Lumbar transforaminal epidural steroid injections: Incidental extraspinal findings on planning imaging

Objective. Planning imaging performed during CT-guided procedures may occasionally contain important incidental fndings. The purpose of this study was to identify and characterize by clinical relevance the extraspinal fndings detected on planning imaging for CTguided lumbar transforaminal epidural steroid injections (TFESIs). MATERIALS AND METHODS. Four radiologists retrospectively evaluated the planning scout views and CT studies for 488 consecutive CT-guided lumbar TFESIs performed in 400 patients over a 1-year period. Incidental extraspinal fndings were identifed and used to characterize patients by the need for follow-up using the CT Colonography Reporting and Data System (C-RADS), a classifcation scheme originally developed to characterize incidental fndings on CT colonography. Patients with C-RADS E4 fndings have potentially important fndings that should be communicated to the referring physician; patients with C-RADS E3 fndings have fndings that are likely unimportant, but workup may be indicated. All previously unknown C-RADS E3 and E4 fndings discovered in the course of this research were reported to referring physicians for appropriate patient follow-up. RESULTS. Ten of 400 (2.5%) patients were classifed as C-RADS E4; the most common C-RADS E4 fnding was vascular aneurysm or stenosis (4/400, 1.0%). Thirteen of 400 (3.3%) patients were classifed as C-RADS E3; the most common C-RADS E3 fnding was hepatomegaly (4/400, 1.0%). Of 22 patients with C-RADS E3 and E4 fndings unknown to clinicians, the fnding for only one (4.5%) was communicated to clinicians at the time of the procedure. CONCLUSION. Clinically important incidental extraspinal fndings were identifed in 5.8% of patients on the planning imaging performed for CT-guided lumbar TFESIs. Communication of clinically important fndings was poor (4.5%).