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Conti L, Mazzoni D, Marzorati C, Grasso R, Busacchio D, Petralia G, Pravettoni G. Observations Regarding the Detection of Abnormal Findings Following a Cancer Screening Whole-Body MRI in Asymptomatic Subjects: The Psychological Consequences and the Role of Personality Traits Over Time. J Magn Reson Imaging 2024. [PMID: 38821883 DOI: 10.1002/jmri.29461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND The use of whole-body MRI (WB-MRI) in oncology has uncovered frequent unexpected abnormal findings (AFs). However, the impact of AFs on the patients' mental well-being is still poorly examined. PURPOSE To investigate the long-term psychological consequences of AF detection following WB-MRI for cancer screening in asymptomatic individuals. STUDY TYPE Prospective, longitudinal. POPULATION 121 consecutive subjects of the general population (mean age = 52.61 ± 11.39 years; 63% males) scheduled for cancer screening by WB-MRI. FIELD STRENGTH/SEQUENCE 1.5-T and 3-T; protocol complied with Oncologically Relevant Findings Reporting and Data System (ONCO-RADS) guidelines. ASSESSMENT Participants completed the first psychological investigation (T0) immediately after the WB-MRI. Subsequently, it was repeated after 1-year (T1), and 4-years (T2, subgroup of 61 participants) without an MRI exam, assessing personality traits, tumor risk perception, quality of life, depressive, and anxious symptoms. Radiologists directly reported WB-MRI findings to the participants, explaining the clinical implications and the location of the AFs. The number and severity of AFs were assessed. STATISTICAL TESTS Pearson's correlations and analysis of variance with repeated measures assessed the psychological health variables' relationship and their changes over time. A P-value <0.05 was considered statistically significant. RESULTS All participants presented AFs, with 101 individuals categorized as ONCO-RADS 2 and 19 as ONCO-RADS 3. The AFs were most prevalent in bones (31.5%). The overall participants showed only a slight increase in depressive symptoms at T1 [F(1,112) = 7.54]. The severity and the number of AFs were not significantly related to psychological changes [ranging from P = 0.503 to P = 0.997]. Depressive and anxious symptoms over time were significantly affected by the traits of conscientiousness [T1: F(1,112) = 7.87; T2: F(1.708,90.544) = 3.40] and openness [T1: F(1,112) = 4.41]. DATA CONCLUSION Disclosing AFs by WB-MRI exams for cancer screening may not lead to long-term psychosocial consequences. Certain personality traits may, however, influence the psychological distress experienced by individuals with AFs after WB-MRI exams. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY Stage 5.
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Affiliation(s)
- Lorenzo Conti
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Davide Mazzoni
- Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy
| | - Chiara Marzorati
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Grasso
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy
| | - Derna Busacchio
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy
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Joo L, Suh CH, Shim WH, Kim SO, Lim JS, Lee JH, Kim HS, Kim SJ. Detection rate of contrast-enhanced brain magnetic resonance imaging in patients with cognitive impairment. PLoS One 2023; 18:e0289638. [PMID: 37549181 PMCID: PMC10406288 DOI: 10.1371/journal.pone.0289638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 07/22/2023] [Indexed: 08/09/2023] Open
Abstract
INTRODUCTION The number of brain MRI with contrast media performed in patients with cognitive impairment has increased without universal agreement. We aimed to evaluate the detection rate of contrast-enhanced brain MRI in patients with cognitive impairment. MATERIALS AND METHODS This single-institution, retrospective study included 4,838 patients who attended outpatient clinics for cognitive impairment evaluation and underwent brain MRI with or without contrast enhancement from December 2015 to February 2020. Patients who tested positive for cognitive impairment were followed-up to confirm whether the result was true-positive and provide follow-up management. Detection rate was defined as the proportion of patients with true-positive results and was compared between groups with and without contrast enhancement. Individual matching in a 1:2 ratio according to age, sex, and year of test was performed. RESULTS The overall detection rates of brain MRI with and without contrast media were 4.7% (57/1,203; 95% CI: 3.6%-6.1%) and 1.8% (65/3,635; 95% CI: 1.4%-2.3%), respectively (P<0.001); individual matching demonstrated similar results (4.7% and 1.9%). Among 1,203 patients with contrast media, 3.6% was only detectable with the aid of contrast media. The proportion of patients who underwent follow-up imaging or treatment for the detected lesions were significantly higher in the group with contrast media (2.0% and 0.6%, P < .001). CONCLUSIONS Detection rate of brain MRI for lesions only detectable with contrast media in patients with cognitive impairment was not high enough and further study is needed to identify whom would truly benefit with contrast media.
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Affiliation(s)
- Leehi Joo
- Department of Radiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woo Hyun Shim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seon-Ok Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Sung Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Joon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Zaki-Metias KM, MacLean JJ, Satei AM, Medvedev S, Wang H, Zarour CC, Arpasi PJ. The FIND Program: Improving Follow-up of Incidental Imaging Findings. J Digit Imaging 2023; 36:804-811. [PMID: 36759382 PMCID: PMC10287591 DOI: 10.1007/s10278-023-00780-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 02/11/2023] Open
Abstract
Incidental findings are findings identified on imaging which are unrelated to the original reason for examination and require follow-up. The Radiology Finding Incidental Disease (FIND) Program was designed to track and improve follow-up of incidental imaging findings. The purpose of this study was to determine the frequency of incidental findings on cross-sectional imaging and the adherence to suggested follow-up of incidental findings prior to and after implementation of a structured reporting and tracking system. A retrospective analysis of 2000 patients with computed tomographic cross-sectional imaging was performed: 1000 patients prior to implementation of the FIND Program and 1000 patients 1 year after establishment of the program. Data collected included the frequency of incidental findings, inclusion of follow-up recommendations in the radiology report, and adherence to suggested follow-up. There was a higher rate of completion of recommended follow-up imaging in the post-implementation group (34/67, 50.7%) compared to the pre-implementation (16/52, 30.8%) (p = 0.03). Implementation of an incidental findings tracking program resulted in improved follow-up of incidental imaging findings. This has the potential to reduce the burden of clinically significant incidental findings possibly resulting in later presentation of advanced disease.
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Affiliation(s)
- Kaitlin M Zaki-Metias
- Department of Radiology, Trinity Health Oakland Hospital/Wayne State University School of Medicine, Pontiac, MI, USA.
| | - Jeffrey J MacLean
- Department of Radiology, Trinity Health Oakland Hospital/Wayne State University School of Medicine, Pontiac, MI, USA
| | - Alexander M Satei
- Department of Radiology, Trinity Health Oakland Hospital/Wayne State University School of Medicine, Pontiac, MI, USA
| | - Serguei Medvedev
- Department of Radiology, Trinity Health Oakland Hospital/Wayne State University School of Medicine, Pontiac, MI, USA
| | - Huijuan Wang
- Department of Radiology, Trinity Health Oakland Hospital/Wayne State University School of Medicine, Pontiac, MI, USA
| | - Christopher C Zarour
- Department of Radiology, Trinity Health Oakland Hospital/Wayne State University School of Medicine, Pontiac, MI, USA
| | - Paul J Arpasi
- Department of Radiology, Trinity Health Oakland Hospital/Wayne State University School of Medicine, Pontiac, MI, USA
- Huron Valley Radiology, Ypsilanti, MI, USA
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Cekuolis A, Schreiber-Dietrich D, Augustinienė R, Taut H, Squires J, Chaves EL, Dong Y, Dietrich CF. Incidental Findings in Pediatric Patients: How to Manage Liver Incidentaloma in Pediatric Patients. Cancers (Basel) 2023; 15:cancers15082360. [PMID: 37190288 DOI: 10.3390/cancers15082360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
The World Federation for Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings (IFs) with a series of publications entitled "Incidental imaging findings-the role of ultrasound". IFs in the liver of newborns and children are rare and much less commonly encountered than in adults; as a result, they are relatively much more frequently malignant and life-threatening, even when they are of benign histology. Conventional B-mode ultrasound is the well-established first line imaging modality for the assessment of liver pathology in pediatric patients. US technological advances, resulting in image quality improvement, contrast-enhanced ultrasound (CEUS), liver elastography and quantification tools for steatosis have expanded the use of ultrasound technology in daily practice. The following overview is intended to illustrate incidentally detected liver pathology covering all pediatric ages. It aims to aid the examiner in establishing the final diagnosis. Management of incidentally detected focal liver lesions (FLL) needs to take into account the diagnostic accuracy of each imaging modality, the patient's safety issues (including ionizing radiation and nephrotoxic contrast agents), the delay in diagnosis, the psychological burden on the patient and the cost for the healthcare system. Moreover, this paper should help the pediatric clinician and ultrasound practitioner to decide which pathologies need no further investigation, which ones require interval imaging and which cases require further and immediate diagnostic procedures.
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Affiliation(s)
- Andrius Cekuolis
- Ultrasound Section, Department of Pediatric Radiology, Radiology and Nuclear Medicine Centre, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
| | | | - Rasa Augustinienė
- Ultrasound Section, Department of Pediatric Radiology, Radiology and Nuclear Medicine Centre, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
| | - Heike Taut
- Children's Hospital, Universitätsklinikum Dresden, Technische Universität Dresden, 01062 Dresden, Germany
| | - Judy Squires
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Edda L Chaves
- Radiology Department, Hospital Regional Nicolas Solano, La Chorrera 1007, Panama
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, 3013 Bern, Switzerland
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Bhaskar SMM. An Equity and Justice-Informed Ethical Framework to Guide Incidental Findings in Brain Imaging Research. Clin Pract 2023; 13:116-124. [PMID: 36648851 PMCID: PMC9890311 DOI: 10.3390/clinpract13010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/24/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
The handling of incidental findings (IFs) in brain imaging studies has been a source of contention among scientists and bioethicists. A conceptual framework informed by diversity, equity, and inclusion (DEI) and distributive justice approaches, namely EUSTICE, is proposed for the ethical handling and reporting of IFs in brain imaging research. I argue that EUSTICE provides a systematic and inclusive approach to addressing the ethical conundrum around IF disclosure and managing IFs proportionately and sensitively in brain imaging research. The EUSTICE framework may have implications for the field of neurosciences or human studies broadly in guiding ethics of IFs in research.
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Affiliation(s)
- Sonu M. M. Bhaskar
- Global Health Neurology Lab, Sydney, NSW 2000, Australia; ; Tel.: +61-(02)-873-89179; Fax: +61-(02)-8738-3648
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- Department of Neurology & Neurophysiology, Liverpool Hospital & South West Sydney Local Health District (SWSLHD), Liverpool, NSW 2170, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW 2170, Australia
- Stroke & Neurology Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
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Long-Term Psychosocial Consequences of Whole-Body Magnetic Resonance Imaging and Reporting of Incidental Findings in a Population-Based Cohort Study. Diagnostics (Basel) 2022; 12:diagnostics12102356. [PMID: 36292045 PMCID: PMC9600583 DOI: 10.3390/diagnostics12102356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/19/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
Management of radiological incidental findings (IF) is of rising importance; however, psychosocial implications of IF reporting remain unclear. We compared long-term psychosocial effects between individuals who underwent whole-body magnetic resonance imaging (MRI) with and without reported IF, and individuals who did not undergo imaging. We used a longitudinal population-based cohort from Western Europe. Longitudinal analysis included three examinations (exam 1, 6 years prior to MRI; exam 2, MRI; exam 3, 4 years after MRI). Psychosocial outcomes included PHQ-9 (Patient Health Questionnaire), DEEX (Depression and Exhaustion Scale), PSS-10 (Perceived Stress Scale) and a Somatization Scale. Univariate analyses and adjusted linear mixed models were calculated. Among 855 included individuals, 25% (n = 212) underwent MRI and 6% (n = 50) had at least one reported IF. Compared to MRI participants, non-participants had a higher psychosocial burden indicated by PHQ-9 in exam 1 (3.3 ± 3.3 vs. 2.5 ± 2.3) and DEEX (8.6 ± 4.7 vs. 7.7 ± 4.4), Somatization Scale (5.9 ± 4.3 vs. 4.8 ± 3.8) and PSS-10 (14.7 ± 5.7 vs. 13.7 ± 5.3, all p < 0.05) in exam 3. MRI participation without IF reporting was significantly associated with lower values of DEEX, PHQ-9 and Somatization Scale. There were no significant differences at the three timepoints between MRI participants with and without IF. In conclusion, individuals who voluntarily participated in whole-body MRI had less psychosocial burden and imaging and IF reporting were not associated with adverse long-term psychosocial consequences. However, due to the study design we cannot conclude that the MRI exam itself represented a beneficial intervention causing improvement in mental health scores.
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Na Kim J, Jin Park H, Yeon Won S, Kim M, Woo Hong S, Kim E, Jin Park S, Taek Lee Y. Whole-body MRI for preventive health screening in a general population: Prevalence of incidental findings around the hip. Eur J Radiol 2022; 150:110239. [DOI: 10.1016/j.ejrad.2022.110239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/27/2022] [Accepted: 03/05/2022] [Indexed: 11/26/2022]
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Oerlemans AJM, Barendregt DMH, Kooijman SC, Bunnik EM. Impact of incidental findings on young adult participants in brain imaging research: an interview study. Eur Radiol 2022; 32:3839-3845. [DOI: 10.1007/s00330-021-08474-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/25/2021] [Accepted: 11/19/2021] [Indexed: 01/02/2023]
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Schmidt CO, Sierocinski E, Baumeister S, Hegenscheid K, Völzke H, Chenot JF. Effects of whole-body MRI on outpatient health service costs: a general-population prospective cohort study in Mecklenburg-Vorpommern, Germany. BMJ Open 2022; 12:e056572. [PMID: 34996801 PMCID: PMC8744128 DOI: 10.1136/bmjopen-2021-056572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Whole-body MRI (wb-MRI) is increasingly used in research and screening but little is known about the effects of incidental findings (IFs) on health service utilisation and costs. Such effects are particularly critical in an observational study. Our principal research question was therefore how participation in a wb-MRI examination with its resemblance to a population-based health screening is associated with outpatient service costs. DESIGN Prospective cohort study. SETTING General population Mecklenburg-Vorpommern, Germany. PARTICIPANTS Analyses included 5019 participants of the Study of Health in Pomerania with statutory health insurance data. 2969 took part in a wb-MRI examination in addition to a clinical examination programme that was administered to all participants. MRI non-participants served as a quasi-experimental control group with propensity score weighting to account for baseline differences. PRIMARY AND SECONDARY OUTCOME MEASURES Outpatient costs (total healthcare usage, primary care, specialist care, laboratory tests, imaging) during 24 months after the examination were retrieved from claims data. Two-part models were used to compute treatment effects. RESULTS In total, 1366 potentially relevant IFs were disclosed to 948 MRI participants (32% of all participants); most concerned masses and lesions (769 participants, 81%). Costs for outpatient care during the 2-year observation period amounted to an average of €2547 (95% CI 2424 to 2671) for MRI non-participants and to €2839 (95% CI 2741 to 2936) for MRI participants, indicating an increase of €295 (95% CI 134 to 456) per participant which corresponds to 11.6% (95% CI 5.2% to 17.9%). The cost increase was sustained rather than being a short-term spike. Imaging and specialist care related costs were the main contributors to the increase in costs. CONCLUSIONS Communicated findings from population-based wb-MRI substantially impacted health service utilisation and costs. This introduced bias into the natural course of healthcare utilisation and should be taken care for in any longitudinal analyses.
