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de Jong KJ, Poon E, Foo M, Maingard J, Kok HK, Barras C, Yazdabadi A, Shaygi B, Fitt GJ, Egan G, Brooks M, Asadi H. Incidental findings in research brain MRI: Definition, prevalence and ethical implications. J Med Imaging Radiat Oncol 2024. [PMID: 39301891 DOI: 10.1111/1754-9485.13744] [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: 03/05/2024] [Accepted: 07/31/2024] [Indexed: 09/22/2024]
Abstract
Radiological incidental findings (IFs) are previously undetected abnormalities which are unrelated to the original indication for imaging and are unexpectedly discovered. In brain magnetic resonance imaging (MRI), the prevalence of IFs is increasing. By reviewing the literature on IFs in brain MRI performed for research purposes and discussing ethical considerations of IFs, this paper provides an overview of brain IF research results and factors contributing to inconsistencies and considers how the consent process can be improved from an ethical perspective. We found that despite extensive literature regarding IFs in research MRI of the brain, there are major inconsistencies in the reported prevalence, ranging from 1.3% to 99%. Many factors appear to contribute to this broad range: lack of standardised definition, participant demographics variance, heterogenous MRI scanner strength and sequences, reporter variation and results classification. We also found significant discrepancies in the review, consent and clinical communication processes pertaining to the ethical nature of these studies. These findings have implications for future studies, particularly those involving artificial intelligence. Further research, particularly in relation to MRI brain IFs would be useful to explore the generalisability of study results.
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Affiliation(s)
- Kenneth J de Jong
- Emergency Department, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Emma Poon
- Department of Imaging, Monash Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michelle Foo
- Department of Radiology, Austin Health, Melbourne, Victoria, Australia
| | - Julian Maingard
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- Interventional Radiology, Austin Hospital, Melbourne, Victoria, Australia
- Interventional Radiology, St Vincent's Hospital, Melbourne, Victoria, Australia
- Interventional Radiology, Epworth Hospital, Melbourne, Victoria, Australia
- Endovascular Clot Retrieval (ECR) Service, Austin Hospital, Melbourne, Victoria, Australia
| | - Hong Kuan Kok
- Interventional Radiology Service, Northern Imaging Victoria, Melbourne, Victoria, Australia
- Medicine (Northern Health), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Christen Barras
- Department of Radiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Anousha Yazdabadi
- Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Monash University, Eastern Health, Melbourne, Victoria, Australia
| | - Benham Shaygi
- London North West University Healthcare NHS Trust, London, UK
| | - Gregory J Fitt
- Department of Radiology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine and Radiology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Gary Egan
- Monash Biomedical Imaging, Monash University, Melbourne, Victoria, Australia
| | - Mark Brooks
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Radiology, Austin Health, Melbourne, Victoria, Australia
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- NeuroInterventional Radiology Unit, Monash Health, Melbourne, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Hamed Asadi
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Radiology, Austin Health, Melbourne, Victoria, Australia
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- NeuroInterventional Radiology Unit, Monash Health, Melbourne, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
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Sharifian MJ, Igland J, Klungsøyr K, Engeland A, Zhou A, Bjørge T. Incidence trends of adult glioma in Norway and its association with occupation and education: A registry-based cohort study. Cancer Epidemiol 2024; 89:102524. [PMID: 38367313 DOI: 10.1016/j.canep.2024.102524] [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: 09/01/2023] [Revised: 01/05/2024] [Accepted: 01/06/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Gliomas constitute 75 % of all malignant primary adult brain tumors. Being the most frequent histologic subtype, glioblastomas (GBMs) cause substantial morbidity and mortality worldwide and the Nordic countries have some of the highest incidence rates in the world. Therefore, we investigated the incidence of gliomas in Norway including time trends and associations with education and occupation. METHODS We retrieved individual-level data from databases at Statistics Norway containing information on education and occupation and linked them to data on adult glioma patients diagnosed during 2004-21 from the Cancer Registry of Norway. Age-standardized incidence rates (ASIRs) (World Standard Population) were calculated and analyzed with regards to sex and morphology. Poisson regression was used to test for time-trends, and to analyze the associations between education, occupation and glioma incidence, adjusted for age, sex, and calendar year. Estimates were reported as incidence rate ratios (IRRs) with 95 % confidence intervals (CIs). RESULTS The overall ASIR of gliomas (per 100,000 person-years) was 7.1 (95 % CI 6.9-7.3), with no specific time trend during the study period. The incidence increased with age. Compared to the other subtypes, GBMs were diagnosed at older ages. The risks of developing glioma overall and GBM were associated with occupation but not with educational level. The relative risk of glioma and GBM were respectively 1.17 (95 % CI 1.05-1.31) and 1.17 (95 % CI 1.02-1.35) among high-skilled white-collar workers compared to blue-collar workers. CONCLUSIONS The overall and sex-specific ASIRs of gliomas and GBMs did not show any noticeable time trends. The higher risk of developing glioma overall and GBM in high-skilled white-collar workers compared to blue-collar workers calls for further investigations.
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Affiliation(s)
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Health and Social Science, Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Ange Zhou
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Statistics and Biostatistics, Cal State East Bay, Hayward, CA, USA
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Cancer Registry of Norway, Oslo, Norway
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Hu YS, Wu CA, Lin DC, Lin PW, Lee HJ, Lin LY, Lin CJ. Applying ONCO-RADS to whole-body MRI cancer screening in a retrospective cohort of asymptomatic individuals. Cancer Imaging 2024; 24:22. [PMID: 38326850 PMCID: PMC10848416 DOI: 10.1186/s40644-024-00665-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/20/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Whole-body magnetic resonance imaging (WB-MRI) has emerged as a valuable tool for cancer detection. This study evaluated the prevalence rates of cancer in asymptomatic individuals undergoing WB-MRI according to the Oncologically Relevant Findings Reporting and Data System (ONCO-RADS) classifications in order to assess the reliability of the classification method. METHODS We retrospectively enrolled 2064 asymptomatic individuals who participated in a WB-MRI cancer screening program between 2017 and 2022. WB-MRI was acquired on a 3-T system with a standard protocol, including regional multisequence and gadolinium-based contrast agent-enhanced oncologic MRI. Results of further examinations, including additional imaging and histopathology examinations, performed at our institute were used to validate the WB-MRI findings. Two radiologists blinded to the clinical outcome classified the WB-MRI findings according to the ONCO-RADS categories as follows: 1 (normal), 2 (benign finding highly likely), 3 (benign finding likely), 4 (malignant finding likely), and 5 (malignant finding highly likely). Firth logistic regression analysis was performed to determine the associations between participant characteristics and findings of ONCO-RADS category ≥ 4. RESULTS Of the 2064 participants with median age of 55 years, 1120 (54.3%) were men, 43 (2.1%) had findings of ONCO-RADS category ≥ 4, and 24 (1.2%) had confirmed cancer. The cancer prevalence rates were 0.1%, 5.4%, 42.9%, and 75% for ONCO-RADS categories 2, 3, 4, and 5, respectively. In the multivariable model, older age (OR: 1.035, p = 0.029) and history of hypertension (OR: 2.051, p = 0.026), hepatitis B carrier (OR: 2.584, p = 0.013), or prior surgery (OR: 3.787, p < 0.001) were independently associated with the findings for ONCO-RADS category ≥ 4. CONCLUSIONS The ONCO-RADS categories for cancer risk stratification were validated and found to be positively correlated with cancer risk. The application of ONCO-RADS facilitates risk-based management after WB-MRI for cancer screening.
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Affiliation(s)
- Yong-Sin Hu
- Department of Radiology, Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-An Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Radiology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Dao-Chen Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Endocrine and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Wei Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Han-Jui Lee
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Lo-Yi Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Jung Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.
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Blackman G, Kempton MJ, McGuire P. Concerns Regarding Strength of Conclusions in Systematic Review and Meta-Analysis of Neuroradiological Abnormalities in First-Episode Psychosis-Reply. JAMA Psychiatry 2024; 81:109. [PMID: 37966847 DOI: 10.1001/jamapsychiatry.2023.4399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Affiliation(s)
- Graham Blackman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Philip McGuire
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Sooby P, Huang X, Kontorinis G. Incidental findings on magnetic resonance imaging of the internal auditory meatus for vestibular schwannoma: a systematic review. J Laryngol Otol 2023; 137:1215-1221. [PMID: 36514824 DOI: 10.1017/s0022215122002596] [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] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Magnetic resonance imaging of the internal auditory meatus is a highly sensitive and specific way to diagnose vestibular schwannoma. However, the rate of incidental findings with this method is believed to be high and can lead to increased patient anxiety and health interventions with unclear benefit. METHOD A systematic review of the literature was performed using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify incidental findings from magnetic resonance imaging of the internal auditory meatus; 12 studies were identified for inclusion within this review. RESULTS A total of 10 666 patients were included within the review. The overall rate of diagnosis of vestibular schwannoma was 0.87 per cent; 21 per cent of the study population had incidental findings on magnetic resonance imaging of the internal auditory meatus, and 9.56 per cent had clinically significant incidental findings. CONCLUSION Standardised pre-scan counselling may mitigate the risks of overdiagnosis, but future work should be undertaken to assess the benefits of such a strategy as well as the exact significance of some incidental findings.
