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E1814. Expect the Unexpected: Edge of Image Pathology on Neuroimaging: Patterns, Pitfalls, and Pearls
Authors
  1. Muthanna Jabbar; Einstein Healthcare Network
  2. Ward Mazyad; Einstein Healthcare Network
  3. Joyce Li; Einstein Healthcare Network
  4. Cynthia Chan; Einstein Healthcare Network
  5. Brooke Devenney; Einstein Healthcare Network
Background
Evaluation of an imaging study is generally focused on directly addressing the clinical indication for the examination; however, some clinically significant unexpected and edge of the film findings might be overlooked by radiologists if not anticipated and routinely included in the search pattern.

Educational Goals / Teaching Points
In this pictorial review, a series of cases of unexpected or edge of the image findings will be presented with pertinent teaching points, pitfalls and pearls. The presented cases will be grouped into categories including vascular (cranial and cardiac aneurysm, thrombosis, embolus, and dissection), neoplastic (malignant and clinically significant benign tumors), degenerative (disc herniation with cord compression at the edge of the image), genetic (cystic fibrosis), infectious (discitis-osteomyelitis, abscess, and skull base infection), musculoskeletal (fractures, Paget’s disease), and inflammatory (sarcoidosis, granulomatosis with polyangiitis and Sjogren's syndrome).

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Imaging protocols are tailored to best assess the area of interest or concern and the radiologist's attention is focused on answering the clinical question. However, significant pathology can be partially and inadvertently included within the field of view of the localizer sequence or at the margin of the field of view. It is essential that the radiologist reviews all acquired images, anticipates these pitfalls and includes the location of common incidental pathology to their search pattern.

Conclusion
It is essential that the radiologist evaluates beyond the scope of the clinical indication of the examination to account for unexpected or edge of the image findings. These findings may be pertinent in addressing the clinical indication of the examination as well as represent potentially important clinically significant pathology.