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Affiliation(s)
- Carsten Oliver Schmidt
- Institute for Community Medicine - Department SHIP/KEF, University Medicine Greifswald, Greifswald, MV, Germany
| | - Elizabeth Sierocinski
- Institute for Community Medicine - Department of Family Medicine, University Medicine Greifswald, Greifswald, MV, Germany
| | - Sebastian Baumeister
- Institute of Health Services Research in Dentistry, University of Muenster, Muenster, Niedersachsen, Germany
| | - Katrin Hegenscheid
- Unfallkrankenhaus Berlin, Berlin, Berlin, Germany
- Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, MV, Germany
| | - Henry Völzke
- Institute for Community Medicine - Department SHIP/KEF, University Medicine Greifswald, Greifswald, MV, Germany
- DZD - German Center for Diabetes Research - Partner Site Greifswald, Greifswald, MV, Germany
- DZHK - German Centre for Cardiovascular Research - Partner Site Greifswald, Greifswald, MV, Germany
| | - J-F Chenot
- Institute for Community Medicine - Department of Family Medicine, University Medicine Greifswald, Greifswald, MV, Germany
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Myburgh C, Larsen TB, Kjaer P. 'When the picture does not really tell the story'- A qualitative exploration of the MRI report of findings as a means for generating shared diagnostic meaning during the management of patients suffering from persistent spinal pain. PATIENT EDUCATION AND COUNSELING 2022; 105:221-227. [PMID: 34001396 DOI: 10.1016/j.pec.2021.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To explore the magnetic resonance imaging (MRI) feedback report as a health care encounter for generating shared diagnostic meaning. METHODS An exploratory, qualitative case study was conducted using video observation of the MRI report of findings, individual face-to-face and telephonic interviews. RESULTS From fourteen distinct encounters, three key themes emerged, these being: 'a powerful shared experience, 'a legacy of biomedical thinking' and 'clinical practice quandaries'. Generally speaking, the MRI encounter was observed to be both an effective and satisfying method for developing shared diagnostic meaning. However, in instances where a structure-based diagnosis could not be reasonably established, clinicians experienced doubts in what to present in a 'soft report'. A feature of these was the communication of speculative causal feedback, based on non-visualised structures and/or incidental findings observed. CONCLUSION Shared diagnostic meaning can result from a 'soft' MRI report of findings. However, the emergence of diagnostic closure is not guaranteed. Further exploration of this phenomenon in the context of shared decision making and the therapeutic alliance is warranted. PRACTICE IMPLICATIONS Pre-feedback peer conferences might be considered in order to standardise the information communicated to patients. Clinicians might also consider limiting the MRI scan as a visual aid in 'soft' reports.
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Affiliation(s)
- Corrie Myburgh
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK 5230 Odense M, Denmark.
| | - Trine Boye Larsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK 5230 Odense M, Denmark
| | - Per Kjaer
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK 5230 Odense M, Denmark; Health Sciences Research Centre, UCL University College, Niels Bohrs Alle 1, DK 5230 Odense M, Denmark
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Hosten N, Bülow R, Völzke H, Domin M, Schmidt CO, Teumer A, Ittermann T, Nauck M, Felix S, Dörr M, Markus MRP, Völker U, Daboul A, Schwahn C, Holtfreter B, Mundt T, Krey KF, Kindler S, Mksoud M, Samietz S, Biffar R, Hoffmann W, Kocher T, Chenot JF, Stahl A, Tost F, Friedrich N, Zylla S, Hannemann A, Lotze M, Kühn JP, Hegenscheid K, Rosenberg C, Wassilew G, Frenzel S, Wittfeld K, Grabe HJ, Kromrey ML. SHIP-MR and Radiology: 12 Years of Whole-Body Magnetic Resonance Imaging in a Single Center. Healthcare (Basel) 2021; 10:33. [PMID: 35052197 PMCID: PMC8775435 DOI: 10.3390/healthcare10010033] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 12/16/2022] Open
Abstract
The Study of Health in Pomerania (SHIP), a population-based study from a rural state in northeastern Germany with a relatively poor life expectancy, supplemented its comprehensive examination program in 2008 with whole-body MR imaging at 1.5 T (SHIP-MR). We reviewed more than 100 publications that used the SHIP-MR data and analyzed which sequences already produced fruitful scientific outputs and which manuscripts have been referenced frequently. Upon reviewing the publications about imaging sequences, those that used T1-weighted structured imaging of the brain and a gradient-echo sequence for R2* mapping obtained the highest scientific output; regarding specific body parts examined, most scientific publications focused on MR sequences involving the brain and the (upper) abdomen. We conclude that population-based MR imaging in cohort studies should define more precise goals when allocating imaging time. In addition, quality control measures might include recording the number and impact of published work, preferably on a bi-annual basis and starting 2 years after initiation of the study. Structured teaching courses may enhance the desired output in areas that appear underrepresented.
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Affiliation(s)
- Norbert Hosten
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, 17475 Greifswald, Germany; (N.H.); (R.B.); (M.D.); (K.H.); (C.R.)
| | - Robin Bülow
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, 17475 Greifswald, Germany; (N.H.); (R.B.); (M.D.); (K.H.); (C.R.)
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, 17475 Greifswald, Germany; (H.V.); (C.O.S.); (A.T.); (T.I.); (W.H.); (J.-F.C.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, 10785 Berlin, Germany; (M.N.); (S.F.); (M.D.); (M.R.P.M.); (U.V.); (N.F.); (S.Z.); (A.H.)
| | - Martin Domin
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, 17475 Greifswald, Germany; (N.H.); (R.B.); (M.D.); (K.H.); (C.R.)
| | - Carsten Oliver Schmidt
- Institute for Community Medicine, University Medicine Greifswald, 17475 Greifswald, Germany; (H.V.); (C.O.S.); (A.T.); (T.I.); (W.H.); (J.-F.C.)
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, 17475 Greifswald, Germany; (H.V.); (C.O.S.); (A.T.); (T.I.); (W.H.); (J.-F.C.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, 10785 Berlin, Germany; (M.N.); (S.F.); (M.D.); (M.R.P.M.); (U.V.); (N.F.); (S.Z.); (A.H.)
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, 17475 Greifswald, Germany; (H.V.); (C.O.S.); (A.T.); (T.I.); (W.H.); (J.-F.C.)
| | - Matthias Nauck
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, 10785 Berlin, Germany; (M.N.); (S.F.); (M.D.); (M.R.P.M.); (U.V.); (N.F.); (S.Z.); (A.H.)
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Stephan Felix
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, 10785 Berlin, Germany; (M.N.); (S.F.); (M.D.); (M.R.P.M.); (U.V.); (N.F.); (S.Z.); (A.H.)
- Department of Internal Medicine B, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Marcus Dörr
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, 10785 Berlin, Germany; (M.N.); (S.F.); (M.D.); (M.R.P.M.); (U.V.); (N.F.); (S.Z.); (A.H.)
- Department of Internal Medicine B, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Marcello Ricardo Paulista Markus
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, 10785 Berlin, Germany; (M.N.); (S.F.); (M.D.); (M.R.P.M.); (U.V.); (N.F.); (S.Z.); (A.H.)
- Department of Internal Medicine B, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Uwe Völker
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, 10785 Berlin, Germany; (M.N.); (S.F.); (M.D.); (M.R.P.M.); (U.V.); (N.F.); (S.Z.); (A.H.)
- Interfaculty Institute of Genetics and Functional Genomics, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Amro Daboul
- Department of Prosthetic Dentistry, Gerodontology and Biomaterials, University Medicine Greifswald, 17475 Greifswald, Germany; (A.D.); (C.S.); (T.M.); (S.S.); (R.B.)
| | - Christian Schwahn
- Department of Prosthetic Dentistry, Gerodontology and Biomaterials, University Medicine Greifswald, 17475 Greifswald, Germany; (A.D.); (C.S.); (T.M.); (S.S.); (R.B.)
| | - Birte Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, 17475 Greifswald, Germany; (B.H.); (T.K.)
| | - Torsten Mundt
- Department of Prosthetic Dentistry, Gerodontology and Biomaterials, University Medicine Greifswald, 17475 Greifswald, Germany; (A.D.); (C.S.); (T.M.); (S.S.); (R.B.)
| | - Karl-Friedrich Krey
- Department of Orthodontics, University Medicine Greifswald, 17475 Greifswald, Germany;
| | - Stefan Kindler
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Medicine Greifswald, 17475 Greifswald, Germany; (S.K.); (M.M.)
| | - Maria Mksoud
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Medicine Greifswald, 17475 Greifswald, Germany; (S.K.); (M.M.)
| | - Stefanie Samietz
- Department of Prosthetic Dentistry, Gerodontology and Biomaterials, University Medicine Greifswald, 17475 Greifswald, Germany; (A.D.); (C.S.); (T.M.); (S.S.); (R.B.)
| | - Reiner Biffar
- Department of Prosthetic Dentistry, Gerodontology and Biomaterials, University Medicine Greifswald, 17475 Greifswald, Germany; (A.D.); (C.S.); (T.M.); (S.S.); (R.B.)
| | - Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine Greifswald, 17475 Greifswald, Germany; (H.V.); (C.O.S.); (A.T.); (T.I.); (W.H.); (J.-F.C.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, 10785 Berlin, Germany; (M.N.); (S.F.); (M.D.); (M.R.P.M.); (U.V.); (N.F.); (S.Z.); (A.H.)
- German Centre for Neurodegenerative Diseases (DZNE), Partner Site Rostock/Greifswald, 17489 Greifswald, Germany
| | - Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, 17475 Greifswald, Germany; (B.H.); (T.K.)
| | - Jean-Francois Chenot
- Institute for Community Medicine, University Medicine Greifswald, 17475 Greifswald, Germany; (H.V.); (C.O.S.); (A.T.); (T.I.); (W.H.); (J.-F.C.)
| | - Andreas Stahl
- Clinic of Ophthalmology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.S.); (F.T.)
| | - Frank Tost
- Clinic of Ophthalmology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.S.); (F.T.)
| | - Nele Friedrich
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, 10785 Berlin, Germany; (M.N.); (S.F.); (M.D.); (M.R.P.M.); (U.V.); (N.F.); (S.Z.); (A.H.)
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Stephanie Zylla
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, 10785 Berlin, Germany; (M.N.); (S.F.); (M.D.); (M.R.P.M.); (U.V.); (N.F.); (S.Z.); (A.H.)
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Anke Hannemann
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, 10785 Berlin, Germany; (M.N.); (S.F.); (M.D.); (M.R.P.M.); (U.V.); (N.F.); (S.Z.); (A.H.)
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Martin Lotze
- Functional Imaging Unit, Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, 17475 Greifswald, Germany;
| | - Jens-Peter Kühn
- Institute and Policlinic of Diagnostic and Interventional Radiology, Medical University, Carl-Gustav Carus, 01307 Dresden, Germany;
| | - Katrin Hegenscheid
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, 17475 Greifswald, Germany; (N.H.); (R.B.); (M.D.); (K.H.); (C.R.)
| | - Christian Rosenberg
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, 17475 Greifswald, Germany; (N.H.); (R.B.); (M.D.); (K.H.); (C.R.)
| | - Georgi Wassilew
- Clinic of Orthopedics, University Medicine Greifswald, 17475 Greifswald, Germany;
| | - Stefan Frenzel
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, 17475 Greifswald, Germany; (S.F.); (K.W.); (H.J.G.)
| | - Katharina Wittfeld
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, 17475 Greifswald, Germany; (S.F.); (K.W.); (H.J.G.)
- German Center of Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Site Greifswald, 17489 Greifswald, Germany
| | - Hans J. Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, 17475 Greifswald, Germany; (S.F.); (K.W.); (H.J.G.)
- German Center of Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Site Greifswald, 17489 Greifswald, Germany
| | - Marie-Luise Kromrey
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, 17475 Greifswald, Germany; (N.H.); (R.B.); (M.D.); (K.H.); (C.R.)
- Correspondence:
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Luu JM, Sergeant AK, Anand SS, Desai D, Schulze K, Knoppers BM, Zawati MH, Smith EE, Moody AR, Black SE, Larose E, Marcotte F, Kleiderman E, Tardif JC, Lee DS, Friedrich MG. The impact of reporting magnetic resonance imaging incidental findings in the Canadian alliance for healthy hearts and minds cohort. BMC Med Ethics 2021; 22:145. [PMID: 34711210 PMCID: PMC8551943 DOI: 10.1186/s12910-021-00706-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 09/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies. METHODS Between 2013 and 2019, 8252 participants (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported. RESULTS Severe structural abnormalities occurred in 8.3% (95% confidence interval 7.7-8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy. CONCLUSION The management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT02220582 .
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Affiliation(s)
- Judy M Luu
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada
| | - Anand K Sergeant
- Arts and Science Program, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Sonia S Anand
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada. .,Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Dipika Desai
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada
| | - Karleen Schulze
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada.,Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Bartha M Knoppers
- Centre of Genomics and Policy, McGill University, 740 Dr Penfield Ave, Suite 5200, Montréal, QC, H3A 0G1, Canada
| | - Ma'n H Zawati
- Centre of Genomics and Policy, McGill University, 740 Dr Penfield Ave, Suite 5200, Montréal, QC, H3A 0G1, Canada
| | - Eric E Smith
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Alan R Moody
- Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON, Canada
| | - Sandra E Black
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Eric Larose
- Institut Universitaire de Cardiologie Et de Pneumologie de Québec - Université Laval, 2725 chemin Sainte-Foy, Québec, G1V 4G5, Canada
| | - Francois Marcotte
- School of Population and Public Health and Cancer Control Research, BC Cancer, University of British Columbia, 675 W 10th Avenue, Vancouver, BC, V5Z 1L3, Canada
| | - Erika Kleiderman
- Centre of Genomics and Policy, McGill University, 740 Dr Penfield Ave, Suite 5200, Montréal, QC, H3A 0G1, Canada
| | - Jean-Claude Tardif
- Research Centre, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
| | - Douglas S Lee
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Matthias G Friedrich
- Department of Medicine and Diagnostic Radiology, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
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Return of individual research results: What do participants prefer and expect? PLoS One 2021; 16:e0254153. [PMID: 34324495 PMCID: PMC8320928 DOI: 10.1371/journal.pone.0254153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 06/21/2021] [Indexed: 11/20/2022] Open
Abstract
Newer data platforms offer increased opportunity to share multidimensional health data with research participants, but the preferences of participants for which data to receive and how is evolving. Our objective is to describe the preferences and expectations of participants for the return of individual research results within Project Baseline Health Study (PBHS). The PBHS is an ongoing, multicenter, longitudinal cohort study with data from four initial enrollment sites. PBHS participants are recruited from the general population along with groups enriched for heart disease and cancer disease risk. Cross-sectional data on return of results were collected in 2017–2018 from an (1) in-person enrollment survey (n = 1,890), (2) benchmark online survey (n = 1,059), and (3) participant interviews (n = 21). The main outcomes included (1) preferences for type of information to be added next to returned results, (2) participant plans for sharing returned results with a non-study clinician, and (3) choice to opt-out of receiving genetic results. Results were compared by sociodemographic characteristics. Enrollment and benchmark survey respondents were 57.1% and 53.5% female, and 60.0% and 66.2% white, respectively. Participants preferred the following data types be added to returned results in the future: genetics (29.9%), heart imaging, (16.4%), study watch (15.8%), and microbiome (13.3%). Older adults (OR 0.60, 95% CI: 0.41–0.87) were less likely to want their genetic results returned next. Forty percent of participants reported that they would not share all returned results with their non–study clinicians. Black (OR 0.64, 95% CI 0.43–0.95) and Asian (OR 0.47, 95% CI 0.30–0.73) participants were less likely, and older participants more likely (OR 1.45–1.61), to plan to share all results with their clinician than their counterparts. At enrollment, 5.8% of participants opted out of receiving their genetics results. The study showed that substantial heterogeneity existed in participant’s preferences and expectations for return of results, and variations were related to sociodemographic characteristics.
