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104 Utility and incidental findings on CT chest, abdomen and pelvis scans in neurology patients
  1. Ian Monaghan1,
  2. Peter Fernandes2
  1. 1Department of Clinical Neurosciences, Western General Hospital, Edinburgh
  2. 2Centre for Clinical Brain Sciences, University of Edinburgh

Abstract

CT scanning of the chest, abdomen and pelvis (CT-CAP) is often used by neurologists to identify underlying disease processes such as malignancy or sarcoidosis. However, the utility of CT-CAP, and the rate of incidental findings, remains uncertain.

This retrospective study investigated all CT-CAP requests by the neurology department in Edinburgh over a 5-year period (n=261), combining CT-CAP reports with electronic patient records. Incidental findings were classified by need for further investigations. Category 1 findings required further investigations (e.g. pulmonary nodule >4 mm). Category 2 findings required extra tests depending on clinical context (e.g. dilated biliary tract; liver function and surgical history determining need for further investigations). Category 3 findings did not require further investigations (e.g. simple diverticular disease).

20% (n=51) of CT-CAP scans were reported as showing an underlying malignancy, with half (n=26) confirmed as cancer by subsequent investigations. CT-CAP identified three cases of sarcoidosis and one of tuberculosis. There were 191 category 3 incidental findings, 57 category 2 incidental findings, and 27 category 1 findings.

Overall, CT-CAP shows an underlying cause of neurology symptoms in 11.5% of cases. The proportion of patients needing further tests due to category 1 or concerning category 2 incidental findings (12/57) was higher at 14.9%.

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