Incidental abdominopelvic findings on expanded field-of-view lumbar spinal MRI: frequency, clinical importance, and concordance in interpretation by neuroimaging and body imaging radiologists

Frequency of extracardiac findings on "negative" CT coronary angiography studies

AIM

To evaluate the prevalence and nature of extracardiac findings identified on computed tomography (CT) coronary angiography (CTCA) in patients with chest pain but without evidence of coronary artery disease (CAD).

MATERIALS AND METHODS

CTCA studies in patients referred to the hospital between January 2017 to February 2021 with chest pain and a suspected diagnosis of CAD were reviewed retrospectively for the presence of extracardiac findings. Consensus review of CTCA studies was performed by two experienced thoracic radiologists. The presence and severity of extracardiac findings, together with the likelihood that chest pain might be attributed to these, was recorded. Patient records were reviewed to ascertain the recording of extracardiac findings on initial CTCA reports and, where applicable, the nature of the follow-up.

RESULTS

Extracardiac findings (n=210) were present in 110/180 patients (61%) with a mean of 1.9 findings per patient. Extracardiac findings were more prevalent in patients aged ≥65 years compared to those <65 years (p<0.001). At least one extracardiac finding with the potential to cause chest pain was present in 40 patients (22%): degenerative disc disease (n=23 [13%]) and hiatus hernia (n=6 [3.3%]) were the most common extracardiac findings. Only 37.6% (79) of all retrospectively identified findings had been initially reported and, of these, 12.7% (10) required further follow-up.

CONCLUSION

Extracardiac findings are common in patients with no evidence of CAD on CTCA. The entire dataset should be evaluated for the presence of extracardiac findings that could explain chest pain symptoms on wide field of view reconstructions.

Prevalence and clinical potential of extraspinal incidental findings in lumbosacral spine MRI of patients with suspected disc diseases

BACKGROUND Incidental findings could be observed in organs close to the spine while reporting lumbosacral spine magnetic resonance imaging (MRI). This study aimed to report the prevalence and clinical potential of extraspinal incidental findings in lumbosacral MRI of patients with suspected disc diseases. METHODS This single-centered cross-sectional study was carried out on 420 consecutive adult patients who underwent lumbar spine MRI for suspected disc disease from January to July 2019. The MRI was checked for the presence of extraspinal incidental findings, and each finding was categorized according to the body organ and its clinical significance. Each MRI plane that best displayed the findings was recorded, and the association between the findings and patient's age and sex was determined. RESULTS Of 420 samples, 135 cases showed extraspinal findings (32.1%), and 7.6% of the patients displayed suspicious lesions. The urinary tract was the most common system (18.6%) to display both clinically significant (5.0%) and benign findings (13.6%), and the axial MRI section was the plane which showed most of the incidental findings. Incidental findings in any body system were rarely found in the younger patients. Females had significantly higher benign findings than males (p = 0.002). CONCLUSIONS The prevalence of extraspinal findings in lumbosacral spine MRI is high, and some are significant. Most findings are related to the urinary tract and best displayed in the axial plane.

Statement of the German Roentgen Society, German Society of Neuroradiology, and Society of German-speaking Pediatric Radiologists on Requirements for the Performance and Reporting of MR Imaging Examinations Outside of Radiology

BACKGROUND

 Magnetic Resonance Imaging (MRI) is a very innovative, but at the same time complex and technically demanding diagnostic method in radiology. It plays an increasing role in high-quality and efficient patient management. Quality assurance in MRI is of utmost importance to avoid patient risks due to errors before and during the examination and when reporting the results. Therefore, MRI requires higher physician qualification and expertise than any other diagnostic imaging technique in medicine. This holds true for indication, performance of the examination itself, and in particular for image evaluation and writing of the report. In Germany, the radiologist is the only specialist who is systematically educated in all aspects of MRI during medical specialty training and who must document a specified, high number of examinations during this training. However, also non-radiologist physicians are increasingly endeavoring to conduct and bill MRI examinations on their own.

