Incidental Findings Management

The following is a summary of how to manage incidental imaging findings.

Thyroid

  • Evaluate all nodules > 1.5 cm on CT
    • If patient < 35, evaluate if > 1.0 cm (except for reasons as shown below)



Pancreas
  • If < 1.5 cm → 1 year follow-up MRI → benign if stable
  • If 1.5 to 2.5 cm → MRI/MRCP → follow up yearly
  • If > 2.5 cm → consider resection 





Adrenal
For lesions on CECT greater than 1 cm without suspicious features
  • If fat density → Adrenal adenoma
  • If stable > 1 year → consider benign
  • If no priors → consider CT or MR in 12 months
  • If suspicious → MR abdomen without contrast (chemical shift only needed). If not diagnostic, get adrenal protocol CT


Renal
For lesions on a CECT greater than 1 cm and without suspicious features:
  • Fat density → renal angiomyolipoma
  • HU 0 - 20 → Cyst
  • HU > 70 → Hemorrhagic or proteinaceous cyst
  • HU 20 - 70 → Indeterminate: recommend CECT or MRI renal protocol for further evaluation to assess enhancement pattern



References:
  • ACR Appropriateness Criteria
  • Berland, LL et al. "Managing Incidental Findings on Abdominal CT: White Paper of ACR Incidental Findings Committee". JACR 2010; 7:754-773.
  • Hoang, JK et al. "Managing Incidental Thyroid Nodules Detected on Imaging: White Paper of the ACR Incidental Thyroid Findings Committee". J Am Coll Radiol 2015;12:143-150. 
  • Megibow, AJ et al. "Management of Incidental Pancreatic Cysts." J Am Coll Radiol 2017;14:911-923.