Aim: To assess the management of ITNs detected on CT angiography in suspected stroke patients and to audit compliance with the ACR Incidental Thyroid Findings Committee White Paper(1).

Methods: National Integrated Medical Imaging System (NIMIS) Ireland database was used to search for CT angiogram reports performed in suspected stroke patients presenting to University Hospital Kerry from March 2023 to July 2026 in which the keyword “thyroid” was mentioned. Cases with ITNs were identified and compliance with ACR recommendations was evaluated.

Results:

53 patients with ITNs detected on CT angiography were identified. Of these, 50.9% (n=27) had acute stroke. US thyroid was recommended in 43.4% of CT angiogram reports overall (n=23). Recommendation for US thyroid was in accordance with ACR guidance in 60.87% of cases (n=14). Radiologist decision not to recommend US thyroid in CT angiogram reports (n=30), was in accordance with ACR guidance in 83.33% of cases (n=25). Overall percentage compliance of ITN management to ACR guidelines was 73.58% (n=39).

Where thyroid US was recommended in accordance with ACR guidelines, this was subsequently performed in 71.43% of cases (n=10). In cases where US thyroid was recommended in accordance with ACR guidelines but was not subsequently performed, it was found that the recommendation for US thyroid was included in the body of the CT angiogram report only and was omitted from the report conclusion/impression in 75% of cases. 7.54% of patients (n=4) underwent unnecessary US thyroid, not in adherence to ACR guidance.

Conclusion:

Overall compliance with ACR guidance was 73.58%. However this audit demonstrates that omission of the recommendation for US thyroid from the conclusion/impression of CT angiogram reports may result in subsequent failure of referring physicians to arrange completion of this examination. Radiologists should be encouraged to include recommendations for US thyroid, where applicable, in the conclusion/impression of imaging reports.