lesions are mentioned in reports. METHODS: We retrospectively reviewed the cervical spine CTs and reports of all patients scanned between October 2017 and January 2018 for Tornwaldt cysts (TC), thyroglossal duct cysts and remnants (TGDC), laryngoceles (LC), pharyngoceles (PC), carotid artery calcified stenosis (CACS), and aberrant right subclavian arteries (ARSA). Descriptive statistics were performed, and the incidence of cancers (in PC and LCs) and strokes (in high-grade carotid stenosis) was assessed. RESULTS: Among 2116 patients, the incidences of findings were TC 6.6% (138/2100), TGDC 6.3% (122/1770), LC 9.4% (197/2100), PC 6.4% (135/2100), CACS 4.7% (100/2114), and ARSA 0.86% (18/2097). Of the 2116 patients studied, 600/2116 (28.3%) had at least one incidental finding. Only 2.9% (20/701) of incidentalomas were mentioned in the official reports. CONCLUSION: Cervical incidentalomas vary in rates from ARSA (0.86%) to LC (9.4%). They are rarely mentioned in radiologists' reports. Whether improved vigilance and reporting of these incidentalomas would benefit patient care should be explored.

Vascular imaging in the initial evaluation of embolic stroke source.

PURPOSE: During acute ischemic stroke evaluations, neurovascular imaging is commonly performed to localize the source of a thromboembolus and to identify vascular stenoses. In this study, we aimed to analyze 1) the usefulness of intracranial and/or cervical CTA and MRA and carotid doppler ultrasound (DUS) for identifying the stroke source and 2) the incidence of vascular stenoses across stroke etiologies. METHODS: We retrospectively reviewed intracranial and/or cervical CTA, DUS and MRA studies to identify the source of the acute stroke by Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria for 200 consecutive patients admitted with a stroke to our tertiary hospital. Stroke etiologies were ascertained and the rates of intracranial and cervical vascular stenoses were stratified by stroke type. RESULTS: Of 200 patients, the most probable sources of stroke were small vessel disease (29%), cardioembolic (26.0%) and atheroembolic (23.5%). Across all groups, 27.5% of patients had ≥70% stenosis on neurovascular imaging. The rate of ≥70% vascular stenosis in the neck was 6.9% and 5.8% in the small vessel and cardioembolic categories, respectively. CONCLUSIONS: The TOAST etiologies of strokes were nearly equally distributed. Neurovascular imaging was of high utility for identifying large vessel intracranial stenoses in patients presenting with acute stroke across all etiologies, although neck CTA/MRA had a lower rate of positive studies with cardiogenic and small vessel strokes. These findings have implications on the use of CTA/MRA in acute stroke work-up.