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
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.
Available from: Federica Vernuccio
- "The rapid increase of Magnetic Resonance (MR) studies over the past decades , has led to a marked increase in the number of incidental findings (IFs). In a retrospective cohort study  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. "
Available from: Harriet Wittink
- "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 , we decided on the following procedure. "
[Show abstract] [Hide abstract]
Physical inactivity and overweight are two known risk factors for postmenopausal breast cancer. Former exercise intervention studies showed that physical activity influences sex hormone levels, known to be related to postmenopausal breast cancer, mainly when concordant loss of body weight was achieved. The question remains whether there is an additional beneficial effect of physical activity when weight loss is reached.
The SHAPE-2 study is a three-armed, multicentre trial. 243 sedentary, postmenopausal women who are overweight or obese (BMI 25-35 kg/m2) are enrolled. After a 4-6 week run-in period, wherein a baseline diet is prescribed, women are randomly allocated to (1) a diet group, (2) an exercise group or (3) a control group. The aim of both intervention groups is to lose an amount of 5-6 kg body weight in 10-14 weeks. The diet group follows an energy restricted diet and maintains the habitual physical activity level. The exercise group participates in a 16-week endurance and strength training programme of 4 hours per week. Furthermore, they are prescribed a moderate caloric restriction. The control group is asked to maintain body weight and continue the run-in baseline diet.
This study will give insight in the potential attributable effect of physical activity on breast cancer risk biomarkers and whether this effect is mediated by changes in body composition, in postmenopausal women. Eventually this may lead to the design of specific lifestyle guidelines for prevention of breast cancer.
The SHAPE-2 study is registered in the register of clinicaltrials.gov, Identifier: NCT01511276.
Available from: Constantinus F Buckens
- "Preventing unnecessary follow-up stemming from irrelevant un-requested findings and systematically reporting on prognostically relevant imaging information could contribute to this. Unfortunately, there is little clarity about which (classes of) findings hold relevance and which do not, although this is beginning to be addressed . "
[Show abstract] [Hide abstract]
ABSTRACT: To determine the prevalence of clinically relevant unrequested extra-cardiac imaging findings on cardiac Computed Tomography (CT) and explanatory factors thereof.
A systematic review of studies drawn from online electronic databases followed by meta-analysis with meta-regression was performed. The prevalence of clinically relevant unrequested findings and potentially explanatory variables were extracted (proportion of smokers, mean age of patients, use of full FOV, proportion of men, years since publication).
Nineteen radiological studies comprising 12922 patients met the inclusion criteria. The pooled prevalence of clinically relevant unrequested findings was 13% (95% confidence interval 9-18, range: 3-39%). The large differences in prevalence observed were not explained by the predefined (potentially explanatory) variables.
Clinically relevant extra-cardiac findings are common in patients undergoing routine cardiac CT, and their prevalence differs substantially between studies. These differences may be due to unreported factors such as different definitions of clinical relevance and differences between populations. We present suggestions for basic reporting which may improve the interpretability and comparability of future research.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.