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Incidental Findings on CBCT

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Maxillofacial Cone Beam Computed Tomography

Abstract

An incidental finding is a generic term applied in radiology to describe an occult entity discovered unexpectedly on an imaging examination performed for an unrelated reason. Some incidental findings on cone beam computed tomography (CBCT) images are readily identifiable based on radiologic presentation and location (e.g., tonsilloliths) whereas others may be inconclusive and may present as a radiologic diagnostic dilemma. The purpose of this Chapter is to describe and illustrate various CBCT incidental findings and categorize them according to clinical significance. The role of reporting dental and maxillofacial CBCT incidental findings in the context of medical radiography is discussed and recommendations for management presented.

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References

  • Allareddy V, Vincent SD, Hellstein JW, Qian F, Smoker WR, Ruprecht A (2012) Incidental findings on cone beam computed tomography images. Int J Dent 2012:871532

    Article  PubMed  PubMed Central  Google Scholar 

  • American College of Radiology (2011) ACR practice guideline for communication of diagnostic imaging findings. http://wwwacrorg/~/media/C5D1443C9EA4424AA12477D1AD1D927Dpdf. Accessed 30 Dec 2013

  • American College of Radiology (2014) ACR practice parameter for communication of diagnostic imaging findings. Revised 2014 (Resolution 11). Available at: http://www.acr.org/~/media/C5D1443C9EA4424AA12477D1AD1D927D.pdf. Accessed August 28, 2017

  • American Heart Association/American Stroke Association, Heart Disease and Stroke Statistics (2008) Update, Dallas, TX

    Google Scholar 

  • American Medical Association Council on ethical and judicial affairs (2010) Code of medical ethics 2010–2011 edition.8.082. Withholding information from patients, 269–270

    Google Scholar 

  • Arnheiter C, Scarfe WC, Farman AG (2006) Trends in maxillofacial cone beam computed tomography usage. Oral Radiol 22:80–85

    Article  Google Scholar 

  • Ballantyne C (2008) To know or not to know. Nat Med 14:797

    Google Scholar 

  • Balshi T, Wolfinger G, Yang J, Wulc D, Balshi S (2013) Prevalence of non-dental pathology in cone beam computed tomography studies for dental implants. JIACD, J Implant Adv Clin Dent 5(3):21–26

    Google Scholar 

  • Berland LL, Silverman SG, Gore RM, Mayo-Smith WW, Megibow AJ, Yee J, Brink JA, Baker ME, Federle MP, Foley WD, Francis IR, Herts BR, Israel GM, Krinsky G, Platt JF, Shuman WP, Taylor AJ (2010) Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol 7:754–773

    Article  PubMed  Google Scholar 

  • Berlin L (2000) Liability of interpreting too many radiographs. AJR Am J Roentgenol 175:17–22

    Article  CAS  PubMed  Google Scholar 

  • Berlin L (2011) The Incidentaloma: A Medicolegal Dilemma. Radiol Clin N Am 49:45–255

    Article  Google Scholar 

  • Board of Faculty of Clinical Radiology. Royal College of Radiologists (2006) Standards for the reporting and interpretation of imaging investigations. BRCR (06)1 Roy Coll Radiol. http://www.rcr.ac.uk/docs/radiology/pdf/Standardsfor Reporting and Inetrpwebvers.pdf. Last accessed 31 Dec 2013

  • Booth TC, Jackson A, Wardlaw JM, Taylor SA, Waldman AD (2010) Incidental findings found in “healthy” volunteers during imaging performed for research: current legal and ethical implications. Br J Radiol 83:456–465

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Bos D, van der Rijk MJ, Geeraedts TE, Hofman A, Krestin GP, Witteman JC, van der Lugt A, Ikram MA, Vernooij MW (2012) Intracranial carotid artery atherosclerosis prevalence and risk factors in the general population. Stroke 43:1878–1884

    Article  PubMed  Google Scholar 

  • Bouthillier A, van Loveren HR, Keller JT (1996) Segments of the internal carotid artery: a new classification. Neurosurgery 38(3):425–433

    CAS  PubMed  Google Scholar 

  • Brown S (2013) Professional norms regarding how radiologists handle incidental findings. J Am Coll Radiol 10:253–257

    Article  PubMed  Google Scholar 

  • Cağlayan F, Tozoğlu U (2012) Incidental findings in the maxillofacial region detected by cone beam CT. Diagn Interv Radiol 18:159–163

