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      Renal incidental findings on computed tomography : Frequency and distribution in a large non selected cohort

      research-article
      Author(s): , MD a , b , a , , MD a , , MD, PhD a , , MD b , ∗
      Editor(s):
      Publication date (Electronic):
      Journal: Medicine
      Publisher: Wolters Kluwer Health
      Keywords: CT, incidental findings, renal

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          Abstract

          Renal incidental findings (IFs) are common. However, previous reports investigated renal IFs were limited to patient selection. The purpose of this study was to estimate the prevalence and distribution of all renal IFs on computed tomography (CT) in a large patient collective.

          All patients, who underwent CT investigations of the abdominal region at our institution in the time period between January 2006 and February 2014 were included in this study. Inclusion criteria were as follows: no previous history of renal diseases and well image quality. Patients with known kidney disorders were excluded from the study. Overall, 7365 patients meet the inclusion criteria were identified. There were 2924 (39.7%) women and 4441 men (60.3%) with a mean age of 59.8 ± 16.7 years. All CTs were retrospectively analyzed in consensus by 2 radiologists. Collected data were evaluated by means of descriptive statistics.

          Overall, 2756 patients (37.42% of all included patients) showed 3425 different renal IFs (1.24 findings per patient). Of all renal IFs, 123 (3.6%) findings were clinically relevant, 259 (7.6%) were categorized as possibly clinically relevant, and 3043 (88.8%) were clinically non relevant.

          Different renal IFs can be detected on CT. The present study provides a real prevalence and proportion of them in daily clinical routine. Kidneys should be thoroughly evaluated because of the fact that incidental renal findings occur frequently.

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          Managing incidental findings in human subjects research: analysis and recommendations.

          Susan M Wolf, Frances P Lawrenz, Charles A. Nelson … (2008)
          No consensus yet exists on how to handle incidental findings (IFs) in human subjects research. Yet empirical studies document IFs in a wide range of research studies, where IFs are findings beyond the aims of the study that are of potential health or reproductive importance to the individual research participant. This paper reports recommendations of a two-year project group funded by NIH to study how to manage IFs in genetic and genomic research, as well as imaging research. We conclude that researchers have an obligation to address the possibility of discovering IFs in their protocol and communications with the IRB, and in their consent forms and communications with research participants. Researchers should establish a pathway for handling IFs and communicate that to the IRB and research participants. We recommend a pathway and categorize IFs into those that must be disclosed to research participants, those that may be disclosed, and those that should not be disclosed.
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            Incidental findings in imaging diagnostic tests: a systematic review.

            B Lumbreras, L Donat, I Hernández-Aguado (2010)
            The objective of this review is to summarise the available evidence on the frequency and management of incidental findings in imaging diagnostic tests. Original articles were identified by a systematic search of the MEDLINE, EMBASE and Cochrane Library Plus databases using appropriate medical headings. Extracted variables were study design; sample size; type of imaging test; initial diagnosis; frequency and location of incidental findings; whether clinical follow-up was performed; and whether a definitive diagnosis was made. Study characteristics were assessed by one reviewer and checked by a second reviewer. Any disagreement was solved by consensus. The relationship between the frequency of incidental findings and the study characteristics was assessed using a one-way ANOVA test, as was the frequency of follow-up of incidental findings and the frequency of confirmation. 251 potentially relevant abstracts were identified and 44 articles were finally included in the review. Overall, the mean frequency of incidental findings was 23.6% (95% confidence interval (CI) 15.8-31.3%). The frequency of incidental findings was higher in studies involving CT technology (mean 31.1%, 95% CI 20.1-41.9%), in patients with an unspecific initial diagnosis (mean 30.5, 95% CI 0-81.6) and when the location of the incidental findings was unspecified (mean 33.9%, 95% CI 18.1-49.7). The mean frequency of clinical follow-up was 64.5% (95% CI 52.9-76.1%) and mean frequency of clinical confirmation was 45.6% (95% CI 32.1-59.2%). Although the optimal strategy for the management of these abnormalities is still unclear, it is essential to be aware of the low clinical confirmation in findings of moderate and major importance.
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              Incidental finding of renal masses at unenhanced CT: prevalence and analysis of features for guiding management.

              Perry Pickhardt, S. Silverman, Octavio M. Oliva … (2011)
              The purposes of this study were to investigate the frequency and clinical relevance of the incidental finding of renal masses at low-dose unenhanced CT and to analyze the results for features that can be used to guide evaluation. Images from unenhanced CT colonographic examinations of 3001 consecutively registered adults without symptoms (1667 women, 1334 men; mean age, 57 years) were retrospectively reviewed for the presence of cystic and solid renal masses 1 cm in diameter or larger. An index mass, that is, the most complex or concerning, in each patient was assessed for size, mean attenuation, and morphologic features. Masses containing fat or with attenuation less than 20 HU or greater than 70 HU were considered benign if they did not contain thickened walls or septations, three or more septations, mural nodules, or thick calcifications. Masses with attenuation between 20 and 70 HU or any of these features were considered indeterminate. The performance of CT colonography in the detection of renal cell carcinoma was calculated for masses with 2 or more years of follow-up. At least one renal mass was identified in 433 (14.4%) patients. The mean size of the index masses was 25 ± 16 mm; 376 (86.8%) masses were classified as benign and 57 (13.2%) as indeterminate. The 20- to 70-HU attenuation criterion alone was used for classification of 53 indeterminate lesions. Follow-up data (mean follow-up period, 4.4 years; range, 2-6.3 years) were available for 353 (81.5%) patients with masses (41 indeterminate, 312 benign). Four of the 41 indeterminate masses were diagnosed as renal cell carcinoma. The sensitivity and specificity for renal cell carcinoma on the basis of the indeterminate criteria were 100% and 89.4%. The positive and negative predictive values were 9.8% and 100%. The incidental finding of a renal mass is relatively common at unenhanced CT, but imaging criteria can be used for reliable identification of most of these lesions as benign without further workup. Mean attenuation alone appears reliable for determining which renal masses need further evaluation.
              Article 0 comments Cited 36 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Medicine (Baltimore)
                Journal ID (iso-abbrev): Medicine (Baltimore)
                Journal ID (publisher-id): MEDI
                Title: Medicine
                Publisher: Wolters Kluwer Health
                ISSN (Print): 0025-7974
                ISSN (Electronic): 1536-5964
                Publication date Collection: June 2017
                Publication date (Electronic): 30 June 2017
                Volume: 96
                Issue: 26
                Electronic Location Identifier: e7039
                Affiliations
                [a ]Department of Radiology, Martin-Luther-University Halle-Wittenberg, Halle
                [b ]Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany.
                Author notes
                [∗ ]Correspondence: Alexey Surov, Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany (e-mail: Alexey.Surov@ 123456medizin.uni-leipzig.de ).
                Article
                Publisher ID: MD-D-17-01363 Accession ID: 07039
                DOI: 10.1097/MD.0000000000007039
                PMC ID: 5500020
                PubMed ID: 28658098
                SO-VID: a2ae4964-f99c-4ee5-b0be-2c5689ab6407
                Copyright © Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0

                History
                Date received : 13 March 2017
                Date revision received : 9 May 2017
                Date accepted : 10 May 2017
                Categories
                Subject: 5200
                Subject: Research Article
                Subject: Observational Study
                Custom metadata
                OPEN-ACCESS TRUE

                Keywords: ct,incidental findings,renal
                Data availability:
                Keywords: ct, incidental findings, renal

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