Incidental findings in imaging research: evaluating incidence, benefit, and burden.
ABSTRACT 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.
- [Show abstract] [Hide abstract]
ABSTRACT: Objective: The purpose of this study was to identify the frequency and grading of non osseous incidental findings (NOIF) in non contrast whole body low dose CT (LDCT) in patients with multiple myeloma. Methods: In the time period from 2010 to 2013, 93 patients with multiple myeloma were staged by non contrast whole body LDCT at our radiological department. LDCT images were analyzed retrospectively for NOIF, which also included unsuspected extramedullary manifestation of multiple myeloma. All NOIF were classified as major or clinically significant, moderate or possibly clinically significant, and minor or not clinically significant. Medical records were analyzed regarding further investigation and follow-up of the identified NOIF. Results: In the 93 patients, 295 NOIF were identified (on average 3.2 NOIF per patient). Most of the NOIF (52.4%) were not clinically significant, 25.8% of the NOIF were possibly clinically significant, and 21.8% of the NOIF were clinically significant. Clinically significant NOIF were investigated further by CT after intravenous administration of contrast medium and/or by ultrasound or magnetic resonance imaging. In 34 of these cases, extramedullary relapse of myeloma, occult carcinoma or infectious/septic incidental findings were diagnosed (11.5% of all NOIF). In the remaining 10.3% of the NOIF classified as clinically significant, various benign lesions were diagnosed. Conclusion: LDCT detected various non osseous lesions in patients with multiple myeloma. 36.6% of the patients had clinically significant NOIF. These findings underline the importance to check LDCT examinations in patients with multiple myeloma carefully for the presence of NOIF.British Journal of Radiology 07/2014; 87(1041):20140185. · 1.53 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The term functional gastrointestinal disorders (FGID) describes various aggregations of chronic gastrointestinal (GI) symptoms not explained by identifiable organic pathology; accordingly, their diagnosis rests on symptom-based criteria and a process of exclusion. Evidence is lacking on the appropriate use of abdominal imaging studies (AIS) in FGIDs.European Radiology 07/2014; · 4.34 Impact Factor
- Digestive and Liver Disease 09/2014; · 2.89 Impact Factor