    PubMed  Google Scholar 

  • Carter L, Farman AG, Geist J, Scarfe WC, Angelopoulos C, Nair MK, Hildebolt CF, Tyndall D, Shrout M, American Academy of Oral and Maxillofacial Radiology (2008) American Academy of Oral and Maxillofacial Radiology executive opinion statement on performing and interpreting diagnostic cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 106:561–562

    Article  PubMed  Google Scholar 

  • Carter LC, Haller AD, Nadarajah V, Calamel AD, Aguirre A (1997) Use of panoramic radiography among an ambulatory dental population to detect patients at risk of stroke. J Am Dent Assoc 128:977–984

    Google Scholar 

  • Cha JY, Mah J, Sinclair P (2007) Incidental findings in the maxillofacial area with 3-dimensional cone-beam imaging. Am J Orthod Dentofacial Orthop 132:7–14

    Google Scholar 

  • Damaskos S, Aartman IH, Tsiklakis K, van der Stelt P, Berkhout WE (2015a) Association between extra- and intracranial calcifications of the internal carotid artery: a CBCT imaging study. Dentomaxillofac Radiol 44:20140432

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Damaskos S, Tsiklakis K, Syriopoulos K, Stelt P v d (2015b) Extra- and intra-cranial arterial calcifications in adults depicted as incidental findings on cone beam CT images. Acta Odontol Scand 73(3):202–209

    Article  PubMed  Google Scholar 

  • de Weert TT, Cakir H, Rozie S, Cretier S, Meijering E, Dippel DW, van der Lugt A (2009) Intracranial internal carotid artery calcifications: association with vascular risk factors and ischemic cerebrovascular disease. AJNR Am J Neuroradiol 30:177–184

    Article  PubMed  Google Scholar 

  • Dobele I, Kise L, Apse P, Kragis G, Bigestans A (2013) Radiographic assessment of findings in the maxillary sinus using cone-beam computed tomography. Stomatologija 15:119–122

    Google Scholar 

  • Doğramacı EJ, Rossi-Fedele G, McDonald F (2014) Clinical importance of incidental findings reported on smallvolume dental cone beam computed tomography scans focused on impacted maxillary canine teeth. Oral Surg Oral Med Oral Pathol Oral Radiol 118:e205–e209

    Google Scholar 

  • Drage N, Rogers S, Greenall C, Playle R (2013) Incidental findings on cone beam computed tomography in orthodontic patients. J Orthod 40:29–37

    Article  PubMed  Google Scholar 

  • Edwards R, Altalibi M, Flores-Mir C (2013) The frequency and nature of incidental findings in cone-beam computed tomographic scans of the head and neck region: a systematic review. J Am Dent Assoc 144:161–170

    Google Scholar 

  • Edwards R, Alsufyani N, Heo G, Flores-Mir C (2014) The frequency and nature of incidental findings in large-field cone beam computed tomography scans of an orthodontic sample. Prog Orthod 15:37–49

    Google Scholar 

  • Epstein RM, Korones DN, Quill TE (2010) Withholding information from patients: when less is more. N Engl J Med 362:380–381

    Article  CAS  PubMed  Google Scholar 

  • Friedlander AH, Aghazadehsanai N, Chang TI, Harada N, Garrett NR (2013) Prevalence of calcified carotid artery atheromas on panoramic images of individuals with primary hyperparathyroidism. Dentomaxillofac Radiol 42(8):20130118

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Friedlander AH, Garrett NR, Chin EE, Baker JD (2005) Ultrasonic confirmation of carotid artery atheromas diagnosed via panoramic radiography. J Am Dent Assoc 136:635–640

    Article  PubMed  Google Scholar 

  • Friedlander AH, Garrett NR, Norman DC (2002) The prevalence of calcified carotid artery atheromas on the panoramic radiographs of patients with type 2 diabetes mellitus. J Am Dent Assoc 133:1516–1523

    Article  PubMed  Google Scholar 

  • Friedlander AH, Golub MS (2006) The significance of carotid artery, atheromas on panoramic radiographs in the diagnosis of occult metabolic syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 101:95–101

    Article  PubMed  Google Scholar 

  • Friedlander AH, Lande A (1981) Panoramic radiographic identification of carotid arterial plaques. Oral Surg Oral Med Oral Pathol 52:102–104

    Article  CAS  PubMed  Google Scholar 

  • Friedlander AH, Liebeskind DS, Tran HQ, Mallya SM (2014) What are the potential implications of identifying intracranial internal carotid artery atherosclerotic lesions on cone-beam computed tomography? A systematic review and illustrative case studies. J Oral Maxillofac Surg 72:2167–2177