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Affiliation(s)
- P Sooby
- Department of Otorhinolaryngology, Head and Neck Surgery, Queen Elizabeth University Hospital Campus, Glasgow, UK
| | - X Huang
- Department of Neurology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - G Kontorinis
- Department of Otorhinolaryngology, Head and Neck Surgery, Queen Elizabeth University Hospital Campus, Glasgow, UK
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Blackman G, Neri G, Al-Doori O, Teixeira-Dias M, Mazumder A, Pollak TA, Hird EJ, Koutsouleris N, Bell V, Kempton MJ, McGuire P. Prevalence of Neuroradiological Abnormalities in First-Episode Psychosis: A Systematic Review and Meta-analysis. JAMA Psychiatry 2023; 80:1047-1054. [PMID: 37436735 PMCID: PMC10339221 DOI: 10.1001/jamapsychiatry.2023.2225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/08/2023] [Indexed: 07/13/2023]
Abstract
Importance Individuals presenting with first-episode psychosis (FEP) may have a secondary ("organic") etiology to their symptoms that can be identified using neuroimaging. Because failure to detect such cases at an early stage can have serious clinical consequences, it has been suggested that brain magnetic resonance imaging (MRI) should be mandatory for all patients presenting with FEP. However, this remains a controversial issue, partly because the prevalence of clinically relevant MRI abnormalities in this group is unclear. Objective To derive a meta-analytic estimate of the prevalence of clinically relevant neuroradiological abnormalities in FEP. Data Sources Electronic databases Ovid, MEDLINE, PubMed, Embase, PsychINFO, and Global Health were searched up to July 2021. References and citations of included articles and review articles were also searched. Study Selection Magnetic resonance imaging studies of patients with FEP were included if they reported the frequency of intracranial radiological abnormalities. Data Extraction and Synthesis Independent extraction was undertaken by 3 researchers and a random-effects meta-analysis of pooled proportions was calculated. Moderators were tested using subgroup and meta-regression analyses. Heterogeneity was evaluated using the I2 index. The robustness of results was evaluated using sensitivity analyses. Publication bias was assessed using funnel plots and Egger tests. Main Outcomes and Measures Proportion of patients with a clinically relevant radiological abnormality (defined as a change in clinical management or diagnosis); number of patients needed to scan to detect 1 such abnormality (number needed to assess [NNA]). Results Twelve independent studies (13 samples) comprising 1613 patients with FEP were included. Of these patients, 26.4% (95% CI, 16.3%-37.9%; NNA of 4) had an intracranial radiological abnormality, and 5.9% (95% CI, 3.2%-9.0%) had a clinically relevant abnormality, yielding an NNA of 18. There were high degrees of heterogeneity among the studies for these outcomes, 95% to 73%, respectively. The most common type of clinically relevant finding was white matter abnormalities, with a prevalence of 0.9% (95% CI, 0%-2.8%), followed by cysts, with a prevalence of 0.5% (95% CI, 0%-1.4%). Conclusions and Relevance This systematic review and meta-analysis found that 5.9% of patients presenting with a first episode of psychosis had a clinically relevant finding on MRI. Because the consequences of not detecting these abnormalities can be serious, these findings support the use of MRI as part of the initial clinical assessment of all patients with FEP.
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Affiliation(s)
- Graham Blackman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Giulia Neri
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Omar Al-Doori
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Maria Teixeira-Dias
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Asif Mazumder
- Department of Neuroradiology, King’s College Hospital NHS Foundation Trust, London, United Kingdom
- Department of Radiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Thomas A. Pollak
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Emily J. Hird
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - Nikolaos Koutsouleris
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
- Max-Planck Institute of Psychiatry, Munich, Germany
| | - Vaughan Bell
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Matthew J. Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Philip McGuire
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
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Kimberly WT, Sorby-Adams AJ, Webb AG, Wu EX, Beekman R, Bowry R, Schiff SJ, de Havenon A, Shen FX, Sze G, Schaefer P, Iglesias JE, Rosen MS, Sheth KN. Brain imaging with portable low-field MRI. NATURE REVIEWS BIOENGINEERING 2023; 1:617-630. [PMID: 37705717 PMCID: PMC10497072 DOI: 10.1038/s44222-023-00086-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 09/15/2023]
Abstract
The advent of portable, low-field MRI (LF-MRI) heralds new opportunities in neuroimaging. Low power requirements and transportability have enabled scanning outside the controlled environment of a conventional MRI suite, enhancing access to neuroimaging for indications that are not well suited to existing technologies. Maximizing the information extracted from the reduced signal-to-noise ratio of LF-MRI is crucial to developing clinically useful diagnostic images. Progress in electromagnetic noise cancellation and machine learning reconstruction algorithms from sparse k-space data as well as new approaches to image enhancement have now enabled these advancements. Coupling technological innovation with bedside imaging creates new prospects in visualizing the healthy brain and detecting acute and chronic pathological changes. Ongoing development of hardware, improvements in pulse sequences and image reconstruction, and validation of clinical utility will continue to accelerate this field. As further innovation occurs, portable LF-MRI will facilitate the democratization of MRI and create new applications not previously feasible with conventional systems.
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Affiliation(s)
- W Taylor Kimberly
- Department of Neurology and the Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Annabel J Sorby-Adams
- Department of Neurology and the Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrew G Webb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ed X Wu
- Laboratory of Biomedical Imaging and Signal Processing, Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong SAR, China
| | - Rachel Beekman
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale New Haven Hospital and Yale School of Medicine, Yale Center for Brain & Mind Health, New Haven, CT, USA
| | - Ritvij Bowry
- Departments of Neurosurgery and Neurology, McGovern Medical School, University of Texas Health Neurosciences, Houston, TX, USA
| | - Steven J Schiff
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Adam de Havenon
- Division of Vascular Neurology, Department of Neurology, Yale New Haven Hospital and Yale School of Medicine, New Haven, CT, USA
| | - Francis X Shen
- Harvard Medical School Center for Bioethics, Harvard law School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Gordon Sze
- Department of Radiology, Yale New Haven Hospital and Yale School of Medicine, New Haven, CT, USA
| | - Pamela Schaefer
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Juan Eugenio Iglesias
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Centre for Medical Image Computing, University College London, London, UK
- Computer Science and AI Laboratory, Massachusetts Institute of Technology, Boston, MA, USA
| | - Matthew S Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kevin N Sheth
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale New Haven Hospital and Yale School of Medicine, Yale Center for Brain & Mind Health, New Haven, CT, USA
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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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Rowley PA, Paukner MJ, Eisenmenger LB, Field AS, Davidson RJ, Johnson SC, Asthana S, Chin NA, Prabhakaran V, Bendlin BB, Postle BR, Goldsmith HH, Carlsson CM, Brooks MA, Kalin NH, Williams LE, Rowley HA. Incidental Findings from 16,400 Brain MRI Examinations of Research Volunteers. AJNR Am J Neuroradiol 2023; 44:417-423. [PMID: 36927761 PMCID: PMC10084899 DOI: 10.3174/ajnr.a7821] [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: 12/16/2022] [Accepted: 02/20/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND AND PURPOSE Incidental findings are discovered in neuroimaging research, ranging from trivial to life-threatening. We describe the prevalence and characteristics of incidental findings from 16,400 research brain MRIs, comparing spontaneous detection by nonradiology scanning staff versus formal neuroradiologist interpretation. MATERIALS AND METHODS We prospectively collected 16,400 brain MRIs (7782 males, 8618 females; younger than 1 to 94 years of age; median age, 38 years) under an institutional review board directive intended to identify clinically relevant incidental findings. The study population included 13,150 presumed healthy volunteers and 3250 individuals with known neurologic diagnoses. Scanning staff were asked to flag concerning imaging findings seen during the scan session, and neuroradiologists produced structured reports after reviewing every scan. RESULTS Neuroradiologists reported 13,593/16,400 (83%) scans as having normal findings, 2193/16,400 (13.3%) with abnormal findings without follow-up recommended, and 614/16,400 (3.7%) with "abnormal findings with follow-up recommended." The most common abnormalities prompting follow-up were vascular (263/614, 43%), neoplastic (130/614, 21%), and congenital (92/614, 15%). Volunteers older than 65 years of age were significantly more likely to have scans with abnormal findings (P < .001); however, among all volunteers with incidental findings, those younger than 65 years of age were more likely to be recommended for follow-up. Nonradiologists flagged <1% of MRIs containing at least 1 abnormality reported by the neuroradiologists to be concerning enough to warrant further evaluation. CONCLUSIONS Four percent of individuals who undergo research brain MRIs have an incidental, potentially clinically significant finding. Routine neuroradiologist review of all scans yields a much higher rate of significant lesion detection than selective referral from nonradiologists who perform the examinations. Workflow and scan review processes need to be carefully considered when designing research protocols.
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Affiliation(s)
- P A Rowley
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Departments of Radiology (P.A.R., LB.E., A.S.F., V.P., H.A.R.)
| | | | - L B Eisenmenger
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Departments of Radiology (P.A.R., LB.E., A.S.F., V.P., H.A.R.)
| | - A S Field
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Departments of Radiology (P.A.R., LB.E., A.S.F., V.P., H.A.R.)
| | - R J Davidson
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Psychology (R.J.D., B.R.P., H.H.G.)
| | - S C Johnson
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Wisconsin Alzheimer's Disease Research Center (S.C.J., S.A., B.B.B., C.M.C.)
