Extraspinal Findings at Lumbar Spine CT Examinations: Prevalence and Clinical Importance
Radiology: Volume 263: Number 2-May 2012
Stefanie Y.Lee, MD Mark S.Landis, MD, MSc, FRCPC Ian G. Ross, MD, FRCPC Aashish Goela, MD, MSc, FRCPC Andrew E. Leung, MD, FRCPC
Purpose: : To prospectively determine the prevalence and clinical im-portance of extraspinal abnormalities in adult outpatients undergoing computed tomography (CT) of the lumbar spine.
Materials and methods: Institutional review board approval was obtained for this prospective study. Informed consent was obtained from 400 consecutive adult outpatients (mean age, 49 years; 212 male and 188 female patients) undergoing lumbar spine CT for low back pain and/or radiculopathy. Those with known malignancy were excluded. Dedicated spinal and abdominal full-field-of-view (FOV) images for each patient were reviewed by at least one neuroradiologist and two body radiologists. Extraspinal abnormalities were classified according to the CT Colonography Reporting and Data System (C-RADS). The electronic medical re-cord of the patients with C-RADS E3 and E4 extraspinal findings were reviewed to assess how many of these find¬ings were previously unknown, and the patients were fol¬lowed up 24-36 months after the initial CT to determine their work-up and outcome.
Results: Extraspinal findings were present on images in 162 (40.5%) of 400 lumbar spine CT examinations; 59 (14.8%) patients had indeterminate or clinically important findings requiring clinical correlation or further evaluation. After review of the electronic medical record, the prevalence of clinically important findings was 4.3%, comprising an early-stage renal cell carcinoma and transitional cell car-cinoma, chronic lymphocytic leukemia, sarcoidosis, and 13 abdominal aortic aneurysms. Excluding anatomic vari-ants, the full FOV was required to best visualize extraspi¬nal abnormalities in 127 (79.4%) of 160 patients.
Conclusion: Reviewing the full-FOV images from lumbar spine CT examinations will result in the detection of a small number of substantial extraspinal pathologic findings in addition to many benign incidental findings.