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14
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Petralia G, Koh DM, Attariwala R, Busch JJ, Eeles R, Karow D, Lo GG, Messiou C, Sala E, Vargas HA, Zugni F, Padhani AR. Oncologically Relevant Findings Reporting and Data System (ONCO-RADS): Guidelines for the Acquisition, Interpretation, and Reporting of Whole-Body MRI for Cancer Screening. Radiology 2021; 299:494-507. [PMID: 33904776 DOI: 10.1148/radiol.2021201740] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Acknowledging the increasing number of studies describing the use of whole-body MRI for cancer screening, and the increasing number of examinations being performed in patients with known cancers, an international multidisciplinary expert panel of radiologists and a geneticist with subject-specific expertise formulated technical acquisition standards, interpretation criteria, and limitations of whole-body MRI for cancer screening in individuals at higher risk, including those with cancer predisposition syndromes. The Oncologically Relevant Findings Reporting and Data System (ONCO-RADS) proposes a standard protocol for individuals at higher risk, including those with cancer predisposition syndromes. ONCO-RADS emphasizes structured reporting and five assessment categories for the classification of whole-body MRI findings. The ONCO-RADS guidelines are designed to promote standardization and limit variations in the acquisition, interpretation, and reporting of whole-body MRI scans for cancer screening. Published under a CC BY 4.0 license Online supplemental material is available for this article.
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Affiliation(s)
- Giuseppe Petralia
- From the Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences (G.P.), and Department of Radiology (F.Z.), IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Italy (G.P.); Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Sutton, England (D.M.K., C.M.); AIM Medical Imaging, Vancouver, Canada (R.A.); Busch Center, Alpharetta, Ga (J.J.B.); The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, England (R.E.); Human Longevity, San Diego, Calif (D.K.); Department of Diagnostic & Interventional Radiology, Hong Kong Sanatorium & Hospital, Hong Kong (G.G.L.); Department of Radiology and Cancer Research, UK Cambridge Center, Cambridge, England (E.S.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.); and Paul Strickland Scanner Centre, Northwood, England (A.R.P.)
| | - Dow-Mu Koh
- From the Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences (G.P.), and Department of Radiology (F.Z.), IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Italy (G.P.); Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Sutton, England (D.M.K., C.M.); AIM Medical Imaging, Vancouver, Canada (R.A.); Busch Center, Alpharetta, Ga (J.J.B.); The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, England (R.E.); Human Longevity, San Diego, Calif (D.K.); Department of Diagnostic & Interventional Radiology, Hong Kong Sanatorium & Hospital, Hong Kong (G.G.L.); Department of Radiology and Cancer Research, UK Cambridge Center, Cambridge, England (E.S.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.); and Paul Strickland Scanner Centre, Northwood, England (A.R.P.)
| | - Raj Attariwala
- From the Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences (G.P.), and Department of Radiology (F.Z.), IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Italy (G.P.); Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Sutton, England (D.M.K., C.M.); AIM Medical Imaging, Vancouver, Canada (R.A.); Busch Center, Alpharetta, Ga (J.J.B.); The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, England (R.E.); Human Longevity, San Diego, Calif (D.K.); Department of Diagnostic & Interventional Radiology, Hong Kong Sanatorium & Hospital, Hong Kong (G.G.L.); Department of Radiology and Cancer Research, UK Cambridge Center, Cambridge, England (E.S.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.); and Paul Strickland Scanner Centre, Northwood, England (A.R.P.)
| | - Joseph J Busch
- From the Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences (G.P.), and Department of Radiology (F.Z.), IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Italy (G.P.); Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Sutton, England (D.M.K., C.M.); AIM Medical Imaging, Vancouver, Canada (R.A.); Busch Center, Alpharetta, Ga (J.J.B.); The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, England (R.E.); Human Longevity, San Diego, Calif (D.K.); Department of Diagnostic & Interventional Radiology, Hong Kong Sanatorium & Hospital, Hong Kong (G.G.L.); Department of Radiology and Cancer Research, UK Cambridge Center, Cambridge, England (E.S.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.); and Paul Strickland Scanner Centre, Northwood, England (A.R.P.)
| | - Ros Eeles
- From the Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences (G.P.), and Department of Radiology (F.Z.), IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Italy (G.P.); Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Sutton, England (D.M.K., C.M.); AIM Medical Imaging, Vancouver, Canada (R.A.); Busch Center, Alpharetta, Ga (J.J.B.); The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, England (R.E.); Human Longevity, San Diego, Calif (D.K.); Department of Diagnostic & Interventional Radiology, Hong Kong Sanatorium & Hospital, Hong Kong (G.G.L.); Department of Radiology and Cancer Research, UK Cambridge Center, Cambridge, England (E.S.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.); and Paul Strickland Scanner Centre, Northwood, England (A.R.P.)
| | - David Karow
- From the Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences (G.P.), and Department of Radiology (F.Z.), IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Italy (G.P.); Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Sutton, England (D.M.K., C.M.); AIM Medical Imaging, Vancouver, Canada (R.A.); Busch Center, Alpharetta, Ga (J.J.B.); The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, England (R.E.); Human Longevity, San Diego, Calif (D.K.); Department of Diagnostic & Interventional Radiology, Hong Kong Sanatorium & Hospital, Hong Kong (G.G.L.); Department of Radiology and Cancer Research, UK Cambridge Center, Cambridge, England (E.S.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.); and Paul Strickland Scanner Centre, Northwood, England (A.R.P.)
| | - Gladys G Lo
- From the Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences (G.P.), and Department of Radiology (F.Z.), IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Italy (G.P.); Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Sutton, England (D.M.K., C.M.); AIM Medical Imaging, Vancouver, Canada (R.A.); Busch Center, Alpharetta, Ga (J.J.B.); The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, England (R.E.); Human Longevity, San Diego, Calif (D.K.); Department of Diagnostic & Interventional Radiology, Hong Kong Sanatorium & Hospital, Hong Kong (G.G.L.); Department of Radiology and Cancer Research, UK Cambridge Center, Cambridge, England (E.S.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.); and Paul Strickland Scanner Centre, Northwood, England (A.R.P.)
| | - Christina Messiou
- From the Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences (G.P.), and Department of Radiology (F.Z.), IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Italy (G.P.); Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Sutton, England (D.M.K., C.M.); AIM Medical Imaging, Vancouver, Canada (R.A.); Busch Center, Alpharetta, Ga (J.J.B.); The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, England (R.E.); Human Longevity, San Diego, Calif (D.K.); Department of Diagnostic & Interventional Radiology, Hong Kong Sanatorium & Hospital, Hong Kong (G.G.L.); Department of Radiology and Cancer Research, UK Cambridge Center, Cambridge, England (E.S.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.); and Paul Strickland Scanner Centre, Northwood, England (A.R.P.)
| | - Evis Sala
- From the Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences (G.P.), and Department of Radiology (F.Z.), IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Italy (G.P.); Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Sutton, England (D.M.K., C.M.); AIM Medical Imaging, Vancouver, Canada (R.A.); Busch Center, Alpharetta, Ga (J.J.B.); The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, England (R.E.); Human Longevity, San Diego, Calif (D.K.); Department of Diagnostic & Interventional Radiology, Hong Kong Sanatorium & Hospital, Hong Kong (G.G.L.); Department of Radiology and Cancer Research, UK Cambridge Center, Cambridge, England (E.S.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.); and Paul Strickland Scanner Centre, Northwood, England (A.R.P.)
| | - Hebert A Vargas
- From the Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences (G.P.), and Department of Radiology (F.Z.), IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Italy (G.P.); Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Sutton, England (D.M.K., C.M.); AIM Medical Imaging, Vancouver, Canada (R.A.); Busch Center, Alpharetta, Ga (J.J.B.); The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, England (R.E.); Human Longevity, San Diego, Calif (D.K.); Department of Diagnostic & Interventional Radiology, Hong Kong Sanatorium & Hospital, Hong Kong (G.G.L.); Department of Radiology and Cancer Research, UK Cambridge Center, Cambridge, England (E.S.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.); and Paul Strickland Scanner Centre, Northwood, England (A.R.P.)
| | - Fabio Zugni
- From the Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences (G.P.), and Department of Radiology (F.Z.), IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Italy (G.P.); Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Sutton, England (D.M.K., C.M.); AIM Medical Imaging, Vancouver, Canada (R.A.); Busch Center, Alpharetta, Ga (J.J.B.); The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, England (R.E.); Human Longevity, San Diego, Calif (D.K.); Department of Diagnostic & Interventional Radiology, Hong Kong Sanatorium & Hospital, Hong Kong (G.G.L.); Department of Radiology and Cancer Research, UK Cambridge Center, Cambridge, England (E.S.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.); and Paul Strickland Scanner Centre, Northwood, England (A.R.P.)
| | - Anwar R Padhani
- From the Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences (G.P.), and Department of Radiology (F.Z.), IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Italy (G.P.); Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Sutton, England (D.M.K., C.M.); AIM Medical Imaging, Vancouver, Canada (R.A.); Busch Center, Alpharetta, Ga (J.J.B.); The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, England (R.E.); Human Longevity, San Diego, Calif (D.K.); Department of Diagnostic & Interventional Radiology, Hong Kong Sanatorium & Hospital, Hong Kong (G.G.L.); Department of Radiology and Cancer Research, UK Cambridge Center, Cambridge, England (E.S.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (H.A.V.); and Paul Strickland Scanner Centre, Northwood, England (A.R.P.)
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15
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Beriault DR, Gilmour JA, Hicks LK. Overutilization in laboratory medicine: tackling the problem with quality improvement science. Crit Rev Clin Lab Sci 2021; 58:430-446. [PMID: 33691585 DOI: 10.1080/10408363.2021.1893642] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Overutilization of tests and treatments is a widespread problem in contemporary heath care, and laboratory medicine is no exception. It is estimated that 10-70% of laboratory tests may be unnecessary, with estimates in the literature varying depending on the situation and the laboratory test. Inappropriate use of laboratory tests can lead to further unnecessary testing, adverse events, inaccurate diagnoses, and inappropriate treatments. Altogether, this increases the risk of harm to a patient, which can be physical, psychological, or financial in nature. Overutilization in healthcare is driven by complex factors including care delivery models, litigious practice environments, and medical and patient culture. Quality improvement (QI) methods can help to tackle overutilization. In this review, we outline the global healthcare problem of laboratory overutilization, particularly in the developed world, and describe how an understanding of and application of quality improvement principles can help to address this challenge.
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Affiliation(s)
- Daniel R Beriault
- Department of Laboratory Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Julie A Gilmour
- Division of Endocrinology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lisa K Hicks
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Hematology and Oncology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
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Sönksen SE, Kühn SR, Noblé HJ, Knopf H, Ehling J, Jakobs FM, Frischmuth J, Weber F. Incidental Finding Prevalences in 3-Tesla Brain and Spine MRI of Military Pilot Applicants. Aerosp Med Hum Perform 2021; 92:146-152. [PMID: 33754971 DOI: 10.3357/amhp.5749.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION: Incidental findings in brain and spine MRI are common. In aerospace medicine, pilot selection may be affected by improved sensitivity of modern MRI devices. We investigated the occurrence of medically unfit rates caused by incidental findings in military pilot applicants using a 3-Tesla scanner as compared to the outcomes of a lower field strength 1-Tesla device based on similar screening protocols.METHODS: A total of 3315 military pilot applicants were assessed by a standardized German Air Force Imaging Screening Protocol and retrospectively subdivided into two cohorts, one of which was assessed by 1-Tesla MRI (2012-2015; N 1782), while in the second cohort (2016-2019; N 1808), a 3-Tesla MRI was used. Cohorts were statistically analyzed relating to three entities of incidental findings: 1) intervertebral disc displacements, 2) intracerebral vessel malformations, and 3) other abnormal findings in the brain.RESULTS: Pooled prevalences of incidental findings in medically unfit applicants significantly increased by use of 3-Tesla MRI as compared to lower resolution 1-Tesla MRI. Regarding the spine, prevalences more than doubled (1.46 vs. 4.99%; P < 0.05) for intervertebral disc displacements. Similarly, prevalences of cerebral vessel malformations as well as other abnormal CNS incidental findings considerably increased by use of 3-Tesla MRI (0.28 vs. 1.67%; P < 0.05, and 5.12 vs. 9.80%; P < 0.05). Effect sizes and correlations were substantial in all conditions analyzed (Cohens d > 0.8; Pearsons r > 0.75).CONCLUSIONS: Our data suggest a strong dependency of incidental cerebrospinal findings on image resolution and sensitivity of MRI devices used for screening, which is enhanced by refined imaging protocols and followed by increased medical unfit rates in prospective aviators. Adjusted strategies in the assessment of such lesions are needed to redefine their natural history and physiological impact, and to optimize screening protocols for future pilot selection.Snksen S-E, Khn SR, Nobl H-J, Knopf H, Ehling J, Jakobs FM, Frischmuth J, Weber F. Incidental finding prevalences in 3-Tesla brain and spine MRI of military pilot applicants. Aerosp Med Hum Perform. 2021; 92(3):146152.