- Departments of Medicine (S.C.J., S.A., N.A.C., B.B.B., C.M.C.)
| | - S Asthana
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Wisconsin Alzheimer's Disease Research Center (S.C.J., S.A., B.B.B., C.M.C.)
- Departments of Medicine (S.C.J., S.A., N.A.C., B.B.B., C.M.C.)
| | - N A Chin
- Departments of Medicine (S.C.J., S.A., N.A.C., B.B.B., C.M.C.)
| | - V Prabhakaran
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Departments of Radiology (P.A.R., LB.E., A.S.F., V.P., H.A.R.)
| | - B B Bendlin
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Wisconsin Alzheimer's Disease Research Center (S.C.J., S.A., B.B.B., C.M.C.)
- Departments of Medicine (S.C.J., S.A., N.A.C., B.B.B., C.M.C.)
| | - B R Postle
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Psychology (R.J.D., B.R.P., H.H.G.)
| | - H H Goldsmith
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Psychology (R.J.D., B.R.P., H.H.G.)
| | - C M Carlsson
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Wisconsin Alzheimer's Disease Research Center (S.C.J., S.A., B.B.B., C.M.C.)
- Departments of Medicine (S.C.J., S.A., N.A.C., B.B.B., C.M.C.)
| | - M A Brooks
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Orthopedics (M.A.B.)
| | - N H Kalin
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Psychiatry (N.H.K., L.E.W.), University of Wisconsin-Madison, Madison, Wisconsin
| | - L E Williams
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Psychiatry (N.H.K., L.E.W.), University of Wisconsin-Madison, Madison, Wisconsin
| | - H A Rowley
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Departments of Radiology (P.A.R., LB.E., A.S.F., V.P., H.A.R.)
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10
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Sharpe RE, Huffman RI, McLaughlin CG, Blubaugh P, Strobel MJ, Palen T. Applying Implementation Science Principles to Systematize High-Quality Care for Potentially Significant Imaging Findings. J Am Coll Radiol 2023; 20:324-334. [PMID: 36922106 DOI: 10.1016/j.jacr.2022.11.019] [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: 06/30/2022] [Revised: 10/29/2022] [Accepted: 11/16/2022] [Indexed: 03/14/2023]
Abstract
OBJECTIVE Use principles of implementation science to improve the diagnosis and management of potentially significant imaging findings. METHODS Multidisciplinary stakeholders codified the diagnosis and management of potentially significant imaging findings in eight organs and created a finding tracking management system that was embedded in radiologist workflows and IT systems. Radiologists were trained to use this system. An automated finding tracking management system was created to support consistent high-quality care through care pathway visualizations, increased awareness of specific findings in the electronic medical record, templated notifications, and creation of an electronic safety net. Primary outcome was the rate of quality reviews related to eight targeted imaging findings. Secondary outcome was radiologist use of the finding tracking management tool. RESULTS In the 4 years after implementation, the tool was used to track findings in 7,843 patients who received 10,015 ultrasound, CT, MRI, x-ray, and nuclear medicine examinations that were interpreted by all 34 radiologists. Use of the tool lead to a decrease in related quality reviews (from 8.0% to 0.0%, P < .007). Use of the system increased from 1.7% of examinations in the early implementation phase to 3.1% (+82%, P < .00001) in the postimplementation phase. Each radiologist used the tool on an average of 294.6 unique examinations (SD 404.8). Overall, radiologists currently use the tool approximately 4,000 times per year. DISCUSSION Radiologists frequently used a finding tracking management system to ensure effective communication and raise awareness of the importance of recommended future follow-up studies. Use of this system was associated with a decrease in the rate of quality review requests in this domain.
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Affiliation(s)
- Richard E Sharpe
- Division Chair of Breast Imaging and Radiologist, Mayo Clinic, Phoenix, Arizona; Member, ACR Peer Learning Committee; Member, ACR Appropriateness Panel for Breast Imaging; and Member, ACR Commission on Screening & Emerging Technology Committee.
| | - Ryan I Huffman
- Radiologist, Scripps Clinic Medical Group, La Jolla, California
| | - Christopher G McLaughlin
- Radiologist, Department Technical Lead, Radiology, Colorado Permanente Medical Group, Denver, Colorado
| | | | - Mary Jo Strobel
- Director, Clinical Quality Oversight, Quality, Risk, and Patient Safety, Kaiser Permanente Colorado, Denver, Colorado
| | - Ted Palen
- Internal Medicine Physician and Scientific Investigator, Colorado Permanente Medical Group, Denver, Colorado
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11
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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: 2] [Impact Index Per Article: 2.0] [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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12
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Tadd K, Rego T, Gaillard F, Malpas CB, Walterfang M, Velakoulis D, Farrand S. Neuroimaging in the Acute Psychiatric Setting: Associations With Neuropsychiatric Risk Factors. J Neuropsychiatry Clin Neurosci 2022; 35:184-191. [PMID: 36128679 DOI: 10.1176/appi.neuropsych.21110269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The appropriateness and clinical utility of neuroimaging in psychiatric populations has been long debated, and the ambiguity of guideline recommendations is well established. Most of the literature is focused on first-episode psychosis. The investigators aimed to review ordering practices and identify risk factors associated with neuroradiological MRI abnormalities and their clinical utility in a general psychiatric population. METHODS A retrospective file review was undertaken for 100 consecutive brain MRI scans for adult psychiatric inpatients who received scanning as part of their clinical care in an Australian hospital. RESULTS Brain MRI was abnormal in 79.0% of scans; in these cases, 72.2% of patients required further investigation or follow-up, with 17.7% requiring urgent referral within days to weeks, despite only 3.7% of admitted patients undergoing MRI during the study period. Psychiatrically relevant abnormalities were found in 32.0% of scans. Abnormalities were more likely to be found in the presence of cognitive impairment, older age, and longer duration of psychiatric disorder. Psychiatrically relevant abnormalities had further associations with older age at onset of the psychiatric disorder and a weak association with abnormal neurological examination. Multiple indications for imaging were present in 57.0% of patients; the most common indications were physical, neurological, and cognitive abnormalities. CONCLUSIONS Brain MRI is a useful part of psychiatric management in the presence of certain neuropsychiatric risk factors. The present findings suggest that treating teams can judiciously tailor radiological investigations while limiting excessive imaging. Future research in larger cohorts across multiple centers may contribute to shaping more consistent neuroimaging guidelines in psychiatry.
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Affiliation(s)
- Katelyn Tadd
- Mental Health Program, NorthWestern Mental Health (Tadd, Rego, Farrand) and Eastern Health (Tadd), Melbourne, Victoria, Australia; Department of Psychiatry (Rego), Faculty of Medicine, Dentistry and Health Sciences (Gaillard), and Melbourne School of Psychological Sciences (Malpas), University of Melbourne; Department of Radiology (Gaillard), Clinical Outcomes Research Unit, Department of Medicine (Malpas), Department of Neurology (Malpas), and Department of Neuropsychiatry (Walterfang, Velakoulis, Farrand), Royal Melbourne Hospital; Melbourne Neuropsychiatry Center, University of Melbourne and NorthWestern Mental Health (Walterfang, Velakoulis); Florey Institute of Neuroscience and Mental Health, Melbourne (Walterfang)
| | - Thomas Rego
- Mental Health Program, NorthWestern Mental Health (Tadd, Rego, Farrand) and Eastern Health (Tadd), Melbourne, Victoria, Australia; Department of Psychiatry (Rego), Faculty of Medicine, Dentistry and Health Sciences (Gaillard), and Melbourne School of Psychological Sciences (Malpas), University of Melbourne; Department of Radiology (Gaillard), Clinical Outcomes Research Unit, Department of Medicine (Malpas), Department of Neurology (Malpas), and Department of Neuropsychiatry (Walterfang, Velakoulis, Farrand), Royal Melbourne Hospital; Melbourne Neuropsychiatry Center, University of Melbourne and NorthWestern Mental Health (Walterfang, Velakoulis); Florey Institute of Neuroscience and Mental Health, Melbourne (Walterfang)
| | - Frank Gaillard
- Mental Health Program, NorthWestern Mental Health (Tadd, Rego, Farrand) and Eastern Health (Tadd), Melbourne, Victoria, Australia; Department of Psychiatry (Rego), Faculty of Medicine, Dentistry and Health Sciences (Gaillard), and Melbourne School of Psychological Sciences (Malpas), University of Melbourne; Department of Radiology (Gaillard), Clinical Outcomes Research Unit, Department of Medicine (Malpas), Department of Neurology (Malpas), and Department of Neuropsychiatry (Walterfang, Velakoulis, Farrand), Royal Melbourne Hospital; Melbourne Neuropsychiatry Center, University of Melbourne and NorthWestern Mental Health (Walterfang, Velakoulis); Florey Institute of Neuroscience and Mental Health, Melbourne (Walterfang)
| | - Charles B Malpas
- Mental Health Program, NorthWestern Mental Health (Tadd, Rego, Farrand) and Eastern Health (Tadd), Melbourne, Victoria, Australia; Department of Psychiatry (Rego), Faculty of Medicine, Dentistry and Health Sciences (Gaillard), and Melbourne School of Psychological Sciences (Malpas), University of Melbourne; Department of Radiology (Gaillard), Clinical Outcomes Research Unit, Department of Medicine (Malpas), Department of Neurology (Malpas), and Department of Neuropsychiatry (Walterfang, Velakoulis, Farrand), Royal Melbourne Hospital; Melbourne Neuropsychiatry Center, University of Melbourne and NorthWestern Mental Health (Walterfang, Velakoulis); Florey Institute of Neuroscience and Mental Health, Melbourne (Walterfang)
| | - Mark Walterfang
