A new medical imaging postprocessing and interpretation concept to investigate the clinical relevance of incidentalomas: can we keep Pandora's box closed?. (June 2023)

• Record Type: Journal Article
• Authors: Kwee, Thomas C; Roest, Christian; Kasalak, Ömer; Pennings, Jan P; de Jong, Igle Jan; Yakar, Derya
• Is Part Of: Acta radiologica. Volume 64:Number 6(2023)
• Page Start: 2170
• Page End: 2179
• Publication Date: 2023-06
• Subjects: Computed tomography -- diagnostic imaging -- incidental findings -- medical overuse; Radiology, Medical -- Periodicals; Radiography, Medical -- Periodicals; Radiotherapy -- Periodicals; 616.0757
• DOI: 10.1177/02841851231158769
• Languages: English
• ISSNs: 0284-1851

Abstract

Background: Incidental imaging findings (incidentalomas) are common, but there is currently no effective means to investigate their clinical relevance. Purpose: To introduce a new concept to postprocess a medical imaging examination in a way that incidentalomas are concealed while its diagnostic potential is maintained to answer the referring physician's clinical questions. Material and Methods: A deep learning algorithm was developed to automatically eliminate liver, gallbladder, pancreas, spleen, adrenal glands, lungs, and bone from unenhanced computed tomography (CT). This deep learning algorithm was applied to a separately held set of unenhanced CT scans of 27 patients who underwent CT to evaluate for urolithiasis, and who had a total of 32 incidentalomas in one of the aforementioned organs. Results: Median visual scores for organ elimination on modified CT were 100% for the liver, gallbladder, spleen, and right adrenal gland, 90%–99% for the pancreas, lungs, and bones, and 80%–89% for the left adrenal gland. In 26 out of 27 cases (96.3%), the renal calyces and pelves, ureters, and urinary bladder were completely visible on modified CT. In one case, a short (<1 cm) trajectory of the left ureter was not clearly visible due to adjacent atherosclerosis that was mistaken for bone by the algorithm. Of 32 incidentalomas, 28 (87.5%) were completely concealed on modified CT. Conclusion: This preliminary technical report demonstrated the feasibility of a new approach to postprocess and evaluate medical imaging examinations that can be used by future prospective research studies with long-term follow-up to investigate the clinical relevance of incidentalomas.