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17
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Basar Y, Alis D, Tekcan Sanli DE, Akbas T, Karaarslan E. Whole-body MRI for preventive health screening: Management strategies and clinical implications. Eur J Radiol 2021; 137:109584. [PMID: 33596499 DOI: 10.1016/j.ejrad.2021.109584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/04/2021] [Accepted: 01/30/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To document the diagnostic yields of whole-body MRI (WB-MRI) screening for asymptomatic individuals by using a classification system that categorizes the findings by clinical relevance and provides a flowchart for further investigations, and to determine the influence of WB-MRI findings on clinical decision-making. METHODS In this institutional review board-approved study, a retrospective review of individuals who underwent WB-MRI between 2009 and 2020 was conducted, and asymptomatic participants who underwent non-contrast-enhanced comprehensive WB-MRI for screening were enrolled. Participants were classified into four categories based on WB-MRI findings, and those with relevant findings (i.e., categories 3 and 4) were referred for further diagnostic workup. The participants' medical records were investigated, and interviews were conducted to reveal false-negative findings and identify the number of WB-MRI-triggered treatments. RESULTS We included 576 participants (377 [65.4 %] men, 199 [34.6 %] women; mean age, 48.40 ± 10.82 years), of which 266 (46.2 %) and 310 (53.8 %) underwent WB-MRI with 1.5 T and 3.0 T magnets, respectively. Approximately one-third of the participants showed clinically relevant findings, and 65 (11.2 %) received a treatment triggered by WB-MRI. Notably, 15 (2.6 %) and 28 (4.8 %) participants had cancers and intracranial aneurysms, respectively. Of the 576 participants, 16 (2.8 %) had false-negative findings, among which five had cancers. CONCLUSION WB-MRI yields numerous important findings that trigger therapeutic interventions in a large sample of asymptomatic adults. However, considering its inherent limitations, WB-MRI might be inadequate for detecting malignancies such as colon, thyroid, and breast cancers; thus, it may serve as a complementary screening method for health-conscious individuals.
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Affiliation(s)
- Yeliz Basar
- Acibadem Maslak Hospital, Department of Radiology, Istanbul, Turkey.
| | - Deniz Alis
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Department of Radiology, Istanbul, Turkey.
| | | | - Tugana Akbas
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Department of Radiology, Istanbul, Turkey.
| | - Ercan Karaarslan
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Department of Radiology, Istanbul, Turkey.
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18
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Schlett CL, Rospleszcz S, Korbmacher D, Lorbeer R, Auweter S, Hetterich H, Selder S, Heier M, Linkohr B, Weckbach S, Ertl-Wagner B, Peters A, Bamberg F. Incidental findings in whole-body MR imaging of a population-based cohort study: Frequency, management and psychosocial consequences. Eur J Radiol 2020; 134:109451. [PMID: 33279799 DOI: 10.1016/j.ejrad.2020.109451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/27/2020] [Accepted: 11/22/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Management of incidental findings (IF) remains controversial but highly relevant. Our aim was to assess the frequency, management and psychosocial consequences of IF reporting in a population-based cohort study undergoing whole-body MR imaging. METHODS The study was nested in a prospective cohort from a longitudinal, population-based cohort (KORA-FF4) in southern Germany. All MR obtained on 3 T MR scanner were reviewed by board-certified radiologists regarding clinically relevant IF. A baseline and follow-up questionnaires including PHQ-9 were completed prior to and 6-month after to the scan. RESULTS Of 400 participants (56.3 ± 9.2years, 58 % male) undergoing whole-body MR, IF were found in 22 % of participants (n = 89); most frequently located in the abdominal sequences. In the pre-scan survey, most participants stated as the motivation that they wanted to "contribute to a scientific purpose" (91 %), while "knowing whether I'm healthy" was the most frequent motivation reported 6 months post-scan (88 %). The desire for IF reporting increased over time (pre- vs. 6-months-post-scan), also for clinically less important IF (72 % vs. 84 %, p = 0.001). Regarding psychosocial impact, a small portion (3.4 %) reported that awaiting the IF report added "definitely" or "very probably" additional stress burden. Of participants with reported IF, 56.8 % classified the results as "very helpful". In the post-scan survey moderate depression was observed in 3.3 % and severe depression in 1.2 %. This did not differ between participants with and without reported IF. CONCLUSION In a cohort with whole-body MR imaging, the prevalence of IF was high. Participants considered reporting of IF highly important and added only minor psychological burden.
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Affiliation(s)
- Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Susanne Rospleszcz
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Dorina Korbmacher
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Roberto Lorbeer
- Department of Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Sigrid Auweter
- Department of Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Holger Hetterich
- Department of Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Sonja Selder
- Department of Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Margit Heier
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany; KORA Study Centre, University Hospital Augsburg, Augsburg, Germany
| | - Birgit Linkohr
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Sabine Weckbach
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Birgit Ertl-Wagner
- Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-University Munich, Munich, Germany; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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19
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Hommes D, Klatte D, Otten W, Beltman M, Klass G, Zand A, Sprangers R. Health outcomes and experiences of direct-to-consumer high-intensity screening using both whole-body magnetic resonance imaging and cardiological examination. PLoS One 2020; 15:e0242066. [PMID: 33216779 PMCID: PMC7678982 DOI: 10.1371/journal.pone.0242066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022] Open
Abstract
Background Alongside a clinical and research setting, whole body magnetic resonance imaging (WB-MRI) is increasingly offered as a direct-to-consumer screening service. Data is needed on the clinical relevance of findings and associated psychological impact of such screening. Therefore, we conducted a prospective follow-up study to provide insight in the effectiveness and psychological impact of direct-to-consumer screening using both WB-MRI and cardiological examination. Methods and findings The study population consisted of 3603 voluntary, primarily middle-aged participants who underwent commercial WB-MRI and cardiological screening at one of 6 study clinics in Germany or the Netherlands between July 2014 and March 2016. MRI investigation consisted of directed scans of the brain, neck, abdomen and pelvis. Cardiovascular examination included pulmonary function, resting electrocardiogram, transthoracic echocardiogram and a bicycle exercise stress test. Findings were assessed by experienced radiologists and cardiologists. In addition, participants were inquired about several (psychological) domains, including the expectations and consequences of the screening procedure. Out of 3603 individuals, 402 (11.2%) demonstrated abnormal MRI (n = 381) and/or cardiological findings (n = 79) for which they were advised to undergo further consultation <3 months in regular healthcare. In 59.1% of cases of abnormal MRI findings which were consulted, fully completed consultations were available in 87.1%. After consultation, 77.6% of initial MRI outcomes were adopted. In 40.9% of cases of abnormal MRI findings, recommendations for consultation were not adhered to during the study period. 71.1% of adopted MRI-findings required treatment or monitoring, including 19 malignancies. For abnormal cardiological findings, 70.9% of cases were consulted in regular healthcare. Of these, 91.1% had a completed follow-up procedure of which 72.5% of initial findings were adopted and 83.8% of these findings required treatment or monitoring. The most frequently reported psychological consequences of the screening procedure were getting reassurance (72.0%) and insight into one’s own health status (83.0%). 5.0% reported to feel insecure about their health and 6.2% worried more about their health as a consequence of screening. Main limitations of the study were considered the telephonic follow-up of referred clients and the heterogeneity of screening equipment and assessment of radiologists and cardiologists. Conclusions Direct-to-consumer screening using whole-body MRI and cardiological testing is feasible and effective for the detection of clinically relevant and treatable abnormalities. Psychological harm was not frequently reported in study participants.
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Affiliation(s)
- Daniel Hommes
- Dept. of Gastroenterology, Leiden University Medical Centre, Leiden, The Netherlands
- Dept. of Internal Medicine, University of California Los Angeles (UCLA), Los Angeles, California, United States of America
- * E-mail:
| | - Derk Klatte
- Dept. of Gastroenterology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Wilma Otten
- Expertise Group Child Health, Unit Healthy Living, The Netherlands Organization for Applied Scientific Research (TNO), The Netherlands
| | - Maaike Beltman
- Expertise Group Child Health, Unit Healthy Living, The Netherlands Organization for Applied Scientific Research (TNO), The Netherlands
| | - Günter Klass
- Dept. of Radiology, Mathias-Spital, Rheine, Germany
| | - Aria Zand
- Dept. of Gastroenterology, Leiden University Medical Centre, Leiden, The Netherlands
- Dept. of Internal Medicine, University of California Los Angeles (UCLA), Los Angeles, California, United States of America
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20
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The Impact of Incidental Findings Detected During Brain Imaging on Research Participants of the Rotterdam Study: An Interview Study. Camb Q Healthc Ethics 2020; 29:542-556. [PMID: 32892773 PMCID: PMC7525112 DOI: 10.1017/s0963180120000304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This interview study investigates the short- and long-term implications of incidental findings detected through brain imaging on research participants’ lives and their surroundings. For this study, nine participants of the Rotterdam Scan Study with an incidental finding were approached and interviewed. When examining research participants’ narratives on the impact of the disclosure of incidental findings, the authors identified five sets of tensions with regard to motivations for and expectations of research participation, preferences regarding disclosure, short- and long-term impacts and impacts on self and others. The paper shows: (1) that the impact of incidental findings may be greater than participants at first let on; (2) incidental findings can have significant effects on participants’ social environment; and (3) participants may not feel prepared for disclosure even if incidental findings have been discussed during the informed consent process. The authors call for investigators to be aware of research participants’ experiences and these short- and long-term impacts when designing suitable courses of action for the detection and management of incidental findings in research settings.
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21
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Richter A, Sierocinski E, Singer S, Bülow R, Hackmann C, Chenot JF, Schmidt CO. The effects of incidental findings from whole-body MRI on the frequency of biopsies and detected malignancies or benign conditions in a general population cohort study. Eur J Epidemiol 2020; 35:925-935. [PMID: 32860149 PMCID: PMC7524843 DOI: 10.1007/s10654-020-00679-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/19/2020] [Indexed: 12/12/2022]
Abstract
Magnetic resonance imaging (MRI) yields numerous tumor-related incidental findings (IFs) which may trigger diagnostics such as biopsies. To clarify these effects, we studied how whole-body MRI IF disclosure in a population-based cohort affected biopsy frequency and the detection of malignancies. Laboratory disclosures were also assessed. Data from 6753 participants in the Study of Health in Pomerania (SHIP) examined between 2008 and 2012 were utilized. All underwent laboratory examinations and 3371 (49.9%) a whole-body MRI. Electronic biopsy reports from 2002 to 2017 were linked to participants and assigned to outcome categories. Biopsy frequency 2 years pre- and post-SHIP was investigated using generalized estimating equations with a negative-binomial distribution. Overall 8208 IFs (laboratory findings outside reference limits: 6839; MRI: 1369) were disclosed to 4707 participants; 2271 biopsy reports belonged to 1200 participants (17.8%). Of these, 938 biopsies occurred pre-SHIP; 1333 post-SHIP (event rate/100 observation years = 6.9 [95% CI 6.5; 7.4]; 9.9 [9.3; 10.4]). Age, cancer history, recent hospitalization, female sex, and IF disclosure were associated with higher biopsy rates. Nonmalignant biopsy results increased more in participants with disclosures (post-/pre-SHIP rate ratio 1.39 [95% CI 1.22; 1.58]) than without (1.09 [95% CI 0.85; 1.38]). Malignant biopsy results were more frequent post-SHIP (rate ratio 1.74 [95% CI 1.27; 2.42]). Biopsies increased after participation in a population-based cohort study with MRI and laboratory IF disclosure. Most biopsies resulted in no findings and few malignancies were diagnosed, indicating potential overtesting and overdiagnosis. A more restrictive policy regarding IF disclosure from research findings is required.
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Affiliation(s)
- Adrian Richter
- Department SHIP-KEF, Institute for Community Medicine, Greifswald University Medical Center, Walther Rathenau Str. 48, 17475, Greifswald, Germany.
| | - Elizabeth Sierocinski
- Department SHIP-KEF, Institute for Community Medicine, Greifswald University Medical Center, Walther Rathenau Str. 48, 17475, Greifswald, Germany.,Department of Family Medicine, Institute for Community Medicine, Fleischmannstr. 42, 17475, Greifswald, Germany
| | - Stephan Singer
- Institute for Pathology, Greifswald University Medical Center, Friedrich-Loeffler-Str. 23e, 17487, Greifswald, Germany.,Institute of Pathology, University Hospital Tuebingen, Liebermeisterstrasse 8, 72076, Tuebingen, Germany
| | - Robin Bülow
- Department of Diagnostic Radiology and Neuroradiology, Greifswald University Medical Center Greifswald, 17475, Greifswald, Germany
| | - Carolin Hackmann
- Department SHIP-KEF, Institute for Community Medicine, Greifswald University Medical Center, Walther Rathenau Str. 48, 17475, Greifswald, Germany.,Institute for Hygiene and Environmental Medicine, Charité - University Medicine Berlin, Hindenburgdamm 27, 12203, Berlin, Germany
| | - Jean-François Chenot
- Department of Family Medicine, Institute for Community Medicine, Fleischmannstr. 42, 17475, Greifswald, Germany
| | - Carsten Oliver Schmidt
- Department SHIP-KEF, Institute for Community Medicine, Greifswald University Medical Center, Walther Rathenau Str. 48, 17475, Greifswald, Germany
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22
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Piontek K, Richter A, Hegenscheid K, Chenot JF, Schmidt CO. Recall accuracy of notifications about incidental findings from an MRI examination: results from a population-based study. J Epidemiol Community Health 2020; 74:838-844. [PMID: 32661134 DOI: 10.1136/jech-2019-212824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 02/10/2020] [Accepted: 05/26/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Self-reports of medical findings are indispensable in clinical practice and research but subject to recall bias. We analysed the recall accuracy of notifications about incidental findings (IFs) from a whole-body MRI examination and assessed determinants of recall error. METHODS Data from 3746 participants of a postal follow-up survey conducted on average 2.47 years after examination in the population-based Study of Health in Pomerania were analysed. Among those, 2185 (58.3%) underwent whole-body MRI at baseline, and findings of potential clinical relevance were disclosed in standardised postal letters. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated to determine the accuracy of self-reports. Poisson regression analysis was conducted to analyse predictors for false-positive and false-negative recall. RESULTS An IF was disclosed to 622 (28.5%) individuals; 81.5% had tumour relevance. The overall sensitivity and PPV of participants' self-reports were 80% and 60%, respectively. PPvs were higher among women, better educated and married participants and among those with good verbal memory. Among MRI participants, lower educational level was associated with a higher risk of false-positive recall (risk ratio (RR) 1.44, 95% CI 1.01 to 2.03), while increasing age was associated with a higher risk of false-negative recall (RR 1.64, 95% CI 1.33 to 2.01). CONCLUSIONS Most participants correctly recalled disclosed IFs. However, the probability of an event in case of a positive recall is barely above 50%. Therefore, relying on subjects' recall of disclosed IFs will lead to a relevant proportion of errors. Clinicians and researchers should be aware of this problem and of participants' characteristics which may moderate the probability of correct decisions based on recalled findings.