- Mental Health Program, NorthWestern Mental Health (Tadd, Rego, Farrand) and Eastern Health (Tadd), Melbourne, Victoria, Australia; Department of Psychiatry (Rego), Faculty of Medicine, Dentistry and Health Sciences (Gaillard), and Melbourne School of Psychological Sciences (Malpas), University of Melbourne; Department of Radiology (Gaillard), Clinical Outcomes Research Unit, Department of Medicine (Malpas), Department of Neurology (Malpas), and Department of Neuropsychiatry (Walterfang, Velakoulis, Farrand), Royal Melbourne Hospital; Melbourne Neuropsychiatry Center, University of Melbourne and NorthWestern Mental Health (Walterfang, Velakoulis); Florey Institute of Neuroscience and Mental Health, Melbourne (Walterfang)
| | - Dennis Velakoulis
- Mental Health Program, NorthWestern Mental Health (Tadd, Rego, Farrand) and Eastern Health (Tadd), Melbourne, Victoria, Australia; Department of Psychiatry (Rego), Faculty of Medicine, Dentistry and Health Sciences (Gaillard), and Melbourne School of Psychological Sciences (Malpas), University of Melbourne; Department of Radiology (Gaillard), Clinical Outcomes Research Unit, Department of Medicine (Malpas), Department of Neurology (Malpas), and Department of Neuropsychiatry (Walterfang, Velakoulis, Farrand), Royal Melbourne Hospital; Melbourne Neuropsychiatry Center, University of Melbourne and NorthWestern Mental Health (Walterfang, Velakoulis); Florey Institute of Neuroscience and Mental Health, Melbourne (Walterfang)
| | - Sarah Farrand
- Mental Health Program, NorthWestern Mental Health (Tadd, Rego, Farrand) and Eastern Health (Tadd), Melbourne, Victoria, Australia; Department of Psychiatry (Rego), Faculty of Medicine, Dentistry and Health Sciences (Gaillard), and Melbourne School of Psychological Sciences (Malpas), University of Melbourne; Department of Radiology (Gaillard), Clinical Outcomes Research Unit, Department of Medicine (Malpas), Department of Neurology (Malpas), and Department of Neuropsychiatry (Walterfang, Velakoulis, Farrand), Royal Melbourne Hospital; Melbourne Neuropsychiatry Center, University of Melbourne and NorthWestern Mental Health (Walterfang, Velakoulis); Florey Institute of Neuroscience and Mental Health, Melbourne (Walterfang)
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13
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Incidental findings in brain imaging research: spotlight on ethical considerations. Eur Radiol 2022; 32:6977-6978. [PMID: 35731289 DOI: 10.1007/s00330-022-08944-8] [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: 04/21/2022] [Revised: 05/19/2022] [Accepted: 05/29/2022] [Indexed: 11/04/2022]
Abstract
Brain imaging has revolutionized our ability to characterize brain structure and function. Since the first use of magnetic resonance imaging in a live human subject in 1977, the use of brain imaging in research and clinical medicine has seen exponential growth. Incidental findings (IFs) in brain imaging research have been a subject of contentious debate regarding the disclosure of IFs to human participants of research. In this paper, ethical considerations, as they apply, to IFs in brain imaging research have been discussed. KEY POINTS: • Ethical considerations merit discussion vis a vis disclosure of incidental findings in brain imaging research.
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14
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Webber M, Falconer D, AlFarih M, Joy G, Chan F, Davie C, Hamill Howes L, Wong A, Rapala A, Bhuva A, Davies RH, Morton C, Aguado-Sierra J, Vazquez M, Tao X, Krausz G, Tanackovic S, Guger C, Xue H, Kellman P, Pierce I, Schott J, Hardy R, Chaturvedi N, Rudy Y, Moon JC, Lambiase PD, Orini M, Hughes AD, Captur G. Study protocol: MyoFit46-the cardiac sub-study of the MRC National Survey of Health and Development. BMC Cardiovasc Disord 2022; 22:140. [PMID: 35365075 PMCID: PMC8972905 DOI: 10.1186/s12872-022-02582-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/23/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The life course accumulation of overt and subclinical myocardial dysfunction contributes to older age mortality, frailty, disability and loss of independence. The Medical Research Council National Survey of Health and Development (NSHD) is the world's longest running continued surveillance birth cohort providing a unique opportunity to understand life course determinants of myocardial dysfunction as part of MyoFit46-the cardiac sub-study of the NSHD. METHODS We aim to recruit 550 NSHD participants of approximately 75 years+ to undertake high-density surface electrocardiographic imaging (ECGI) and stress perfusion cardiovascular magnetic resonance (CMR). Through comprehensive myocardial tissue characterization and 4-dimensional flow we hope to better understand the burden of clinical and subclinical cardiovascular disease. Supercomputers will be used to combine the multi-scale ECGI and CMR datasets per participant. Rarely available, prospectively collected whole-of-life data on exposures, traditional risk factors and multimorbidity will be studied to identify risk trajectories, critical change periods, mediators and cumulative impacts on the myocardium. DISCUSSION By combining well curated, prospectively acquired longitudinal data of the NSHD with novel CMR-ECGI data and sharing these results and associated pipelines with the CMR community, MyoFit46 seeks to transform our understanding of how early, mid and later-life risk factor trajectories interact to determine the state of cardiovascular health in older age. TRIAL REGISTRATION Prospectively registered on ClinicalTrials.gov with trial ID: 19/LO/1774 Multimorbidity Life-Course Approach to Myocardial Health- A Cardiac Sub-Study of the MCRC National Survey of Health and Development (NSHD).
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Affiliation(s)
- Matthew Webber
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Debbie Falconer
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Mashael AlFarih
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - George Joy
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Fiona Chan
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Clare Davie
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Lee Hamill Howes
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Andrew Wong
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Alicja Rapala
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Anish Bhuva
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Institute of Health Informatics, UCL, Euston Road, London, UK
| | - Rhodri H Davies
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | | | - Jazmin Aguado-Sierra
- ELEM Biotech, S.L, Bristol, BS1 6QH, UK
- Barcelona Supercomputing Center (BSC), 08034, Barcelona, Spain
| | - Mariano Vazquez
- ELEM Biotech, S.L, Bristol, BS1 6QH, UK
- Barcelona Supercomputing Center (BSC), 08034, Barcelona, Spain
| | - Xuyuan Tao
- École Nationale Supérieure Des Arts Et Industries Textiles, 2 allée Louise et Victor Champier, 59056, Roubaix Cedex 1, France
| | - Gunther Krausz
- g.Tec Medical Engineering GmbH, Siernigtrabe 14, 4521, Schiedlberg, Austria
| | | | - Christoph Guger
- g.Tec Medical Engineering GmbH, Siernigtrabe 14, 4521, Schiedlberg, Austria
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Iain Pierce
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Jonathan Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | | | - Nishi Chaturvedi
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Yoram Rudy
- Cardiac Bioelectricity and Arrhythmia Center, Washington University, St. Louis, MO, 63130, USA
- Department of Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA
| | - James C Moon
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Pier D Lambiase
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Michele Orini
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Gabriella Captur
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK.
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK.
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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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Pendlebury ST, Thomson RJ, Welch SJV, Kuker W, Rothwell PM. Utility of white matter disease and atrophy on routinely acquired brain imaging for prediction of long-term delirium risk: population-based cohort study. Age Ageing 2022; 51:6427231. [PMID: 34793588 PMCID: PMC8753040 DOI: 10.1093/ageing/afab200] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/04/2021] [Indexed: 12/15/2022] Open
Abstract
Background brain imaging done as part of standard care may have clinical utility beyond its immediate indication. Using delirium as an exemplar, we determined the predictive value of baseline brain imaging variables [white matter changes (WMC) and atrophy] for delirium risk on long-term follow-up after transient ischemic attack (TIA)/stroke in a population-based cohort study. Methods surviving TIA/stroke participants in the Oxford Vascular Study (OXVASC) were assessed prospectively for delirium during all hospitalisations over 6 months (2013–14). Using logistic regression, independent associations were determined between baseline OXVASC computed tomography or magnetic resonance brain imaging measures of WMC and cerebral atrophy (none/mild versus moderate/severe) and delirium adjusted for age, sex, baseline stroke severity, depression, illness severity and pre-admission cognition. Results among 1,565 TIA/stroke survivors with 194 hospital admissions (158 patients, mean/standard deviation age at admission = 79.2/11.5 years), delirium occurred in 59 (37%). WMC and atrophy on baseline imaging were associated with delirium [odds ratio (OR) = 3.41, 1.21–5.85, P = 0.001 and OR = 2.50, 1.23–5.08, P = 0.01 (unadjusted) and OR = 2.67, 1.21–5.85, P = 0.02 and OR = 2.18, 1.00–4.73, P = 0.05 (adjusted age and sex)]. Associations were strengthened when analyses were restricted to patients hospitalised within 5 years of baseline brain imaging [OR = 6.04, 2.39–15.24, P < 0.0001 and OR = 4.64, 1.46–14.82, P = 0.009 (unadjusted)] but only WMC remained significant after adjustment for all covariates including pre-admission cognition (OR = 4.83, 1.29–18.13, P = 0.02 for Mini-Mental State Examination and OR = 5.15, 1.26–21.09, P = 0.02 for Montreal Cognitive Assessment). Conclusions WMC and atrophy on brain imaging done up to 5 years earlier predicted delirium and may have clinical utility in risk stratification. Associations with WMC but not atrophy were independent of pre-admission cognitive impairment.