    Article  PubMed  Google Scholar 

  • Gorelick PB et al (1999) Prevention of a first stroke: a review of guidelines and a multidisciplinary consensus statement from the National Stroke Association. J Am Med Assoc 281:1112–1120

    Article  CAS  Google Scholar 

  • Heller MT, Harisinghani M, Neitlich JD, Yeghiayan P, Berland LL (2013) Managing incidental findings on abdominal and pelvic CT and MRI, part 3: white paper of the ACR Incidental Findings Committee II on splenic and nodal findings. J Am Coll Radiol 10:833–839

    Article  PubMed  Google Scholar 

  • Johnson PT, Horton KM, Megibow AJ, Jeffrey RB, Fishman EK (2011) Common incidental findings on MDCT: survey of radiologist recommendations for patient management. J Am Coll Radiol 8:762–767

    Article  PubMed  Google Scholar 

  • Khosa F, Krinsky G, Macari M, Yucel EK, Berland LL (2013) Managing incidental findings on abdominal and pelvic CT and MRI, part 2: white paper of the ACR incidental findings committee II on vascular findings. J Am Coll Radiol 10:789–794

    Article  PubMed  Google Scholar 

  • Koch B, Blackham A, Jones B (2007) Incidental internal carotid artery calcifications on temporal bone CT in children. Pediatr Radiol 37:141–144

    Article  PubMed  Google Scholar 

  • Lana JP, Carneiro PM, Machado Vde C, de Souza PE, Manzi FR, Horta MC (2012) Anatomic variations and lesions of the maxillary sinus detected in cone beam computed tomography for dental implants. Clin Oral Implants Res 23:1398–1403

    Google Scholar 

  • Lumbreras B, Donat L, Hernández-Aguado I (2010) Incidental findings in imaging diagnostic tests: a systematic review. Br J Radiol 83:276–289

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • MacDonald D, Chan A, Harris A, Vertinsky T, Farman AG, Scarfe WC (2012) Diagnosis and management of calcified carotid artery atheroma: dental perspectives. Oral Surg Oral Med Oral Pathol Oral Radiol 114:533–547

    Article  PubMed  Google Scholar 

  • Miles DA (2005) Clinical experience with conebeam volumetric imaging report of findings in 381 cases. Comput Tomogr 20:416–424

    Google Scholar 

  • Patel MD, Ascher SM, Paspulati RM, Shanbhogue AK, Siegelman ES, Stein MW, Berland LL (2013) Managing incidental findings on abdominal and pelvic CT and MRI, part 1: white paper of the ACR incidental findings committee II on adnexal findings. J Am Coll Radiol 10:675–681

    Article  PubMed  Google Scholar 

  • Pazera P, Bornstein MM, Pazera A, Sendi P, Katsaros C (2011) Incidental maxillary sinus findings in orthodontic patients: a radiographic analysis using cone-beam computed tomography (CBCT). Orthod Craniofac Res 14:17–24

    Google Scholar 

  • Pette GA, Norkin FJ, Ganeles J, Hardigan P, Lask E, Zfaz S, Parker W (2012) Incidental findings from a retrospective study of 318 cone beam computed tomography consultation reports. Int J Oral Maxillofac Implants 27:595–603

    PubMed  Google Scholar 

  • Pliska B, DeRocher M, Larson BE (2011) Incidence of significant findings on CBCT scans of an orthodontic patient population. Northwest Dent 90:12–16

    PubMed  Google Scholar 

  • Presidential Commission for the Study of Bioethical Issues (2013) Anticipate and communicate: ethical management of incidental and secondary findings in the clinical, research, and direct-to-consumer contexts (December 2013 Report of the Presidential Commission for the Study of Bioethical Issues. http://bioethicsgov/sites/default/files/FINALAnticipateCommunicate_PCSBI_0pdf. Accessed 16 Dec 2015

  • Price JB, Thaw KL, Tyndall DA, Ludlow JB, Padilla RJ (2012) Incidental findings from cone beam computed tomography of the maxillofacial region: a descriptive retrospective study. Clin Oral Implants Res 23:1261–1268

    Article  PubMed  Google Scholar 

  • Rogers AJ, Maher CO, Schunk JE, Quayle K, Jacobs E, Lichenstein R, Powell E, Miskin M, Dayan P, Holmes JF, Kuppermann N (2013) Pediatric emergency care applied research network. Incidental findings in children with blunt head trauma evaluated with cranial CT scans. Pediatrics 132:e356–e363