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Affiliation(s)
- Katharina Piontek
- Institute for Social Medicine and Health Systems Research, Medical Faculty Magdeburg, Magdeburg, Germany
| | - Adrian Richter
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Katrin Hegenscheid
- Department of Radiology, University Medicine Greifswald, Greifswald, Germany
| | - Jean-Francois Chenot
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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23
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Dietrich CF, Westerway S, Nolsøe C, Kim S, Jenssen C. Commentary on the World Federation for Ultrasound in Medicine and Biology Project "Incidental Findings". ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1815-1820. [PMID: 32409233 DOI: 10.1016/j.ultrasmedbio.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/25/2020] [Accepted: 02/03/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Hirslanden Klinik Beau-Site, Salem und Permanence, Bern, Switzerland; Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sue Westerway
- Centre for Surgical Ultrasound, Dep of Surgery, Zealand University Hospital, Køge Asc Prof, Copenhagen Academy for Medical Education and Simulation (CAMES) University of Copenhagen Denmark
| | - Christian Nolsøe
- Copenhagen Academy for Medical Education and Simulation (CAMES), Ultrasound Section, Department of Gastroenterology, Division of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Seung Kim
- Seoul National University, Seoul, South Korea
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen and Brandenburg Institute for Clinical Ultrasound, Neuruppin, Germany
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24
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Zugni F, Padhani AR, Koh DM, Summers PE, Bellomi M, Petralia G. Whole-body magnetic resonance imaging (WB-MRI) for cancer screening in asymptomatic subjects of the general population: review and recommendations. Cancer Imaging 2020; 20:34. [PMID: 32393345 PMCID: PMC7216394 DOI: 10.1186/s40644-020-00315-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/03/2020] [Indexed: 12/28/2022] Open
Abstract
Background The number of studies describing the use of whole-body magnetic resonance imaging (WB-MRI) for screening of malignant tumours in asymptomatic subjects is increasing. Our aim is to review the methodologies used and the results of the published studies on per patient and per lesion analysis, and to provide recommendations on the use of WB-MRI for cancer screening. Main body We identified 12 studies, encompassing 6214 WB-MRI examinations, which provided the rates of abnormal findings and findings suspicious for cancer in asymptomatic subjects, from the general population. Eleven of 12 studies provided imaging protocols that included T1- and T2-weighted sequences, while only five included diffusion weighted imaging (DWI) of the whole body. Different categorical systems were used for the classification and the management of abnormal findings. Of 17,961 abnormal findings reported, 91% were benign, while 9% were oncologically relevant, requiring further investigations, and 0.5% of lesions were suspicious for cancer. A per-subject analysis showed that just 5% of subjects had no abnormal findings, while 95% had abnormal findings. Findings requiring further investigation were reported in 30% of all subjects, though in only 1.8% cancer was suspected. The overall rate of histologically confirmed cancer was 1.1%. Conclusion WB-MRI studies of cancer screening in the asymptomatic general population are too heterogeneous to draw impactful conclusions regarding efficacy. A 5-point lesion scale based on the oncological relevance of findings appears the most appropriate for risk-based management stratification. WB-MRI examinations should be reported by experienced oncological radiologists versed on WB-MRI reading abnormalities and on onward referral pathways.
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Affiliation(s)
- Fabio Zugni
- Division of Radiology, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy.
| | - Anwar Roshanali Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, HA6 2RN, UK
| | - Dow-Mu Koh
- Department of Radiology, The Royal Marsden Hospital (Surrey), Downs Rd, Sutton, SM2 5PT, UK
| | - Paul Eugene Summers
- Division of Radiology, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
| | - Massimo Bellomi
- Division of Radiology, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Via S. Sofia, 9/1, 20122, Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-Oncology, University of Milan, Via S. Sofia, 9/1, 20122, Milan, Italy.,Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
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25
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Bancroft EK, Saya S, Brown E, Thomas S, Taylor N, Rothwell J, Pope J, Chamberlain A, Page E, Benafif S, Hanson H, Dias A, Mikropoulos C, Izatt L, Side L, Walker L, Donaldson A, Cook JA, Barwell J, Wiles V, Limb L, Eccles DM, Leach MO, Shanley S, Gilbert FJ, Gallagher D, Rajashanker B, Whitehouse RW, Koh DM, Sohaib SA, Evans DG, Eeles RA, Walker LG. Psychosocial effects of whole-body MRI screening in adult high-risk pathogenic TP53 mutation carriers: a case-controlled study (SIGNIFY). J Med Genet 2020; 57:226-236. [PMID: 31719169 PMCID: PMC7146942 DOI: 10.1136/jmedgenet-2019-106407] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/18/2019] [Accepted: 09/21/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Germline TP53 gene pathogenic variants (pv) cause a very high lifetime risk of developing cancer, almost 100% for women and 75% for men. In the UK, annual MRI breast screening is recommended for female TP53 pv carriers. The SIGNIFY study (Magnetic Resonance Imaging screening in Li Fraumeni syndrome: An exploratory whole body MRI) study reported outcomes of whole-body MRI (WB-MRI) in a cohort of 44 TP53 pv carriers and 44 matched population controls. The results supported the use of a baseline WB-MRI screen in all adult TP53 pv carriers. Here we report the acceptability of WB-MRI screening and effects on psychosocial functioning and health-related quality of life in the short and medium terms. METHODS Psychosocial and other assessments were carried out at study enrolment, immediately before MRI, before and after MRI results, and at 12, 26 and 52 weeks' follow-up. RESULTS WB-MRI was found to be acceptable with high levels of satisfaction and low levels of psychological morbidity throughout. Although their mean levels of cancer worry were not high, carriers had significantly more cancer worry at most time-points than controls. They also reported significantly more clinically significant intrusive and avoidant thoughts about cancer than controls at all time-points. There were no clinically significant adverse psychosocial outcomes in either carriers with a history of cancer or in those requiring further investigations. CONCLUSION WB-MRI screening can be implemented in TP53 pv carriers without adverse psychosocial outcomes in the short and medium terms. A previous cancer diagnosis may predict a better psychosocial outcome. Some carriers seriously underestimate their risk of cancer. Carriers of pv should have access to a clinician to help them develop adaptive strategies to cope with cancer-related concerns and respond to clinically significant depression and/or anxiety.
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Affiliation(s)
- Elizabeth K Bancroft
- Oncogenetics Team, The Royal Marsden NHS Foundation Trust, London, UK
- Oncogenetics Team, The Institute of Cancer Research, London, UK
| | - Sibel Saya
- Oncogenetics Team, The Institute of Cancer Research, London, UK
- Centre for Cancer Research & Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Emma Brown
- Medical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Thomas
- Oncogenetics Team, The Royal Marsden NHS Foundation Trust, London, UK
| | - Natalie Taylor
- Oncogenetics Team, The Royal Marsden NHS Foundation Trust, London, UK
| | - Jeanette Rothwell
- Clinical Genetics, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jennifer Pope
- Oncogenetics Team, The Institute of Cancer Research, London, UK
| | | | - Elizabeth Page
- Oncogenetics Team, The Institute of Cancer Research, London, UK
| | - Sarah Benafif
- Oncogenetics Team, The Institute of Cancer Research, London, UK
| | - Helen Hanson
- South West Thames Regional Genetics Service, St Georges NHS Foundation Trust, London, UK
| | - Alexander Dias
- Oncogenetics Team, The Institute of Cancer Research, London, UK
| | | | - Louise Izatt
- Clinical Genetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lucy Side
- Clinical Genetics, Wessex Clinical Genetics Service, Southampton, UK
| | - Lisa Walker
- Clinical Genetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alan Donaldson
- Clinical Genetics, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Jackie A Cook
- Department of Clinical Genetics, Sheffield Children's Hospital, Sheffield, UK
| | - Julian Barwell
- Clinical Genetics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Vicki Wiles
- Clinical Genetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Lauren Limb
- North West Thames Regional Genetics Service (Kennedy-Galton Centre), London North West University Healthcare NHS Trust, Harrow, UK
| | - Diana M Eccles
- Cancer Sciences, University of Southampton Faculty of Medicine, Southampton, UK
| | - Martin O Leach
- Department of Diagnostic Radiology, The Royal Marsden NHS Foundation Trust, London, UK
- Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Susan Shanley
- Formerly at the Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - David Gallagher
- Cancer Genetics Service, Mater Hospital School, Dublin, Ireland
| | | | | | - Dow-Mu Koh
- Department of Diagnostic Radiology, The Royal Marsden NHS Foundation Trust, London, UK
- Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - S Aslam Sohaib
- Department of Diagnostic Radiology, The Royal Marsden NHS Foundation Trust, London, UK
| | - D Gareth Evans
- Clinical Genetics, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rosalind A Eeles
- Oncogenetics Team, The Royal Marsden NHS Foundation Trust, London, UK
- Oncogenetics Team, The Institute of Cancer Research, London, UK
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26
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Kumpulainen V, Lehtola SJ, Tuulari JJ, Silver E, Copeland A, Korja R, Karlsson H, Karlsson L, Merisaari H, Parkkola R, Saunavaara J, Lähdesmäki T, Scheinin NM. Prevalence and Risk Factors of Incidental Findings in Brain MRIs of Healthy Neonates-The FinnBrain Birth Cohort Study. Front Neurol 2020; 10:1347. [PMID: 31969859 PMCID: PMC6960102 DOI: 10.3389/fneur.2019.01347] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/06/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Birth is a traumatic event with molding forces directed to the fetal skull, which may result in intracranial hemorrhages. However, the knowledge on prevalence and risk factors of incidental brain magnetic resonance imaging (MRI) findings in infants is still inconclusive. Methods: The prevalence and nature of incidental MRI findings were assessed in a birth cohort of 175 asymptomatic infants. The role of delivery method as well as other potential risk factors for intracranial hemorrhages were evaluated. The infants underwent 3T MRI at the age of 2–5 weeks, and the neurological status of the infants with an incidental finding was evaluated by a pediatric neurologist. Information on the delivery method, duration of delivery, parity, used anesthesia, oxytocin induction, and Apgar score was gathered to evaluate their association with the prevalence of hemorrhages. Results: Incidental intracranial hemorrhages were detected in 12 infants (6.9%), all following spontaneous or assisted vaginal delivery. Vacuum-assistance was found to be a risk factor for subdural hemorrhages with an odds ratio (OR) of 4.7 (95% CI [1.18; 18.9], p = 0.032). All infants were evaluated to develop normally by their clinical status. Conclusions: Incidental intracranial hemorrhages are relatively common among infants born by vaginal delivery. They are often of little clinical significance within the first years of life and have unlikely consequences for later neurodevelopment either. Despite their benign character, investigators should be prepared to share this information with parents competently as the findings can cause parental anxiety, and especially as the popularity of MRI as a research tool is increasing.
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Affiliation(s)
- Venla Kumpulainen
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Satu J Lehtola
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Jetro J Tuulari
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
| | - Eero Silver
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Anni Copeland
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Riikka Korja
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Psychology, University of Turku, Turku, Finland
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland.,Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
| | - Harri Merisaari
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Future Technologies, University of Turku, Turku, Finland.,Center of Computational Imaging and Personalized Diagnostics, Case Western Reserve University, Cleveland, OH, United States
| | - Riitta Parkkola
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Radiology, Turku University Hospital, University of Turku, Turku, Finland
| | - Jani Saunavaara
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Tuire Lähdesmäki
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Pediatric Neurology, Turku University Hospital, University of Turku, Turku, Finland
| | - Noora M Scheinin
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
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27
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Keuss SE, Parker TD, Lane CA, Hoskote C, Shah S, Cash DM, Keshavan A, Buchanan SM, Murray-Smith H, Wong A, James SN, Lu K, Collins J, Beasley DG, Malone IB, Thomas DL, Barnes A, Richards M, Fox N, Schott JM. Incidental findings on brain imaging and blood tests: results from the first phase of Insight 46, a prospective observational substudy of the 1946 British birth cohort. BMJ Open 2019; 9:e029502. [PMID: 31371298 PMCID: PMC6678011 DOI: 10.1136/bmjopen-2019-029502] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To summarise the incidental findings detected on brain imaging and blood tests during the first wave of data collection for the Insight 46 study. DESIGN Prospective observational sub-study of a birth cohort. SETTING Single-day assessment at a research centre in London, UK. PARTICIPANTS 502 individuals were recruited from the MRC National Survey of Health and Development (NSHD), the 1946 British birth cohort, based on pre-specified eligibility criteria; mean age was 70.7 (SD: 0.7) and 49% were female. OUTCOME MEASURES Data regarding the number and types of incidental findings were summarised as counts and percentages, and 95% confidence intervals were calculated. RESULTS 93.8% of participants completed a brain scan (n=471); 4.5% of scanned participants had a pre-defined reportable abnormality on brain MRI (n=21); suspected vascular malformations and suspected intracranial mass lesions were present in 1.9% (n=9) and 1.5% (n=7) respectively; suspected cerebral aneurysms were the single most common vascular abnormality, affecting 1.1% of participants (n=5), and suspected meningiomas were the most common intracranial lesion, affecting 0.6% of participants (n=3); 34.6% of participants had at least one abnormality on clinical blood tests (n=169), but few reached the prespecified threshold for urgent action (n=11). CONCLUSIONS In older adults, aged 69-71 years, potentially serious brain MRI findings were detected in around 5% of participants, and clinical blood test abnormalities were present in around one third of participants. Knowledge of the expected prevalence of incidental findings in the general population at this age is useful in both research and clinical settings.
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Affiliation(s)
- Sarah E Keuss
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Thomas D Parker
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Christopher A Lane
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Chandrashekar Hoskote
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Sachit Shah
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, UK
| | - David M Cash
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Ashvini Keshavan
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Sarah M Buchanan
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Heidi Murray-Smith
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Sarah-Naomi James
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Kirsty Lu
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Jessica Collins
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Daniel G Beasley
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Ian B Malone
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - David L Thomas
- Leonard Wolfson Experimental Neurology Centre, UCL Queen Square Institute of Neurology, London, UK
- Department of Brain Repair and Neurorehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Anna Barnes
- Institute of Nuclear Medicine, University College London Hospitals, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Nick Fox
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Jonathan M Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
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28
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Feng F, Thompson MP, Thomas BE, Duffy ER, Kim J, Kurosawa S, Tashjian JY, Wei Y, Andry C, Stearns-Kurosawa DJ. A computational solution to improve biomarker reproducibility during long-term projects. PLoS One 2019; 14:e0209060. [PMID: 30995241 PMCID: PMC6469750 DOI: 10.1371/journal.pone.0209060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/16/2019] [Indexed: 12/13/2022] Open
Abstract
Biomarkers are fundamental to basic and clinical research outcomes by reporting host responses and providing insight into disease pathophysiology. Measuring biomarkers with research-use ELISA kits is universal, yet lack of kit standardization and unexpected lot-to-lot variability presents analytic challenges for long-term projects. During an ongoing two-year project measuring plasma biomarkers in cancer patients, control concentrations for one biomarker (PF) decreased significantly after changes in ELISA kit lots. A comprehensive operations review pointed to standard curve shifts with the new kits, an analytic variable that jeopardized data already collected on hundreds of patient samples. After excluding other reasonable contributors to data variability, a computational solution was developed to provide a uniform platform for data analysis across multiple ELISA kit lots. The solution (ELISAtools) was developed within open-access R software in which variability between kits is treated as a batch effect. A defined best-fit Reference standard curve is modelled, a unique Shift factor “S” is calculated for every standard curve and data adjusted accordingly. The averaged S factors for PF ELISA kit lots #1–5 ranged from -0.086 to 0.735, and reduced control inter-assay variability from 62.4% to <9%, within quality control limits. S factors calculated for four other biomarkers provided a quantitative metric to monitor ELISAs over the 10 month study period for quality control purposes. Reproducible biomarker measurements are essential, particularly for long-term projects with valuable patient samples. Use of research-use ELISA kits is ubiquitous and judicious use of this computational solution maximizes biomarker reproducibility.