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Affiliation(s)
- Sarah T Pendlebury
- Wolfson Centre for Prevention of Stroke and Dementia, Wolfson Building, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital and the University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Departments of General (Internal) Medicine and Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ross J Thomson
- Department of Cardiology, Royal Free Hospital, London, UK
| | - Sarah J V Welch
- Wolfson Centre for Prevention of Stroke and Dementia, Wolfson Building, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital and the University of Oxford, Oxford, UK
| | - Wilhelm Kuker
- Wolfson Centre for Prevention of Stroke and Dementia, Wolfson Building, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital and the University of Oxford, Oxford, UK
| | - Peter M Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Wolfson Building, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital and the University of Oxford, Oxford, UK
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18
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Petousis S, Chatzakis C, Westerway SC, Abramowicz JS, Dinas K, Dong Y, Dietrich CF, Sotiriadis A. World Federation for Ultrasound in Medicine Review Paper: Incidental Findings during Obstetrical Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:10-19. [PMID: 34702644 DOI: 10.1016/j.ultrasmedbio.2021.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 06/13/2023]
Abstract
Although the prevalence of incidental findings revealed during an obstetric ultrasound examination is low, the findings may include adnexal and cervical masses, uterine or urinary congenital malformations, free fluid in the pouch of Douglas or tortuous vessels (varices). Adnexal masses are the most common finding and vary in imaging characteristics. They are mainly unilateral, cystic masses with a low risk of malignancy that are treated conservatively. The International Ovarian Tumor Analysis scoring models may be helpful in differentiating benign from malignant masses. For those masses >5 cm, follow-up is recommended, and resection could be considered to avoid risk of torsion, rupture and hemorrhage, which may compromise pregnancy outcome. Uterine masses such as fibroids are commonly diagnosed early in the first trimester and should be followed up during pregnancy to evaluate any changes. Transabdominal and transvaginal ultrasound is the first-line test for the diagnosis of such incidentalomas; however, magnetic resonance ultrasound may have a useful role in excluding malignancy potential. As a result of their low frequency and the lack of good evidence, there are no specific guidelines on the management of incidentalomas detected at obstetric scans. Their management should follow the related general guidelines for ovarian, cervical and uterine masses, with individualized management depending on the pregnancy status.
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Affiliation(s)
- Stamatios Petousis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Christos Chatzakis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | | | - Jacques S Abramowicz
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - Konstantinos Dinas
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland.
| | - Alexandros Sotiriadis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
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19
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Vander Wyst KB, Olson ML, Bailey SS, Valencia AM, Peña A, Miller J, Shub M, Seabrooke L, Pimentel J, Olsen K, Rosenberg RB, Shaibi GQ. Communicating incidental and reportable findings from research MRIs: considering factors beyond the findings in an underrepresented pediatric population. BMC Med Res Methodol 2021; 21:275. [PMID: 34865631 PMCID: PMC8647358 DOI: 10.1186/s12874-021-01459-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/27/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The application of advanced imaging in pediatric research trials introduces the challenge of how to effectively handle and communicate incidental and reportable findings. This challenge is amplified in underserved populations that experience disparities in access to healthcare as recommendations for follow-up care may be difficult to coordinate. Therefore, the purpose of the present report is to describe the process for identifying and communicating findings from a research MRI to low-income Latino children and families. METHODS Latino adolescents (n = 86) aged 12-16 years old with obesity and prediabetes underwent a research MRI (3 Tesla Philips Ingenia®) as part of a randomized controlled diabetes prevention trial. The research MRIs were performed at baseline and 6 months to assess changes in whole-abdominal fat distribution and organ fat in response to the intervention. An institutional pathway was developed for identifying and reporting findings to participants and families. The pathway was developed through a collaborative process with hospital administration, research compliance, radiology, and the research team. All research images were reviewed by a board-certified pediatric radiologist who conveyed findings to the study pediatrician for determination of clinical actionability and reportability to children and families. Pediatric sub-specialists were consulted as necessary and a primary care practitioner (PCP) from a free community health clinic agreed to receive referrals for uninsured participants. RESULTS A total of 139 images (86 pre- and 53 post-intervention) were reviewed with 31 findings identified and 23 deemed clinically actionable and reportable. The only reportable finding was severely elevated liver fat (> 10%, n = 14) with the most common and concerning incidental findings being horseshoe kidney (n = 1) and lung lesion (n = 1). The remainder (n = 7) were less serious. Of youth with a reportable or incidental finding, 18 had a PCP but only 7 scheduled a follow-up appointment. Seven participants without a PCP were referred to a safety-net clinic for follow-up. CONCLUSIONS With the increased utilization of high-resolution imaging in pediatric research, additional standardization is needed on what, when, and how to return incidental and reportable findings to participants, particularly among historically underrepresented populations that may be underserved in the community. TRIAL REGISTRATION Preventing Diabetes in Latino Youth, NCT02615353.
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Affiliation(s)
- Kiley B Vander Wyst
- College of Graduate Studies, Midwestern University, Glendale, AZ, USA
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd St, Phoenix, AZ, 85004, USA
| | - Micah L Olson
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd St, Phoenix, AZ, 85004, USA
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Smita S Bailey
- Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Ana Martinez Valencia
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd St, Phoenix, AZ, 85004, USA
| | - Armando Peña
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd St, Phoenix, AZ, 85004, USA
| | - Jeffrey Miller
- Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Mitchell Shub
- Division of Gastroenterology, Phoenix Children's Hospital, Phoenix, AZ, USA
- Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Lee Seabrooke
- Office of Research, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Janiel Pimentel
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Kiri Olsen
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
- Office of Research, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Robert B Rosenberg
- Office of Research, Phoenix Children's Hospital, Phoenix, AZ, USA
- Division of Pediatric Critical Care Medicine, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd St, Phoenix, AZ, 85004, USA.
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA.
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA.
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20
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Prevalence of incidental meningiomas and gliomas on MRI: a meta-analysis and meta-regression analysis. Acta Neurochir (Wien) 2021; 163:3401-3415. [PMID: 34227013 DOI: 10.1007/s00701-021-04919-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/14/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND The chance of incidentally detecting brain tumors is increasing as the utilization of magnetic resonance imaging (MRI) becomes more prevalent. In this background, knowledge is accumulating in relation to the prediction of their clinical sequence. However, their prevalence-especially the prevalence of glioma-has not been adequately investigated according to age, sex, and region. METHOD We systematically reviewed the articles according to the PRISMA statement and calculated the prevalence of meningiomas and diffuse gliomas in adults using a generalized linear mixed model. Specifically, the differences related to age, sex, and region were investigated. RESULTS The pooled prevalence of incidental meningiomas in MRI studies was 0.52% (95% confidence interval (CI) [0.34-0.78]) in 37,697 individuals from 36 studies. A meta-regression analysis showed that the prevalence was significantly higher in elderly individuals, women, and individuals outside Asia; this remained statistically significant in the multivariate meta-regression analysis. The prevalence reached to 3% at 90 years of age. In contrast, the prevalence of gliomas in 30,918 individuals from 18 studies was 0.064% (95%CI [0.040 - 0.104]). The meta-regression analysis did not show a significant relationship between the prevalence and age, male sex, or region. The prevalence of histologically confirmed glioma was 0.026% (95%CI [0.013-0.052]). CONCLUSIONS Most of meningiomas, especially those in elderlies, remained asymptomatic, and their prevalence increased with age. However, the prevalence of incidental gliomas was much lower and did not increase with age. The number of gliomas that developed and the number that reached a symptomatic stage appeared to be balanced.
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21
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Distress and quality of life do not change over time in patients with operated and conservatively managed intracranial meningioma. Acta Neurochir (Wien) 2021; 163:3417-3424. [PMID: 34643803 PMCID: PMC8511617 DOI: 10.1007/s00701-021-05004-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/12/2021] [Indexed: 10/30/2022]
Abstract
PURPOSE The patients' burden with asymptomatic meningiomas and patients with good clinical outcome after meningioma resection often remains neglected. In this study, we aimed to investigate the longitudinal changes of psychological distress and quality of life in these patient groups. METHODS Patients with conservatively managed (CM) or operated (OM) meningiomas and excellent neurological status, who were screened for psychological distress during the follow-up visit (t1), were included. We performed a follow-up mail/telephone-based survey 3-6 months (t2) after t1. Distress was measured using Hospital Anxiety and Depression Scale (HADS), Distress Thermometer (DT), 36-item Short Form (SF-36), and Brief Fatigue Inventory (BFI). RESULTS Sixty-two patients participated in t1 and 47 in t2. The number of patients reporting increased or borderline values remained high 3 months after initial presentation, with n = 25 (53%) of patients reporting increased anxiety symptom severity and n = 29 (62%) reporting increased depressive symptom severity values. The proportion of distressed patients according to a DT score remained similar after 3 months. Forty-four percent of patients reported significant distress in OM and 33% in CM group. The most common problems among distressed patients were fatigue (t2 75%) and worries (t2 50%), followed by pain, sleep disturbances, sadness, and nervousness. Tumor progress was associated with increased depression scores (OR 6.3 (1.1-36.7)). CONCLUSION The level of psychological distress in asymptomatic meningiomas and postoperative meningiomas with excellent outcome is high. Further investigations are needed to identify and counsel the patients at risk.