    Article  PubMed  Google Scholar 

  • Scarfe WC (2014) Incidental findings on CBCT images. A Pandora’s box? Oral Surg Oral Pathol Oral Med Oral Radiol 117:537–540

    Article  Google Scholar 

  • Schulze R, Friedlander AH (2013) Cone beam CT incidental findings: intracranial carotid artery calcification—a cause for concern. Dentomaxillofac Radiol 2:20130347

    Article  Google Scholar 

  • Sebastian S, Araujo C, Neitlich JD, Berland LL (2013) Managing incidental findings on abdominal and pelvic CT and MRI, part 4: white paper of the ACR incidental findings committee II on gallbladder and biliary findings. J Am Coll Radiol 10:953–956

    Article  PubMed  Google Scholar 

  • Tegos TJ et al (2001) The genesis of atherosclerosis and risk factors: a review. Angiology 52:89–98

    Article  CAS  PubMed  Google Scholar 

  • Tovino SA (2008) Incidental findings: a common law approach. Account Res 15:242–261

    Article  PubMed  Google Scholar 

  • Volk ML, Ubel PA (2011) Better off not knowing: improving clinical care by limiting physician access to unsolicited diagnostic information. Arch Intern Med 171:487–488

    PubMed  PubMed Central  Google Scholar 

  • Welch HG, Schwartz LM, Woloshin S (2011) Overdiagnosed: making people sick in the pursuit of health. Beacon Press, Boston, pp 90–101

    Google Scholar 

  • Wolf SM, Lawrenz FP, Nelson CA, Kahn JP, Cho MK, Clayton EW, Fletcher JG, Georgieff MK, Hammerschmidt D, Hudson K, Illes J, Kapur V, Keane MA, Koenig BA, Leroy BS, McFarland EG, Paradise J, Parker LS, Terry SF, Van Ness B, Wilfond BS (2008) Managing incidental findings in human subjects research: analysis and recommendations. J Law Med Ethics 36:219–248, 211.

    Article  PubMed  PubMed Central  Google Scholar 

  • Woodcock RJ Jr, Goldstein JH, Kallmes DF, Cloft HJ, Phillips CD (1999) Angiographic correlation of CT calcification in the carotid siphon. AJNR Am J Neuroradiol 20:495–499

    PubMed  Google Scholar 

  • Yang J (2015) Unpublished data

    Google Scholar 

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Acknowledgments

Sections of this chapter are reproduced from Scarfe WC (2014) with permission from Elsevier.

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Authors and Affiliations

  1. Division of Oral and Maxillofacial Radiology, Department of Oral and Maxillofacial Pathology, Medicine, and Surgery, Temple University Kornberg School of Dentistry, Philadelphia, PA, USA

    Jie Yang D.D.S., M.Med.Sc., M.S., D.M.D.

  2. Division of Radiology and Imaging Science, Department of Surgical/Hospital Dentistry, University of Louisville School of Dentistry, Louisville, KY, USA

    William C. Scarfe B.D.S., F.R.A.C.D.S., M.S.

  3. Aristotle University of Thessaloniki, Thessaloniki, Greece

    Christos Angelopoulos D.D.S., M.Sc.

  4. Columbia University, College of Dental Medicine, New York City, NY, USA

    Christos Angelopoulos D.D.S., M.Sc.

Authors
  1. Jie Yang D.D.S., M.Med.Sc., M.S., D.M.D.
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  2. William C. Scarfe B.D.S., F.R.A.C.D.S., M.S.
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  3. Christos Angelopoulos D.D.S., M.Sc.
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Corresponding author

Correspondence to Jie Yang D.D.S., M.Med.Sc., M.S., D.M.D. .

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Editors and Affiliations

  1. Division of Radiology and Imaging Science, Department of Surgical/Hospital Dentistry, University of Louisville School of Dentistry, Louisville, Kentucky, USA

    William C. Scarfe

  2. Aristotle University of Thessaloniki, Thessaloniki, Greece

    Christos Angelopoulos

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Yang, J., Scarfe, W.C., Angelopoulos, C. (2018). Incidental Findings on CBCT. In: Scarfe, W., Angelopoulos, C. (eds) Maxillofacial Cone Beam Computed Tomography. Springer, Cham. https://doi.org/10.1007/978-3-319-62061-9_16

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  • DOI: https://doi.org/10.1007/978-3-319-62061-9_16

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