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Affiliation(s)
- Feng Feng
- Department of Microbiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Morgan P Thompson
- Department of Pathology and Laboratory Medicine, Boston Medical Center, Boston, Massachusetts, United States of America
| | - Beena E Thomas
- Department of Pathology and Laboratory Medicine, Boston Medical Center, Boston, Massachusetts, United States of America
| | - Elizabeth R Duffy
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Jiyoun Kim
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Shinichiro Kurosawa
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Joseph Y Tashjian
- Department of Pathology and Laboratory Medicine, Boston Medical Center, Boston, Massachusetts, United States of America.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Yibing Wei
- Department of Pathology and Laboratory Medicine, Boston Medical Center, Boston, Massachusetts, United States of America.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Chris Andry
- Department of Pathology and Laboratory Medicine, Boston Medical Center, Boston, Massachusetts, United States of America.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - D J Stearns-Kurosawa
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
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29
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Kwee RM, Kwee TC. Whole-body MRI for preventive health screening: A systematic review of the literature. J Magn Reson Imaging 2019; 50:1489-1503. [PMID: 30932247 PMCID: PMC6850647 DOI: 10.1002/jmri.26736] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 03/19/2019] [Accepted: 03/19/2019] [Indexed: 12/19/2022] Open
Abstract
Background The yield of whole‐body MRI for preventive health screening is currently not completely clear. Purpose To systematically review the prevalence of whole‐body MRI findings in asymptomatic subjects. Study Type Systematic review and meta‐analysis. Subjects MEDLINE and Embase were searched for original studies reporting whole‐body MRI findings in asymptomatic adults without known disease, syndrome, or genetic mutation. Twelve studies, comprising 5373 asymptomatic subjects, were included. Field Strength/Sequence 1.5T or 3.0T, whole‐body MRI. Assessment The whole‐body MRI literature findings were extracted and reviewed by two radiologists in consensus for designation as either critical or indeterminate incidental finding. Statistical Tests Data were pooled using a random effects model on the assumption that most subjects had ≤1 critical or indeterminate incidental finding. Heterogeneity was assessed by the I2 statistic. Results Pooled prevalences of critical and indeterminate incidental findings together and separately were 32.1% (95% confidence interval [CI]: 18.3%, 50.1%), 13.4% (95% CI: 9.0%, 19.5%), and 13.9% (95% CI: 5.4%, 31.3%), respectively. There was substantial between‐study heterogeneity (I2 = 95.6–99.1). Pooled prevalence of critical and indeterminate incidental findings together was significantly higher in studies that included (cardio)vascular and/or colon MRI compared with studies that did not (49.7% [95% CI, 26.7%, 72.9%] vs. 23.0% [95% CI, 5.5%, 60.3%], P < 0.001). Pooled proportion of reported verified critical and indeterminate incidental findings was 12.6% (95% CI: 3.2%, 38.8%). Six studies reported false‐positive findings, yielding a pooled proportion of 16.0% (95% CI: 1.9%, 65.8%). None of the included studies reported long‐term (>5‐year) verification of negative findings. Only one study reported false‐negative findings, with a proportion of 2.0%. Data Conclusion Prevalence of critical and indeterminate incidental whole‐body MRI findings in asymptomatic subjects is overall substantial and with variability dependent to some degree on the protocol. Verification data are lacking. The proportion of false‐positive findings appears to be substantial. Level of Evidence: 4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;50:1489–1503.
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Affiliation(s)
- Robert M Kwee
- Department of Radiology and Nuclear Medicine, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands
| | - Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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30
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Wong MY, Andrews KA, Challis BG, Park S, Acerini CL, Maher ER, Casey RT. Clinical Practice Guidance: Surveillance for phaeochromocytoma and paraganglioma in paediatric succinate dehydrogenase gene mutation carriers. Clin Endocrinol (Oxf) 2019; 90:499-505. [PMID: 30589099 PMCID: PMC6850004 DOI: 10.1111/cen.13926] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/19/2018] [Accepted: 12/23/2018] [Indexed: 01/08/2023]
Abstract
The succinate dehydrogenase (SDH) enzyme complex functions as a key enzyme coupling the oxidation of succinate to fumarate in the citric acid cycle. Inactivation of this enzyme complex results in the cellular accumulation of the oncometabolite succinate, which is postulated to be a key driver in tumorigenesis. Succinate accumulation inhibits 2-oxoglutarate-dependent dioxygenases, including DNA and histone demethylase enzymes and hypoxic gene response regulators. Biallelic inactivation (typically resulting from one inherited and one somatic event) at one of the four genes encoding the SDH complex (SDHA/B/C/D) is the most common cause for SDH deficient (dSDH) tumours. Germline mutations in the SDHx genes predispose to a spectrum of tumours including phaeochromocytoma and paraganglioma (PPGL), wild type gastrointestinal stromal tumours (wtGIST) and, less commonly, renal cell carcinoma and pituitary tumours. Furthermore, mutations in the SDHx genes, particularly SDHB, predispose to a higher risk of malignant PPGL, which is associated with a 5-year mortality of 50%. There is general agreement that biochemical and imaging surveillance should be offered to asymptomatic carriers of SDHx gene mutations in the expectation that this will reduce the morbidity and mortality associated with dSDH tumours. However, there is no consensus on when and how surveillance should be performed in children and young adults. Here, we address the question: "What age should clinical, biochemical and radiological surveillance for PPGL be initiated in paediatric SDHx mutation carriers?".
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Affiliation(s)
- Mei Yin Wong
- Department of Diabetes and EndocrinologyCambridge University Hospital NHS Foundation TrustCambridgeUK
| | - Katrina A. Andrews
- East Anglian Medical Genetics ServiceCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Benjamin G. Challis
- Department of Diabetes and EndocrinologyCambridge University Hospital NHS Foundation TrustCambridgeUK
| | - Soo‐Mi Park
- East Anglian Medical Genetics ServiceCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | | | - Eamonn R. Maher
- Department of Medical GeneticsUniversity of CambridgeCambridgeUK
- NIHR Cambridge Biomedical Research Centre and Cancer Research UK Cambridge CentreCambridgeUK
| | - Ruth T. Casey
- Department of Diabetes and EndocrinologyCambridge University Hospital NHS Foundation TrustCambridgeUK
- Department of Medical GeneticsUniversity of CambridgeCambridgeUK
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31
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Hegedüs P, von Stackelberg O, Neumann C, Selder S, Werner N, Erdmann P, Granitza A, Völzke H, Bamberg F, Kaaks R, Bertheau RC, Kauczor HU, Schlett CL, Weckbach S. How to report incidental findings from population whole-body MRI: view of participants of the German National Cohort. Eur Radiol 2019; 29:5873-5878. [PMID: 30915558 DOI: 10.1007/s00330-019-06077-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/18/2019] [Accepted: 02/07/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES In the German National Cohort (GNC), 30,000 individuals are examined with whole-body MRI (wbMRI), of which about 3000 participants are expected to receive an incidental finding (IF) disclosure. In order to get feedback from participants and to evaluate the IF-management procedure of the wbMRI substudy, a follow-up questionnaire was developed. This single-center pilot trial was aimed to get a first impression on feasibility reproducibility and validity of such a survey in order to take necessary adjustments before initiating the survey among several thousand participants. METHODS The questionnaires were sent out in test-retest manner to 86 participants who received a wbMRI examination in January-February 2016 at the imaging center in Neubrandenburg. The ratio of participants with and without IF notification was 1:1. Descriptive statistics was performed. RESULTS A first response of 94% and completion proportion of 99% were achieved. Participants were satisfied with the examination procedure. Ninety-five percent of participants considered it very important to receive notification of IFs. Participants reported minimal stress levels while waiting for a possible IF notification letter, but high stress levels when an IF letter was received. Phrasing of the IF reports was rated in 97% as well understandable and in 55% as beneficial to health status. CONCLUSIONS This questionnaire will serve researchers within the GNC as a fundamental instrument not only for quality management analyses but also for the investigation of still unacknowledged scientific and ethical questions contributing to evidence-based guidelines concerning the complex approach to IFs in future population-based imaging. KEY POINTS • Evidence-based guidelines for reporting incidental findings in population whole-body MRI are lacking. • Pilot-testing of a questionnaire for the evaluation of practical and ethical aspects of the procedure to report incidental findings in the German National Cohort shows a high level of acceptance and high return rate by participants. • Participants reported minimal stress levels while waiting for a possible incidental finding notification letter, which increased significantly, when such a letter was received.
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Affiliation(s)
- Peter Hegedüs
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Oyunbileg von Stackelberg
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Christoph Neumann
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Sonja Selder
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Nicole Werner
- Institute of Community Medicine, SHIP/Clinical-Epidemiological Research, University of Greifswald, Greifswald, Germany
| | - Pia Erdmann
- Faculty of Theology, Systematic Theology, University of Greifswald, Greifswald, Germany
| | - Anja Granitza
- Faculty of Theology, Systematic Theology, University of Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute of Community Medicine, SHIP/Clinical-Epidemiological Research, University of Greifswald, Greifswald, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Robert C Bertheau
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Neuenheimer Feld 110, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Sabine Weckbach
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Neuenheimer Feld 110, 69120, Heidelberg, Germany
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32
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Abstract
Improvements in imaging techniques have led to an expansion in the number of cross-sectional cardiac studies being performed. This means that incidental non-cardiac findings (INCF) identified on cardiac imaging have become an important clinical concern. The majority of INCF are not clinically significant. However, some INCF will require follow-up or changes in management. Differentiating clinically significant from non-significant INCF can be challenging, particularly given the breadth of potential findings and the range of organ systems involved. Following up INCF also has economic implications. Recent changes to the lung nodule follow-up guidelines will reduce the cost of following up incidental lung nodules. In this manuscript, we discuss the common and important INCF which may be identified in cardiovascular imaging and explore potential implications of these findings.
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33
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Gibson LM, Littlejohns TJ, Adamska L, Garratt S, Doherty N, Wardlaw JM, Maskell G, Parker M, Brownsword R, Matthews PM, Collins R, Allen NE, Sellors J, Sudlow CL. Impact of detecting potentially serious incidental findings during multi-modal imaging. Wellcome Open Res 2017. [PMID: 30009267 DOI: 10.12688/wellcomeopenres.13181.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: There are limited data on the impact of feedback of incidental findings (IFs) from research imaging. We evaluated the impact of UK Biobank's protocol for handling potentially serious IFs in a multi-modal imaging study of 100,000 participants (radiographer 'flagging' with radiologist confirmation of potentially serious IFs) compared with systematic radiologist review of all images. Methods: Brain, cardiac and body magnetic resonance, and dual-energy x-ray absorptiometry scans from the first 1000 imaged UK Biobank participants were independently assessed for potentially serious IFs using both protocols. We surveyed participants with potentially serious IFs and their GPs up to six months after imaging to determine subsequent clinical assessments, final diagnoses, emotional, financial and work or activity impacts. Results: Compared to systematic radiologist review, radiographer flagging resulted in substantially fewer participants with potentially serious IFs (179/1000 [17.9%] versus 18/1000 [1.8%]) and a higher proportion with serious final diagnoses (21/179 [11.7%] versus 5/18 [27.8%]). Radiographer flagging missed 16/21 serious final diagnoses (i.e., false negatives), while systematic radiologist review generated large numbers of non-serious final diagnoses (158/179) (i.e., false positives). Almost all (90%) participants had further clinical assessment (including invasive procedures in similar numbers with serious and non-serious final diagnoses [11 and 12 respectively]), with additional impact on emotional wellbeing (16.9%), finances (8.9%), and work or activities (5.6%). Conclusions: Compared with systematic radiologist review, radiographer flagging missed some serious diagnoses, but avoided adverse impacts for many participants with non-serious diagnoses. While systematic radiologist review may benefit some participants, UK Biobank's responsibility to avoid both unnecessary harm to larger numbers of participants and burdening of publicly-funded health services suggests that radiographer flagging is a justifiable approach in the UK Biobank imaging study. The potential scale of non-serious final diagnoses raises questions relating to handling IFs in other settings, such as commercial and public health screening.
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Affiliation(s)
- Lorna M Gibson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Thomas J Littlejohns
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ligia Adamska
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | | | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Michael Parker
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Roger Brownsword
- The Dickson Poon School of Law, King's College London, London, UK
| | - Paul M Matthews
- UK Biobank Coordinating Centre, Stockport, UK.,Division of Brain Sciences, Department of Medicine, Hammersmith Hospital, Imperial College London, London, UK
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,UK Biobank Coordinating Centre, Stockport, UK
| | - Naomi E Allen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,UK Biobank Coordinating Centre, Stockport, UK
| | - Jonathan Sellors
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,UK Biobank Coordinating Centre, Stockport, UK
| | - Cathie Lm Sudlow
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,UK Biobank Coordinating Centre, Stockport, UK
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Gibson LM, Littlejohns TJ, Adamska L, Garratt S, Doherty N, Wardlaw JM, Maskell G, Parker M, Brownsword R, Matthews PM, Collins R, Allen NE, Sellors J, Sudlow CLM. Impact of detecting potentially serious incidental findings during multi-modal imaging. Wellcome Open Res 2017; 2:114. [PMID: 30009267 PMCID: PMC6024231 DOI: 10.12688/wellcomeopenres.13181.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2017] [Indexed: 02/09/2024] Open
Abstract
Background: There are limited data on the impact of feedback of incidental findings (IFs) from research imaging. We evaluated the impact of UK Biobank's protocol for handling potentially serious IFs in a multi-modal imaging study of 100,000 participants (radiographer 'flagging' with radiologist confirmation of potentially serious IFs) compared with systematic radiologist review of all images. Methods: Brain, cardiac and body magnetic resonance, and dual-energy x-ray absorptiometry scans from the first 1000 imaged UK Biobank participants were independently assessed for potentially serious IFs using both protocols. We surveyed participants with potentially serious IFs and their GPs up to six months after imaging to determine subsequent clinical assessments, final diagnoses, emotional, financial and work or activity impacts. Results: Compared to systematic radiologist review, radiographer flagging resulted in substantially fewer participants with potentially serious IFs (179/1000 [17.9%] versus 18/1000 [1.8%]) and a higher proportion with serious final diagnoses (21/179 [11.7%] versus 5/18 [27.8%]). Radiographer flagging missed 16/21 serious final diagnoses (i.e., false negatives), while systematic radiologist review generated large numbers of non-serious final diagnoses (158/179) (i.e., false positives). Almost all (90%) participants had further clinical assessment (including invasive procedures in similar numbers with serious and non-serious final diagnoses [11 and 12 respectively]), with additional impact on emotional wellbeing (16.9%), finances (8.9%), and work or activities (5.6%). Conclusions: Compared with systematic radiologist review, radiographer flagging missed some serious diagnoses, but avoided adverse impacts for many participants with non-serious diagnoses. While systematic radiologist review may benefit some participants, UK Biobank's responsibility to avoid both unnecessary harm to larger numbers of participants and burdening of publicly-funded health services suggests that radiographer flagging is a justifiable approach in the UK Biobank imaging study. The potential scale of non-serious final diagnoses raises questions relating to handling IFs in other settings, such as commercial and public health screening.