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22
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Lohner V, Lu R, Enkirch SJ, Stöcker T, Hattingen E, Breteler MMB. Incidental findings on 3 T neuroimaging: cross-sectional observations from the population-based Rhineland Study. Neuroradiology 2021; 64:503-512. [PMID: 34842946 PMCID: PMC8850254 DOI: 10.1007/s00234-021-02852-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/29/2021] [Indexed: 11/30/2022]
Abstract
Purpose Development of best practices for dealing with incidental findings on neuroimaging requires insight in their frequency and clinical relevance. Methods Here, we delineate prevalence estimates with 95% confidence intervals and clinical management of incidental findings, based on the first 3589 participants of the population-based Rhineland Study (age range 30–95 years) who underwent 3 Tesla structural neuroimaging (3D, 0.8 mm3 isotropic resolution). Two trained raters independently assessed all scans for abnormalities, with confirmation and adjudication where needed by neuroradiologists. Participants were referred for diagnostic work-up depending on the potential benefit. Results Of 3589 participants (mean age 55 ± 14 years, 2072 women), 867 had at least one possible incidental finding (24.2%). Most common were pituitary abnormalities (12.3%), arachnoid cysts (4.1%), developmental venous anomalies (2.5%), non-acute infarcts (1.8%), cavernomas (1.0%), and meningiomas (0.7%). Forty-six participants were informed about their findings, which was hitherto unknown in 40 of them (1.1%). Of these, in 19 participants (48%), a wait-and-see policy was applied and nine (23%) received treatment, while lesions in the remainder were benign, could not be confirmed, or the participant refused to inform us about their clinical diagnosis. Conclusion Nearly one-quarter of participants had an incidental finding, but only 5% of those required referral, that mostly remained without direct clinical consequences.
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Affiliation(s)
- Valerie Lohner
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Venusberg-Campus 1/99, 53127, Bonn, Germany
| | - Ran Lu
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Venusberg-Campus 1/99, 53127, Bonn, Germany
| | - Simon J Enkirch
- Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Tony Stöcker
- MR Physics, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Physics and Astronomy, University of Bonn, Bonn, Germany
| | - Elke Hattingen
- Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany.,Department of Neuroradiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Monique M B Breteler
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Venusberg-Campus 1/99, 53127, Bonn, Germany. .,Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), Faculty of Medicine, University of Bonn, Bonn, Germany.
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23
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Ivanovic V, Seiler S, Tarraf W, Crivello E, Martinez O, Lipton RB, Isasi CR, Copello TG, Talavera GA, Gallo LC, Lamar M, Testai F, Schneiderman N, Gellman MD, Daviglus M, Gonzalez HM, DeCarli C, Lipton ML. Prevalence of incidental brain MRI findings of clinical relevance in a diverse Hispanic/Latino population. J Neuroimaging 2021; 31:1166-1175. [PMID: 34288226 PMCID: PMC10332335 DOI: 10.1111/jon.12910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE There is limited literature on the prevalence of incidental brain MRI findings in the Hispanic/Latino population, despite their increased prevalence of vascular disease and undertreatment of chronic conditions. The purpose of our study was to determine the prevalence of clinically relevant incidental findings on brain MRI examinations obtained as a part of the Study of Latinos-Investigation of NeuroCognitive Aging MRI (SOL-INCA-MRI) study. METHODS Brain MRI examinations were obtained on 1389 participants in the SOL-INCA-MRI study, a cross-sectional ancillary study of the Hispanic Community Health Study, Study of Latinos, which is a longitudinal, community-based study. Study design of SOL-INCA-MRI involves imaging cognitively normal and participants with mild cognitive impairment. Brain MRI findings were categorized as Level 1 (normal), Level 1.5 (findings of unclear medical significance), Level 2 (potential medical concern), or Level 3 (medically urgent). This article focuses on Level 2 and Level 3 findings. RESULTS The average age of the sample was 60.8 years (+/- 10.3 years), 66.1% were females. Level 2 and 3 findings were identified in 117 participants, (8.4%), of which 109 (7.8%) were recommended for medical follow-up (Level 2), and 8 (0.6%) were recommended for immediate medical attention (Level 3). Brain MRI findings consisted of chronic infarction in 33 (2.4%), vascular abnormality in 27 (1.9%), intracranial mass in 20 (1.4%), other intracranial findings in 28 (2.0%), and skull base/extracranial findings in 26 (1.9%) patients. CONCLUSION Incidental findings of clinical relevance were common among SOL-INCA-MRI participants, but rarely required urgent medical intervention.
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Affiliation(s)
- Vladimir Ivanovic
- Department of Radiology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Stephan Seiler
- Department of Neurology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Wassim Tarraf
- Wayne State University, Institute of Gerontology, Detroit, MI, USA
| | - Emily Crivello
- Department of Neurology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Oliver Martinez
- Department of Neurology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Richard B. Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Carmen R. Isasi
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | - Linda C. Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Melissa Lamar
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Rush Alzheimer’s Disease Center, Chicago, IL, USA
| | - Fernando Testai
- Department of Neurology, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Marc D. Gellman
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Martha Daviglus
- University of Illinois at Chicago, Institute for Minority Health Research, Chicago, IL, USA
| | - Hector M. Gonzalez
- Department of Neurosciences, Shiley-Marcos Alzheimer’s Disease Research Center, University of California San Diego, San Diego, CA, USA
| | - Charles DeCarli
- Department of Neurology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Michael L. Lipton
- Departments of Radiology, Psychiatry and Behavioral Sciences and The Dominick P Purpura Department of Neuroscience, Albert Einstein College of Medicine and Montefiore Health System, Bronx, NY, USA
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24
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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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Elfatih A, Mohammed I, Abdelrahman D, Mifsud B. Frequency and management of medically actionable incidental findings from genome and exome sequencing data; A systematic review. Physiol Genomics 2021; 53:373-384. [PMID: 34250816 DOI: 10.1152/physiolgenomics.00025.2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The application of whole genome/exome sequencing technologies in clinical genetics and research has resulted in the discovery of incidental findings unrelated to the primary purpose of genetic testing. The American College of Medical Genetics and Genomics published guidelines for reporting pathogenic and likely pathogenic variants that are deemed to be medically actionable, which allowed us to learn about the epidemiology of incidental findings in different populations. However, consensus guidelines for variant reporting and classification are still lacking. We conducted a systematic literature review of incidental findings in whole genome/exome sequencing studies to obtain a comprehensive understanding of variable reporting and classification methods for variants that are deemed to be medically actionable across different populations. The review highlights the elements that demand further consideration or adjustment.
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Affiliation(s)
- Amal Elfatih
- College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar
| | - Idris Mohammed
- College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar
| | - Doua Abdelrahman
- Integrated Genomics Services, Translational Research, Research Branch, Sidra Medicine, Doha, Qatar
| | - Borbala Mifsud
- College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar.,William Harvey Research Institute, Queen Mary University London, London, UK
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26
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Alabousi M, Wilson E, Al-Ghetaa RK, Patlas MN. General Review on the Current Management of Incidental Findings on Cross-Sectional Imaging: What Guidelines to Use, How to Follow Them, and Management and Medical-Legal Considerations. Radiol Clin North Am 2021; 59:501-509. [PMID: 34053601 DOI: 10.1016/j.rcl.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
"Incidentalomas" are a common part of daily practice for radiologists, and knowledge of appropriate management guidelines is important in ensuring that no potentially clinically relevant findings are missed or are lost to follow-up in asymptomatic patients. Incidental findings of the brain, spine, thyroid, lungs, breasts, liver, adrenals, spleen, pancreas, kidneys, bowel, and ovaries are discussed, including where to find guidelines for management recommendations, how to follow them, and medical-legal considerations.
