Incidental findings in imaging research: Evaluating incidence, benefit, and burden

Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Archives of internal medicine (Impact Factor: 17.33). 09/2010; 170(17):1525-32. DOI: 10.1001/archinternmed.2010.317
Source: PubMed


Little information exists concerning the frequency and medical significance of incidental findings (IFs) in imaging research.
Medical records of research participants undergoing a research imaging examination interpreted by a radiologist during January through March 2004 were reviewed, with 3-year clinical follow-up. An expert panel reviewed all IFs generating clinical action to determine medical benefit/burden on the basis of predefined criteria. The frequency of IFs that generated further clinical action was estimated by modality, body part, age, and sex, along with net medical benefit or burden.
Of 1426 research imaging examinations, 567 (39.8%) had at least 1 IF (1055 total). Risk of an IF increased significantly by age (odds ratio [OR], 1.5; 95% confidence interval, 1.4-1.7 per decade increase). Abdominopelvic computed tomography generated more IFs than other examinations (OR, 18.9 vs ultrasonography; 9.2% with subsequent clinical action), with computed tomography of the thorax and magnetic resonance imaging of the head next (OR, 11.9 and 5.9; 2.8% and 2.2% with action, respectively). Of the 567 examinations with an IF, 35 (6.2%) generated clinical action, resulting in clear medical benefit in 1.1% (6 of 567) and clear medical burden in 0.5% (3 of 567). Medical benefit/burden was usually unclear (26 of 567 [4.6%]).
Frequency of IFs in imaging research examinations varies significantly by imaging modality, body region, and age. Research imaging studies at high risk for generating IFs can be identified. Routine evaluation of research images by radiologists may result in identification of IFs in a high number of cases and subsequent clinical action to address them in a small but significant minority. Such clinical action can result in medical benefit to a small number of patients.

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    • "The rapid increase of Magnetic Resonance (MR) studies over the past decades [1], has led to a marked increase in the number of incidental findings (IFs). In a retrospective cohort study [2] of patients who underwent 1426 imaging studies, 39.8% had a minimum of 1 IF and 1.1% of patients benefited from further workup. From July 2005 to August 2009, 1004 consecutive patients underwent MRCP in our department, and in 1000 (46% males; mean age 60.55 ± 15.53 years; range 8–97 years) the exams were considered diagnostic. "
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    • "A side effect of the use of cross sectional imaging in healthy subjects is that there is a risk of incidental findings. Rates of over 30% have been described while the proportion of subjects that might benefit from these findings is likely to be much lower than the proportion that will have no or even an adverse effect [54,55]. Outweighing the risk-benefit ratio and ethical considerations [56], we decided on the following procedure. "
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