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Affiliation(s)
- Lorna M Gibson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Thomas J Littlejohns
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ligia Adamska
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | - UK Biobank Imaging Working Group
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- UK Biobank Coordinating Centre, Stockport, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Royal Cornwall Hospitals NHS Trust, Cornwall, UK
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- The Dickson Poon School of Law, King’s College London, London, UK
- Division of Brain Sciences, Department of Medicine, Hammersmith Hospital, Imperial College London, London, UK
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Michael Parker
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Roger Brownsword
- The Dickson Poon School of Law, King’s College London, London, UK
| | - Paul M Matthews
- UK Biobank Coordinating Centre, Stockport, UK
- Division of Brain Sciences, Department of Medicine, Hammersmith Hospital, Imperial College London, London, UK
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- UK Biobank Coordinating Centre, Stockport, UK
| | - Naomi E Allen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- UK Biobank Coordinating Centre, Stockport, UK
| | - Jonathan Sellors
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- UK Biobank Coordinating Centre, Stockport, UK
| | - Cathie LM Sudlow
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
- UK Biobank Coordinating Centre, Stockport, UK
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Gibson LM, Littlejohns TJ, Adamska L, Garratt S, Doherty N, Wardlaw JM, Maskell G, Parker M, Brownsword R, Matthews PM, Collins R, Allen NE, Sellors J, Sudlow CL. Impact of detecting potentially serious incidental findings during multi-modal imaging. Wellcome Open Res 2017; 2:114. [PMID: 30009267 PMCID: PMC6024231 DOI: 10.12688/wellcomeopenres.13181.3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2017] [Indexed: 12/05/2022] Open
Abstract
Background: There are limited data on the impact of feedback of incidental findings (IFs) from research imaging. We evaluated the impact of UK Biobank’s protocol for handling potentially serious IFs in a multi-modal imaging study of 100,000 participants (radiographer ‘flagging’ with radiologist confirmation of potentially serious IFs) compared with systematic radiologist review of all images. Methods: Brain, cardiac and body magnetic resonance, and dual-energy x-ray absorptiometry scans from the first 1000 imaged UK Biobank participants were independently assessed for potentially serious IFs using both protocols. We surveyed participants with potentially serious IFs and their GPs up to six months after imaging to determine subsequent clinical assessments, final diagnoses, emotional, financial and work or activity impacts. Results: Compared to systematic radiologist review, radiographer flagging resulted in substantially fewer participants with potentially serious IFs (179/1000 [17.9%] versus 18/1000 [1.8%]) and a higher proportion with serious final diagnoses (21/179 [11.7%] versus 5/18 [27.8%]). Radiographer flagging missed 16/21 serious final diagnoses (i.e., false negatives), while systematic radiologist review generated large numbers of non-serious final diagnoses (158/179) (i.e., false positives). Almost all (90%) participants had further clinical assessment (including invasive procedures in similar numbers with serious and non-serious final diagnoses [11 and 12 respectively]), with additional impact on emotional wellbeing (16.9%), finances (8.9%), and work or activities (5.6%). Conclusions: Compared with systematic radiologist review, radiographer flagging missed some serious diagnoses, but avoided adverse impacts for many participants with non-serious diagnoses. While systematic radiologist review may benefit some participants, UK Biobank’s responsibility to avoid both unnecessary harm to larger numbers of participants and burdening of publicly-funded health services suggests that radiographer flagging is a justifiable approach in the UK Biobank imaging study. The potential scale of non-serious final diagnoses raises questions relating to handling IFs in other settings, such as commercial and public health screening.
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Affiliation(s)
- Lorna M Gibson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Thomas J Littlejohns
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ligia Adamska
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | | | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Michael Parker
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Roger Brownsword
- The Dickson Poon School of Law, King's College London, London, UK
| | - Paul M Matthews
- UK Biobank Coordinating Centre, Stockport, UK.,Division of Brain Sciences, Department of Medicine, Hammersmith Hospital, Imperial College London, London, UK
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,UK Biobank Coordinating Centre, Stockport, UK
| | - Naomi E Allen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,UK Biobank Coordinating Centre, Stockport, UK
| | - Jonathan Sellors
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,UK Biobank Coordinating Centre, Stockport, UK
| | - Cathie Lm Sudlow
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,UK Biobank Coordinating Centre, Stockport, UK
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Abdullah SB, Dietz KR, Holm TL. Fetal MRI: incidental findings in the mother. Pediatr Radiol 2016; 46:1736-1743. [PMID: 27554368 DOI: 10.1007/s00247-016-3680-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 06/23/2016] [Accepted: 07/26/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Fetal magnetic resonance imaging (MRI) is a routinely used tool in prenatal diagnosis; however, there is a lack of studies evaluating incidental findings observed in the mother. OBJECTIVE This study describes and quantifies incidental findings observed in the mother during fetal MRI. MATERIALS AND METHODS We reviewed all fetal MRI studies at the University of Minnesota Medical Center from February 2008 to September 2014. Two pediatric radiologists retrospectively conducted a consensus evaluation. The maternal findings were categorized into neurologic, gynecologic, urinary, gastrointestinal and musculoskeletal. Hydronephrosis consistent with the stage of pregnancy was recorded but was not included as an abnormal finding. Abnormal findings were classified into three groups, depending on their clinical significance: level I (low), level II (medium) and level III (high). RESULTS We evaluated 332 pregnant patients with a mean age of 29.3 years and a mean gestational age of 29 weeks. Of these, 55.4% had at least 1 incidental finding, for a total of 262 incidental maternal findings. Of the 262 abnormalities, 113 (43.1%) were neurologic, 69 were gynecologic (26.3%), 36 (13.7%) urinary, 24 (9.2%) gastrointestinal and 20 (7.6%) musculoskeletal. Of the 262 incidental findings, 237 (90.5%) were level I, 24 (9.2%) were level II and 1 (0.4%) was level III. CONCLUSION Our results suggest that although the vast majority of incidental maternal findings are benign, more significant findings are still encountered and should be expected.
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Affiliation(s)
- Selwan B Abdullah
- Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, MD, USA.
- Medical School, University of Minnesota, Minneapolis, MN, USA.
| | - Kelly R Dietz
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Tara L Holm
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
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Population-based imaging biobanks as source of big data. Radiol Med 2016; 122:430-436. [PMID: 27613426 DOI: 10.1007/s11547-016-0684-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 08/28/2016] [Indexed: 12/13/2022]
Abstract
Advances of computational sciences over the last decades have enabled the introduction of novel methodological approaches in biomedical research. Acquiring extensive and comprehensive data about a research subject and subsequently extracting significant information has opened new possibilities in gaining insight into biological and medical processes. This so-called big data approach has recently found entrance into medical imaging and numerous epidemiological studies have been implementing advanced imaging to identify imaging biomarkers that provide information about physiological processes, including normal development and aging but also on the development of pathological disease states. The purpose of this article is to present existing epidemiological imaging studies and to discuss opportunities, methodological and organizational aspects, and challenges that population imaging poses to the field of big data research.
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Fleßa S, Thum C, Raths S, Fischer T, Erdmann P, Langanke M. Systems Medicine: hype or revolution? Per Med 2016; 13:441-453. [PMID: 29767599 DOI: 10.2217/pme-2016-0039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Research and innovation in healthcare can change existing practices aiming at constant improvement of diagnosis, treatment and prevention. As a new holistic approach Systems Medicine (SM) may revolutionize the healthcare system. This paper analyzes ethical and economic obstacles of SMs development from a niche innovation to a standard solution. We adapt a model of innovation theory to structure the barriers of adopting SM to become standard in the medical system. SM has the potential to change the medical system if barriers to this innovation can be overcome. The article discusses the potential of SM in becoming the future health paradigm considering these barriers and provides an overview of the current situation.
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Affiliation(s)
- Steffen Fleßa
- Ernst-Moritz-Arndt-Universität Greifswald, Rechts- und Staatswissenschaftliche Fakultät, Lehrstuhl für Allgemeine Betriebswirtschaftslehre und Gesundheitsmanagement, Friedrich-Loeffler-Straße 70, 17489 Greifswald, Deutschland
| | - Christin Thum
- Ernst-Moritz-Arndt-Universität Greifswald, Rechts- und Staatswissenschaftliche Fakultät, Lehrstuhl für Allgemeine Betriebswirtschaftslehre und Gesundheitsmanagement, Friedrich-Loeffler-Straße 70, 17489 Greifswald, Deutschland
| | - Susan Raths
- Ernst-Moritz-Arndt-Universität Greifswald, Rechts- und Staatswissenschaftliche Fakultät, Lehrstuhl für Allgemeine Betriebswirtschaftslehre und Gesundheitsmanagement, Friedrich-Loeffler-Straße 70, 17489 Greifswald, Deutschland
| | - Tobias Fischer
- Universitätsmedizin Greifswald, Institut für Ethik und Geschichte der Medizin, Ellernholzstraße 1-2, 17487 Greifswald, Deutschland
| | - Pia Erdmann
- Ernst-Moritz-Arndt-Universität Greifswald, TheologischeFakultät, Lehrstuhl für Systematische Theologie, Am Rubenowplatz 2-3, 17489 Greifswald, Deutschland
| | - Martin Langanke
- Universitätsmedizin Greifswald, Institut für Ethik und Geschichte der Medizin, Ellernholzstraße 1-2, 17487 Greifswald, Deutschland.,Ernst-Moritz-Arndt-Universität Greifswald, TheologischeFakultät, Lehrstuhl für Systematische Theologie, Am Rubenowplatz 2-3, 17489 Greifswald, Deutschland
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Bignotti B, Succio G, Nosenzo F, Perinetti M, Gristina L, Barbagallo S, Secondini L, Calabrese M, Tagliafico A. Breast findings incidentally detected on body MRI. SPRINGERPLUS 2016; 5:781. [PMID: 27386267 PMCID: PMC4912526 DOI: 10.1186/s40064-016-2343-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 05/12/2016] [Indexed: 12/21/2022]
Abstract
Objectives To evaluate breast findings incidentally detected on body MRI. Methods A retrospective review of the institutional database identified 1752 body MRI performed between January 2015 and September 2015. MRI of women with breast tissue visible in the field-of-view were reviewed for breast findings. Breast findings were classified with the breast imaging reporting and data system (BI-RADS) lexicon. The standard statistic, costs of additional work-up, and the clinical relevance were used to describe breast findings, and we calculated 95 % exact confidence intervals (CIs). Results 440 body MRI of 440 women (mean age: 57 ± 20 years) included breast tissue in the field-of-view. A total of 41 breast findings were identified in 41 patients. Breast findings were classified BI-RADS 2 N = 25, BI-RADS 3 N = 13, BI-RADS 4 N = 3. A total of 3.6 % [95 % CI 1.6 %, 5.6 %] women with breast tissue visible on MRI had a recommendation for further imaging work-up for a breast finding. The 18.7 % (3 of 16) of these patients had a clinically important finding (breast cancer). Further imaging evaluation increased costs of €108.3 per patient with a breast finding. Conclusions Clinically important breast findings could be detected on body MRI in up to 0.7 % (3 of 440) of women.
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Affiliation(s)
- Bianca Bignotti
- Department of Health Sciences (DISSAL), University of Genova, Via A. Pastore 1, 16132 Genoa, Italy
| | - Giulia Succio
- Department of Diagnostic Senology, IRCCS Azienda Ospedaliera Universitaria San Martino IST-Istituto Nazionale per la Ricerca sul Cancro, Largo Rosanna Benzi 10, 16132 Genoa, Italy
| | - Francesca Nosenzo
- Department of Health Sciences (DISSAL), University of Genova, Via A. Pastore 1, 16132 Genoa, Italy
| | - Michela Perinetti
- Department of Health Sciences (DISSAL), University of Genova, Via A. Pastore 1, 16132 Genoa, Italy
| | - Licia Gristina
- Department of Health Sciences (DISSAL), University of Genova, Via A. Pastore 1, 16132 Genoa, Italy
| | - Stella Barbagallo
- Department of Health Sciences (DISSAL), University of Genova, Via A. Pastore 1, 16132 Genoa, Italy
| | - Lucia Secondini
- Department of Health Sciences (DISSAL), University of Genova, Via A. Pastore 1, 16132 Genoa, Italy
| | - Massimo Calabrese
- Department of Diagnostic Senology, IRCCS Azienda Ospedaliera Universitaria San Martino IST-Istituto Nazionale per la Ricerca sul Cancro, Largo Rosanna Benzi 10, 16132 Genoa, Italy
| | - Alberto Tagliafico
- Institute of Anatomy, Department of Experimental Medicine, University of Genova, Via Leon Battista Alberti, 2, 16132 Genoa, Italy
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Whole-body MRI in patients with lymphoma: collateral findings. Radiol Med 2016; 121:793-800. [PMID: 27307001 DOI: 10.1007/s11547-016-0658-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/30/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE To assess the incidence of collateral findings detected on whole-body magnetic resonance (WB-MRI) scans performed on patients with lymphoma. MATERIALS AND METHODS 114 patients (65 male; median age 45.2 years, range 15-86) with histologically confirmed lymphoma (47 Hodgkin, 67 Non-Hodgkin) underwent WB-MRI. The collateral findings were classified into three classes, according to their clinical significance, as follows: not or low significant (class 1), moderately or potentially significant (class 2), and significant (class 3). A Chi-square (χ (2)) test was performed to assess the statistical significance of differences in the incidence of collateral findings based on age (≤50 and >50 years old), gender and histology (Hodgkin and Non-Hodgkin Lymphoma). RESULTS Ninety-one of 114 patients (79.8 %) had one or more incidental findings on WB-MRI. Collateral findings were more frequent in class 1 (43 %); abnormalities found in 35 patients (30.7 %) were considered potentially significant, whereas seven patients (6.1 %) demonstrated significant collateral findings requiring immediate treatment or further diagnostic evaluation. Collateral findings were more frequent in subjects over 50 years old compared to those of 50 years old or younger; differences were statistical significant (χ (2) = 8.42, p < 0.05). There were not statistically significant differences related to gender (χ (2) = 0.17, p > 0.05) and histology (χ (2) = 0.24, p > 0.05). CONCLUSION WB-MRI is an attractive procedure that allows to detect incidental abnormalities of organs not involved by disease offering the opportunity to obtain an early diagnosis of asymptomatic life-threatening diseases.