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Affiliation(s)
- Mostafa Alabousi
- Department of Radiology, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
| | - Evan Wilson
- Department of Radiology, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Rayeh Kashef Al-Ghetaa
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada
| | - Michael N Patlas
- Department of Radiology, McMaster University, Hamilton General Hospital, 237 Barton St E, Hamilton, ON L8L 2X2, Canada
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27
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Delgado-López PD, Montalvo-Afonso A, Martín-Alonso J, Martín-Velasco V, Castilla-Díez JM, Galacho-Harriero AM, Ortega-Cubero S, Sánchez-Rodríguez A, Rodríguez-Salazar A. Volumetric growth rate of incidental asymptomatic meningiomas: a single-center prospective cohort study. Acta Neurochir (Wien) 2021; 163:1665-1675. [PMID: 33751215 DOI: 10.1007/s00701-021-04815-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Decision about treatment of incidentally found intracranial meningiomas is controversial and conditioned by the growth potential of these tumors. We aimed to evaluate the growth rate of a cohort of incidentally found asymptomatic meningiomas and to analyze their natural course and the need for eventual treatment. METHODS A total of 193 patients harboring intracranial meningiomas (85 with 109 incidental and 108 with 112 symptomatic) were included between 2015 and 2019. In the prospective cohort of incidental meningiomas, we measured size at diagnosis, volumetric growth rate (by segmentation software), appearance of symptoms, and need for surgery or radiotherapy. Progression-free survival and risk factors for growth were assessed with Kaplan-Meier survival and Cox regression analyses. RESULTS Among incidental meningiomas, 94/109 (86.2%) remained untreated during a median follow-up of 49.3 months. Tumor growth was observed in 91 (83.5%) and > 15% growth in 40 (36.7%). Neurological symptoms developed in 1 patient (1.2%). Volume increased an average of 0.51 cm3/year (95% CI, 0.20-0.82). Nine patients were operated (9.2%) and 4 underwent radiotherapy (4.7%). Treatment-related complication rates of incidental and symptomatic meningiomas were 0% and 35.4%, respectively. Persistent neurological defects occurred in 46 (40.7%) of symptomatic versus 2 (2.3%) of incidental meningiomas. Among covariates, only brain edema resulted in an increased risk of significant tumor growth in the female subgroup (Cox regression HR 2.96, 95% CI 1.02-8.61, p = 0.046). Size at diagnosis was significantly greater in the symptomatic meningioma group (37.33 cm3 versus 4.74 cm3, p < 0.001). CONCLUSIONS Overall, 86% of incidentally found meningiomas remained untreated over the first 4 years of follow-up. The majority grew within the 20% range, yet very few developed symptoms. Treatment-related morbidity was absent in the incidental meningioma group.
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Affiliation(s)
- Pedro David Delgado-López
- Neurosurgery Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006, Burgos, Spain.
| | - Antonio Montalvo-Afonso
- Neurosurgery Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006, Burgos, Spain
| | - Javier Martín-Alonso
- Neurosurgery Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006, Burgos, Spain
| | - Vicente Martín-Velasco
- Neurosurgery Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006, Burgos, Spain
| | - José Manuel Castilla-Díez
- Neurosurgery Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006, Burgos, Spain
| | | | - Sara Ortega-Cubero
- Neurosurgery Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006, Burgos, Spain
| | - Antonio Sánchez-Rodríguez
- Neurosurgery Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006, Burgos, Spain
| | - Antonio Rodríguez-Salazar
- Neurosurgery Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006, Burgos, Spain
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28
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Poon MTC, Brennan PM, Jin K, Sudlow CLM, Figueroa JD. Might changes in diagnostic practice explain increasing incidence of brain and central nervous system tumors? A population-based study in Wales (United Kingdom) and the United States. Neuro Oncol 2021; 23:979-989. [PMID: 33346342 PMCID: PMC8168824 DOI: 10.1093/neuonc/noaa282] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Increasing incidence of central nervous system (CNS) tumors has been noted in some populations. However, the influence of changing surgical and imaging practices has not been consistently accounted for. METHODS We evaluated average annual percentage change (AAPC) in age- and gender-stratified incidence of CNS tumors by tumor subtypes and histological confirmation in Wales, United Kingdom (1997-2015) and the United States (2004-2015) using joinpoint regression. FINDINGS In Wales, the incidence of histologically confirmed CNS tumors increased more than all CNS tumors (AAPC 3.62% vs 1.63%), indicating an increasing proportion undergoing surgery. Grade II and III glioma incidence declined significantly (AAPC -3.09% and -1.85%, respectively) but remained stable for those with histological confirmation. Grade IV glioma incidence increased overall (AAPC 3.99%), more markedly for those with histological confirmation (AAPC 5.36%), suggesting reduced glioma subtype misclassification due to increased surgery. In the United States, the incidence of CNS tumors increased overall but was stable for histologically confirmed tumors (AAPC 1.86% vs 0.09%) indicating an increase in patients diagnosed without surgery. An increase in grade IV gliomas (AAPC 0.28%) and a decline in grade II gliomas (AAPC -3.41%) were accompanied by similar changes in those with histological confirmation, indicating the overall trends in glioma subtypes were unlikely to be caused by changing diagnostic and clinical management. CONCLUSIONS Changes in clinical practice have influenced the incidence of CNS tumors in the United Kingdom and the United States. These should be considered when evaluating trends and in epidemiological studies of putative risk factors for CNS tumors.
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Affiliation(s)
- Michael Tin Chung Poon
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Brain Tumour Centre of Excellence, Cancer Research UK Edinburgh Centre, University of Edinburgh, Edinburgh, UK
| | - Paul M Brennan
- Brain Tumour Centre of Excellence, Cancer Research UK Edinburgh Centre, University of Edinburgh, Edinburgh, UK
- Translational Neurosurgery, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kai Jin
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Brain Tumour Centre of Excellence, Cancer Research UK Edinburgh Centre, University of Edinburgh, Edinburgh, UK
| | - Cathie L M Sudlow
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Brain Tumour Centre of Excellence, Cancer Research UK Edinburgh Centre, University of Edinburgh, Edinburgh, UK
| | - Jonine D Figueroa
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Brain Tumour Centre of Excellence, Cancer Research UK Edinburgh Centre, University of Edinburgh, Edinburgh, UK
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29
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Soumaré A, Beguedou N, Laurent A, Brochet B, Bordes C, Mournet S, Mellet E, Pereira E, Pollet C, Lachaize M, Mougin M, Tsuchida A, Loiseau H, Tourdias T, Tzourio C, Mazoyer B, Debette S. Prevalence, Severity, and Clinical Management of Brain Incidental Findings in Healthy Young Adults: MRi-Share Cross-Sectional Study. Front Neurol 2021; 12:675244. [PMID: 34093421 PMCID: PMC8173138 DOI: 10.3389/fneur.2021.675244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/19/2021] [Indexed: 01/17/2023] Open
Abstract
Background and Objectives: Young adults represent an increasingly large proportion of healthy volunteers in brain imaging research, but descriptions of incidental findings (IFs) in this age group are scarce. We aimed to assess the prevalence and severity of IFs on brain MRIs of healthy young research participants aged 18-35 years, and to describe the protocol implemented to handle them. Methods: The study population comprised 1,867 participants aged 22.1 ± 2.3 years (72% women) from MRi-Share, the cross-sectional brain MRI substudy of the i-Share student cohort. IFs were flagged during the MRI quality control. We estimated the proportion of participants with IFs [any, requiring medical referral, potentially serious (PSIFs) as defined in the UK biobank]: overall, by type and severity of the final diagnosis, as well as the number of IFs. Results: 78/1,867 participants had at least one IF [4.2%, 95% Confidence Interval (CI) 3.4-5.2%]. IFs requiring medical referral (n = 38) were observed in 36/1,867 participants (1.9%, 1.4-2.7%), and represented 47.5% of the 80 IFs initially flagged. Referred IFs were retrospectively classified as PSIFs in 25/1,867 participants (1.3%, 0.9-2.0%), accounting for 68.4% of anomalies referred (26/38). The most common final diagnosis was cysts or ventricular abnormalities in all participants (9/1,867; 0.5%, 0.2-0.9%) and in those with referred IFs (9/36; 25.0%, 13.6-41.3%), while it was multiple sclerosis or radiologically isolated syndrome in participants with PSIFs (5/19; 26.3%, 11.5-49.1%) who represented 0.1% (0.0-0.4%) and 0.2% (0.03-0.5%) of all participants, respectively. Final diagnoses were considered serious in 11/1,867 participants (0.6%, 0.3-1.1%). Among participants with referred IFs, 13.9% (5/36) required active intervention, while 50.0% (18/36) were put on clinical surveillance. Conclusions: In a large brain imaging study of young healthy adults participating in research we observed a non-negligible frequency of IFs. The etiological pattern differed from what has been described in older adults.