METHOD

 In this position statement, the following aspects of quality assurance for MRI examinations and billing by radiologists and non-radiologist physician specialists are examined scientifically: Requirements for specialist physician training, MRI risks and contraindications, radiation protection in the case of non-ionizing radiation, application of MR contrast agents, requirements regarding image quality, significance of image artifacts and incidental findings, image evaluation and reporting, interdisciplinary communication and multiple-eyes principle, and impact on healthcare system costs.

CONCLUSION

 The German Roentgen Society, German Society of Neuroradiology, and Society of German-speaking Pediatric Radiologists are critical with regard to MRI performance by non-radiologists in the interest of quality standards, patient welfare, and healthcare payers. The 24-month additional qualification in MRI as defined by the physician specialization regulations (Weiterbildungsordnung) through the German state medical associations (Landesärztekammern) is the only competence-based and quality-assured training program for board-certified specialist physicians outside radiology. This has to be required as the minimum standard for performance and reporting of MRI exams. Exclusively unstructured MRI training outside the physician specialization regulations has to be strictly rejected for reasons of patient safety. The performance and reporting of MRI examinations must be reserved for adequately trained and continuously educated specialist physicians.

KEY POINTS

· MR imaging plays an increasing role due to its high diagnostic value and serves as the reference standard in many indications.. · MRI is a complex technique that implies patient risks in case of inappropriare application or lack of expertise.. · In Germany, the radiologist is the only specialist physician that has been systematically trained in all aspects of MRI such as indication, performance, and reporting of examinations in specified, high numbers.. · The only competence-based and quality-assured MRI training program for specialist physicians outside radiology is the 24-month additional qualification as defined by the regulations through the German state medical associations.. · In view of quality-assurance and patient safety, a finalized training program following the physician specialization regulations has to be required for the performance and reporting of MRI examinations..

CITATION FORMAT

· Hunold P, Bucher AM, Sandstede J et al. Statement of the German Roentgen Society, German Society of Neuroradiology, and Society of German-speaking Pediatric Radiologists on Requirements for the Performance and Reporting of MR Imaging Examinations Outside of Radiology. Fortschr Röntgenstr 2021; 193: 1050 - 1060.

Clinical impact of coronal-STIR sequence in a routine lumbar spine MR imaging protocol to investigate low back pain

Aim of this study is to assess the clinical impact of coronal short tau inversion recovery (STIR)-weighted magnetic resonance (MR) sequence, when acquired in a lumbar spine MR imaging protocol, in detecting significant extraspinal imaging findings in patients with low back pain (LBP).We retrospectively evaluated 931 lumbar spine MR examinations of patients with LBP. Extraspinal MR imaging findings were categorized as: probably related to LBP (Category 1), not related to LBP but with relevant implications on patient's care (Category 2), and not related to LBP without significant implications on patient's care (Category 3). For each MR imaging finding was also assessed if it was detectable or not on the conventional sagittal and axial acquisition planes.Of the 931 evaluated MR examinations, 60 (6.4%) showed additional extraspinal MR imaging findings, categorized as follows: 55% (33/60) probably related to LBP (Category 1), 22% (13/60) not related to LBP but with relevant implications on patient's care (Category 2), and 23% (14/60) not related to LBP and without significant implications on patient's care (Category 3). Among categories 1 and 2 (n = 46), the 72% (33/46) of imaging findings were detected only on coronal plane. Coronal-STIR sequence significantly changed patients' diagnostic work-flow in 3.5% (33/931) of cases.Coronal STIR sequence, acquired in a lumbar spine MR imaging protocol to investigate LBP, may aid radiologists in detecting additional extraspinal MR imaging findings that could be related to LBP, addressing to the most appropriate clinical management.

Breast findings incidentally detected on body MRI

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.

Extravascular incidental findings in run-off CT angiography in patients with acute limb ischaemia: incidence and clinical relevance

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.