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Fischer T, Brothers KB, Erdmann P, Langanke M. Clinical decision-making and secondary findings in systems medicine. BMC Med Ethics 2016; 17:32. [PMID: 27209083 PMCID: PMC4875611 DOI: 10.1186/s12910-016-0113-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 05/10/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Systems medicine is the name for an assemblage of scientific strategies and practices that include bioinformatics approaches to human biology (especially systems biology); "big data" statistical analysis; and medical informatics tools. Whereas personalized and precision medicine involve similar analytical methods applied to genomic and medical record data, systems medicine draws on these as well as other sources of data. Given this distinction, the clinical translation of systems medicine poses a number of important ethical and epistemological challenges for researchers working to generate systems medicine knowledge and clinicians working to apply it. DISCUSSION This article focuses on three key challenges: First, we will discuss the conflicts in decision-making that can arise when healthcare providers committed to principles of experimental medicine or evidence-based medicine encounter individualized recommendations derived from computer algorithms. We will explore in particular whether controlled experiments, such as comparative effectiveness trials, should mediate the translation of systems medicine, or if instead individualized findings generated through "big data" approaches can be applied directly in clinical decision-making. Second, we will examine the case of the Riyadh Intensive Care Program Mortality Prediction Algorithm, pejoratively referred to as the "death computer," to demonstrate the ethical challenges that can arise when big-data-driven scoring systems are applied in clinical contexts. We argue that the uncritical use of predictive clinical algorithms, including those envisioned for systems medicine, challenge basic understandings of the doctor-patient relationship. Third, we will build on the recent discourse on secondary findings in genomics and imaging to draw attention to the important implications of secondary findings derived from the joint analysis of data from diverse sources, including data recorded by patients in an attempt to realize their "quantified self." This paper examines possible ethical challenges that are likely to be raised as systems medicine to be translated into clinical medicine. These include the epistemological challenges for clinical decision-making, the use of scoring systems optimized by big data techniques and the risk that incidental and secondary findings will significantly increase. While some ethical implications remain still hypothetical we should use the opportunity to prospectively identify challenges to avoid making foreseeable mistakes when systems medicine inevitably arrives in routine care.
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Affiliation(s)
- T Fischer
- University Medicine Greifswald, Institute for Ethics and History of Medicine, Ellernholzstraße 1-2, 17487, Greifswald, Germany.
| | - K B Brothers
- Kosair Charities Pediatric Clinical Research Unit, University of Louisville, School of Medicine, Louisville, KY, USA
| | - P Erdmann
- Faculty of Theology, Greifswald University, Greifswald, Germany
| | - M Langanke
- University Medicine Greifswald, Institute for Ethics and History of Medicine, Ellernholzstraße 1-2, 17487, Greifswald, Germany
- Faculty of Theology, Greifswald University, Greifswald, Germany
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MR imaging of the brain in large cohort studies: feasibility report of the population- and patient-based BiDirect study. Eur Radiol 2016; 27:231-238. [PMID: 27059857 DOI: 10.1007/s00330-016-4303-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 02/02/2016] [Accepted: 02/23/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To describe the implementation and protocol of cerebral magnetic resonance imaging (MRI) in the longitudinal BiDirect study and to report rates of study participation as well as management of incidental findings. METHODS Data came from the BiDirect study that investigates the relationship between depression and arteriosclerosis and comprises 2258 participants in three cohorts: 999 patients with depression, 347 patients with manifest cardiovascular disease (CVD) and 912 population-based controls. The study program includes MRI of the brain. Reasons for non-participation were systematically collected. Incidental findings were categorized and disclosed according to clinical relevance. RESULTS At baseline 2176 participants were offered MRI, of whom 1453 (67 %) completed it. Reasons for non-participation differed according to cohort, age and gender with controls showing the highest participation rate of 79 %. Patient cohorts had higher refusal rates and CVD patients a high prevalence of contraindications. In the first follow-up examination 69 % of participating subjects completed MRI. Incidental findings were disclosed to 246 participants (17 %). The majority of incidental findings were extensive white matter hyperintensities requiring further diagnostic work-up. CONCLUSIONS Knowledge about subjects and sensible definition of incidental findings are crucial for large-scale imaging projects. Our data offer practical and concrete information for the design of future studies. KEY POINTS • Willingness to participate in MRI is generally high, also in follow-up examinations. • Rates of refusal and prevalence of contraindications differ according to subject characteristics. • Extensive white matter hyperintensities considerably increase the disclosure rates of incidental findings. • MRI workflow requires continuous case-by-case handling by an interdisciplinary team.
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Shoemaker JM, Cole C, Petree LE, Helitzer DL, Holdsworth MT, Gluck JP, Phillips JP. Evolution of universal review and disclosure of MRI reports to research participants. Brain Behav 2016; 6:e00428. [PMID: 26893955 PMCID: PMC4744862 DOI: 10.1002/brb3.428] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 09/04/2015] [Accepted: 12/16/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Although incidental findings (IF) are commonly encountered in neuroimaging research, there is no consensus regarding what to do with them. Whether researchers are obligated to review scans for IF, or if such findings should be disclosed to research participants at all, is controversial. Objective data are required to inform reasonable research policy; unfortunately, such data are lacking in the published literature. This manuscript summarizes the development of a radiology review and disclosure system in place at a neuroimaging research institute and its impact on key stakeholders. METHODS The evolution of a universal radiology review system is described, from inception to its current status. Financial information is reviewed, and stakeholder impact is characterized through surveys and interviews. RESULTS Consistent with prior reports, 34% of research participants had an incidental finding identified, of which 2.5% required urgent medical attention. A total of 87% of research participants wanted their magnetic resonance imaging (MRI) results regardless of clinical significance and 91% considered getting an MRI report a benefit of study participation. A total of 63% of participants who were encouraged to see a doctor about their incidental finding actually followed up with a physician. Reasons provided for not following-up included already knowing the finding existed (14%), not being able to afford seeing a physician (29%), or being reassured after speaking with the institute's Medical Director (43%). Of those participants who followed the recommendation to see a physician, nine (38%) required further diagnostic testing. No participants, including those who pursued further testing, regretted receiving their MRI report, although two participants expressed concern about the excessive personal cost. The current cost of the radiology review system is about $23 per scan. CONCLUSIONS It is possible to provide universal radiology review of research scans through a system that is cost-effective, minimizes investigator burden, and does not overwhelm local healthcare resources.
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Affiliation(s)
- Jody M Shoemaker
- The Mind Research Network 1101 Yale Blvd NE Albuquerque New Mexico 87122
| | - Caitlin Cole
- The Mind Research Network 1101 Yale Blvd NE Albuquerque New Mexico 87122
| | - Linda E Petree
- The Mind Research Network 1101 Yale Blvd NE Albuquerque New Mexico 87122
| | - Deborah L Helitzer
- Department of Family and Community Medicine University of New Mexico Health Science Center 1 University of New Mexico Albuquerque New Mexico 87131; Clinical and Translational Science Center University of New Mexico Health Science Center 1 University of New Mexico Albuquerque New Mexico 87131
| | - Mark T Holdsworth
- College of Pharmacy University of New Mexico Health Science Center 1 University of New Mexico Albuquerque New Mexico 87131
| | - John P Gluck
- Kennedy Institute of Ethics Georgetown University Healy Hall, 4th Floor Washington District of Columbia 20057; Department of Psychology The University of New Mexico 1 University of New Mexico Albuquerque New Mexico 87131
| | - John P Phillips
- The Mind Research Network 1101 Yale Blvd NE Albuquerque New Mexico 87122; Department of Neurology University of New Mexico Health Sciences Center 1 University of New Mexico Albuquerque New Mexico 87131
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Bunnik EM, Vernooij MW. Incidental findings in population imaging revisited. Eur J Epidemiol 2016; 31:1-4. [PMID: 26861155 PMCID: PMC4756040 DOI: 10.1007/s10654-016-0123-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/28/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Eline M Bunnik
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
| | - Meike W Vernooij
- Departments of Radiology and Epidemiology, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
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Impact of whole-body MRI in a general population study. Eur J Epidemiol 2015; 31:31-9. [DOI: 10.1007/s10654-015-0101-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 11/04/2015] [Indexed: 01/01/2023]
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Chiorean L, Cantisani V, Jenssen C, Sidhu P, Baum U, Dietrich C. Focal masses in a non-cirrhotic liver: The additional benefit of CEUS over baseline imaging. Eur J Radiol 2015; 84:1636-43. [PMID: 26049958 DOI: 10.1016/j.ejrad.2015.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 04/16/2015] [Accepted: 05/02/2015] [Indexed: 02/07/2023]
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Preuß A, Elgeti T, Hamm B, Werncke T. Extravascular incidental findings in run-off CT angiography in patients with acute limb ischaemia: incidence and clinical relevance. Clin Radiol 2015; 70:622-9. [PMID: 25819627 DOI: 10.1016/j.crad.2015.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/07/2015] [Accepted: 02/20/2015] [Indexed: 12/21/2022]
Abstract
AIM To evaluate the incidence and clinical relevance of extravascular incidental findings (EVIFs) in CT angiography of the abdominal aorta and lower extremities (run-off CTA) in patients presenting with acute limb ischaemia (ALI). MATERIALS AND METHODS In this institutional review board-approved, retrospective study, 141 run-off CTA examinations conducted between 2005 and 2013 of patients (67 women, mean age 80 years; 74 men, mean age 69 years) presenting with clinical symptoms of ALI were re-evaluated by two radiologists (2 and 7 years of experience in interpreting run-off CTA). Imaging was conducted using 16- and 64-section CT systems. Image acquisition ranged from the costodiaphragmatic recess to the forefoot. The medical history form of each patient served as the standard of reference for assessment of incidence of EVIFs. CT morphology was assessed to assign EVIFs to one of three categories of clinical relevance: (I) immediate, (II) potential, and (III) no clinical relevance. RESULTS Thirty-eight patients had category I findings, including four patients (2.8%) with previously unknown malignancy and 67 patients with category II EVIFs. In total 473 extravascular EVIFs were found in 141 patients: 52 category I, 163 category II and 258 category III. CONCLUSION EVIFs with immediate clinical relevance are very common in run-off CTA in patients presenting with acute peripheral artery disease. Therefore, it is important to evaluate all body regions included in a CT examination carefully, even if the clinical focus is on vascular evaluation. The adequate classification of these EVIFs is required to avoid possible unnecessary diagnostic work-up with associated risks and costs.
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Affiliation(s)
- A Preuß
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - T Elgeti
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - B Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - T Werncke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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Incidental abdominopelvic findings on expanded field-of-view lumbar spinal MRI: frequency, clinical importance, and concordance in interpretation by neuroimaging and body imaging radiologists. Clin Radiol 2015; 70:161-7. [DOI: 10.1016/j.crad.2014.10.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 10/16/2014] [Accepted: 10/27/2014] [Indexed: 12/21/2022]
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Kaiser D, Leach J, Vannest J, Schapiro M, Holland S. Unanticipated findings in pediatric neuroimaging research: Prevalence of abnormalities and process for reporting and clinical follow-up. Brain Imaging Behav 2014; 9:32-42. [DOI: 10.1007/s11682-014-9327-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Cieszanowski A, Maj E, Kulisiewicz P, Grudzinski IP, Jakoniuk-Glodala K, Chlipala-Nitek I, Kaczynski B, Rowinski O. Non-contrast-enhanced whole-body magnetic resonance imaging in the general population: the incidence of abnormal findings in patients 50 years old and younger compared to older subjects. PLoS One 2014; 9:e107840. [PMID: 25259581 PMCID: PMC4178037 DOI: 10.1371/journal.pone.0107840] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 08/22/2014] [Indexed: 12/29/2022] Open
Abstract
Purpose To assess and compare the incidence of abnormal findings detected during non-contrast-enhanced whole-body magnetic resonance imaging (WB-MRI) in the general population in two age groups: (1) 50 years old and younger; and (2) over 50 years old. Materials and Methods The analysis included 666 non-contrast-enhanced WB-MRIs performed on a 1.5-T scanner between December 2009 and June 2013 in a private hospital in 451 patients 50 years old and younger and 215 patients over 50 years old. The following images were obtained: T2-STIR (whole body-coronal plane), T2-STIR (whole spine-sagittal), T2-TSE with fat-saturation (neck and trunk-axial), T2-FLAIR (head-axial), 3D T1-GRE (thorax-coronal, axial), T2-TSE (abdomen-axial), chemical shift (abdomen-axial). Detected abnormalities were classified as: insignificant (type I), potentially significant, requiring medical attention (type II), significant, requiring treatment (type III). Results There were 3375 incidental findings depicted in 659 (98.9%) subjects: 2997 type I lesions (88.8%), 363 type II lesions (10.8%) and 15 type III lesions (0.4%), including malignant or possibly malignant lesions in seven subjects. The most differences in the prevalence of abnormalities on WB-MRI between patients 50 years old and younger and over 50 years old concerned: brain infarction (22.2%, 45.0% respectively), thyroid cysts/nodules (8.7%, 18.8%), pulmonary nodules (5.0%, 16.2%), significant degenerative disease of the spine (23.3%, 44.5%), extra-spinal degenerative disease (22.4%, 61.1%), hepatic steatosis (15.8%, 24.9%), liver cysts/hemangiomas (24%, 34.5%), renal cysts (16.9%, 40.6%), prostate enlargement (5.1% of males, 34.2% of males), uterine fibroids (16.3% of females, 37.9% of females). Conclusions Incidental findings were detected in almost all of the subjects. WB-MRI demonstrated that the prevalence of the vast majority of abnormalities increases with age.
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Affiliation(s)
- Andrzej Cieszanowski
- 2 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
- Diagnostic Center, Medicover Hospital, Warsaw, Poland
| | - Edyta Maj
- 2 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
- Diagnostic Center, Medicover Hospital, Warsaw, Poland
- * E-mail:
| | - Piotr Kulisiewicz
- 2 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
- Diagnostic Center, Medicover Hospital, Warsaw, Poland
| | - Ireneusz P. Grudzinski
- Department of Toxicology, Medical University of Warsaw, Faculty of Pharmacy, Warsaw, Poland
| | | | - Irena Chlipala-Nitek
- 2 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Bartosz Kaczynski
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw, Poland
| | - Olgierd Rowinski
- 2 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
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