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Affiliation(s)
- Aïcha Soumaré
- UMR1219 Bordeaux Population Health Center (Team VINTAGE), INSERM-University of Bordeaux, Bordeaux, France
| | - Naka Beguedou
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, University of Bordeaux, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CNRS, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CEA, Bordeaux, France
| | - Alexandre Laurent
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, University of Bordeaux, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CNRS, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CEA, Bordeaux, France
| | - Bruno Brochet
- Department of Neurology, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| | - Constance Bordes
- UMR1219 Bordeaux Population Health Center (Team VINTAGE), INSERM-University of Bordeaux, Bordeaux, France
| | - Sandy Mournet
- UMR1219 Bordeaux Population Health Center (Team VINTAGE), INSERM-University of Bordeaux, Bordeaux, France
| | - Emmanuel Mellet
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, University of Bordeaux, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CNRS, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CEA, Bordeaux, France
| | - Edwige Pereira
- UMR1219 Bordeaux Population Health Center (Team HEALTHY), INSERM-University of Bordeaux, Bordeaux, France
| | - Clothilde Pollet
- UMR1219 Bordeaux Population Health Center (Team HEALTHY), INSERM-University of Bordeaux, Bordeaux, France
| | - Morgane Lachaize
- UMR1219 Bordeaux Population Health Center (Team VINTAGE), INSERM-University of Bordeaux, Bordeaux, France
| | - Marie Mougin
- UMR1219 Bordeaux Population Health Center (Team HEALTHY), INSERM-University of Bordeaux, Bordeaux, France
| | - Ami Tsuchida
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, University of Bordeaux, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CNRS, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CEA, Bordeaux, France
| | - Hugues Loiseau
- Department of Neurosurgery, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| | - Thomas Tourdias
- Department of Diagnostic and Therapeutic Radiology and Neuroimaging, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
- Magendie Neurocenter INSERM-U1215, University of Bordeaux, Bordeaux, France
| | - Christophe Tzourio
- UMR1219 Bordeaux Population Health Center (Team HEALTHY), INSERM-University of Bordeaux, Bordeaux, France
- Department of Medical Information, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| | - Bernard Mazoyer
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, University of Bordeaux, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CNRS, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CEA, Bordeaux, France
- Department of Diagnostic and Therapeutic Radiology and Neuroimaging, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| | - Stéphanie Debette
- UMR1219 Bordeaux Population Health Center (Team VINTAGE), INSERM-University of Bordeaux, Bordeaux, France
- Department of Neurology, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
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30
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Li Y, Thompson WK, Reuter C, Nillo R, Jernigan T, Dale A, Sugrue LP, Brown J, Dougherty RF, Rauschecker A, Rudie J, Barch DM, Calhoun V, Hagler D, Hatton S, Tanabe J, Marshall A, Sher KJ, Heeringa S, Hermosillo R, Banich MT, Squeglia L, Bjork J, Zucker R, Neale M, Herting M, Sheth C, Huber R, Reeves G, Hettema JM, Howlett KD, Cloak C, Baskin-Sommers A, Rapuano K, Gonzalez R, Karcher N, Laird A, Baker F, James R, Sowell E, Dick A, Hawes S, Sutherland M, Bagot K, Bodurka J, Breslin F, Morris A, Paulus M, Gray K, Hoffman E, Weiss S, Rajapakse N, Glantz M, Nagel B, Ewing SF, Goldstone A, Pfefferbaum A, Prouty D, Rosenberg M, Bookheimer S, Tapert S, Infante M, Jacobus J, Giedd J, Shilling P, Wade N, Uban K, Haist F, Heyser C, Palmer C, Kuperman J, Hewitt J, Cottler L, Isaiah A, Chang L, Edwards S, Ernst T, Heitzeg M, Puttler L, Sripada C, Iacono W, Luciana M, Clark D, Luna B, Schirda C, Foxe J, Freedman E, Mason M, McGlade E, Renshaw P, Yurgelun-Todd D, Albaugh M, Allgaier N, Chaarani B, Potter A, Ivanova M, Lisdahl K, Do E, Maes H, Bogdan R, Anokhin A, Dosenbach N, Glaser P, Heath A, Casey BJ, Gee D, Garavan HP, Dowling G, Brown S. Rates of Incidental Findings in Brain Magnetic Resonance Imaging in Children. JAMA Neurol 2021; 78:578-587. [PMID: 33749724 PMCID: PMC7985817 DOI: 10.1001/jamaneurol.2021.0306] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Importance Incidental findings (IFs) are unexpected abnormalities discovered during imaging and can range from normal anatomic variants to findings requiring urgent medical intervention. In the case of brain magnetic resonance imaging (MRI), reliable data about the prevalence and significance of IFs in the general population are limited, making it difficult to anticipate, communicate, and manage these findings. Objectives To determine the overall prevalence of IFs in brain MRI in the nonclinical pediatric population as well as the rates of specific findings and findings for which clinical referral is recommended. Design, Setting, and Participants This cohort study was based on the April 2019 release of baseline data from 11 810 children aged 9 to 10 years who were enrolled and completed baseline neuroimaging in the Adolescent Brain Cognitive Development (ABCD) study, the largest US population-based longitudinal observational study of brain development and child health, between September 1, 2016, and November 15, 2018. Participants were enrolled at 21 sites across the US designed to mirror the demographic characteristics of the US population. Baseline structural MRIs were centrally reviewed for IFs by board-certified neuroradiologists and findings were described and categorized (category 1, no abnormal findings; 2, no referral recommended; 3; consider referral; and 4, consider immediate referral). Children were enrolled through a broad school-based recruitment process in which all children of eligible age at selected schools were invited to participate. Exclusion criteria were severe sensory, intellectual, medical, or neurologic disorders that would preclude or interfere with study participation. During the enrollment process, demographic data were monitored to ensure that the study met targets for sex, socioeconomic, ethnic, and racial diversity. Data were analyzed from March 15, 2018, to November 20, 2020. Main Outcomes and Measures Percentage of children with IFs in each category and prevalence of specific IFs. Results A total of 11 679 children (52.1% boys, mean [SD] age, 9.9 [0.62] years) had interpretable baseline structural MRI results. Of these, 2464 participants (21.1%) had IFs, including 2013 children (17.2%) assigned to category 2, 431 (3.7%) assigned to category 3, and 20 (0.2%) assigned to category 4. Overall rates of IFs did not differ significantly between singleton and twin gestations or between monozygotic and dizygotic twins, but heritability analysis showed heritability for the presence or absence of IFs (h2 = 0.260; 95% CI, 0.135-0.387). Conclusions and Relevance Incidental findings in brain MRI and findings with potential clinical significance are both common in the general pediatric population. By assessing IFs and concurrent developmental and health measures and following these findings over the longitudinal study course, the ABCD study has the potential to determine the significance of many common IFs.
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Affiliation(s)
- Yi Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Wesley K. Thompson
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Chase Reuter
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Ryan Nillo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Terry Jernigan
- Center for Human Development, University of California, San Diego, La Jolla
| | - Anders Dale
- Center for Human Development, University of California, San Diego, La Jolla
| | - Leo P. Sugrue
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | | | - Julian Brown
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Robert F Dougherty
- Center for Cognitive and Neurobiological Imaging, Stanford University, Stanford, California
| | - Andreas Rauschecker
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Jeffrey Rudie
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Psychiatry, Radiology, Washington University in St Louis, St Louis, Missouri
| | - Vince Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science, Georgia State University, Georgia Tech, Emory University, Atlanta
| | - Donald Hagler
- Department of Radiology, University of California, San Diego, La Jolla
| | - Sean Hatton
- Department of Neurosciences, University of California, San Diego, La Jolla
| | - Jody Tanabe
- Department of Radiology, University of Colorado Anschutz Medical Center, Aurora
| | - Andrew Marshall
- Department of Pediatrics, Children's Hospital Los Angeles/University of Southern California, Los Angeles
| | - Kenneth J Sher
- Department of Psychological Sciences, University of Missouri, Columbia
| | - Steven Heeringa
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Robert Hermosillo
- Department of Behavioral Neuroscience, Oregon Health Sciences University, Portland
| | - Marie T Banich
- Institute of Cognitive Science, Department of Psychology and Neuroscience, University of Colorado, Boulder
| | - Lindsay Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - James Bjork
- Department of Psychiatry, Virginia Commonwealth University, Richmond
| | - Robert Zucker
- Department of Psychiatry and Psychology, University of Michigan, Ann Arbor
| | - Michael Neale
- Department of Psychiatry, Virginia Commonwealth University, Richmond
| | - Megan Herting
- Department of Preventive Medicine, University of Southern California, Los Angeles
| | - Chandni Sheth
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City
| | - Rebeka Huber
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City
| | - Gloria Reeves
- Department of Psychiatry, University of Maryland, Baltimore
| | - John M Hettema
- Department of Psychiatry, Texas A&M Health Science Center, Bryan
| | - Katia Delrahim Howlett
- Division of Extramural Research, National Institute on Drug Abuse/National Institutes of Health, Bethesda, Maryland
| | - Christine Cloak
- Department of Radiology and Nuclear Medicine, University of Maryland, Baltimore
| | | | - Kristina Rapuano
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Raul Gonzalez
- Department of Psychology, Florida International University, Miami
| | - Nicole Karcher
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Angela Laird
- Department of Physics, Florida International University, Miami
| | | | - Regina James
- Department of Clinical Research, 2M Research Services, Arlington, Virginia
| | - Elizabeth Sowell
- Department of Pediatrics, Children's Hospital Los Angeles/University of Southern California, Los Angeles
| | - Anthony Dick
- Department of Psychology, Florida International University, Miami
| | - Samuel Hawes
- Department of Psychology, Florida International University, Miami
| | | | - Kara Bagot
- Department of Psychiatry, Icahn School of Medicine at Mt Sinai, New York, New York
| | - Jerzy Bodurka
- Laureate Institute for Brain Research, Tulsa, Oklahoma
| | | | - Amanda Morris
- Laureate Institute for Brain Research, Tulsa, Oklahoma
| | - Martin Paulus
- Laureate Institute for Brain Research, Tulsa, Oklahoma
| | - Kevin Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Elizabeth Hoffman
- Division of Extramural Research, National Institute on Drug Abuse/National Institutes of Health, Bethesda, Maryland
| | - Susan Weiss
- Division of Extramural Research, National Institute on Drug Abuse/National Institutes of Health, Bethesda, Maryland
| | - Nishadi Rajapakse
- Department of Scientific Programs, National Institute on Minority Health and Health Disparities, Bethesda, Maryland
| | - Meyer Glantz
- Department of Psychology, National Institute on Drug Abuse/National Institutes of Health, Bethesda, Maryland
| | - Bonnie Nagel
- Department of Psychiatry, Oregon Health and Science University, Portland
| | | | | | | | | | - Monica Rosenberg
- Department of Psychology, University of Chicago, Chicago, Illinois
| | - Susan Bookheimer
- Department of Psychiatry and Biobehavioral Sciences, School of Medicine, University of California, Los Angeles
| | - Susan Tapert
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Maria Infante
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Joanna Jacobus
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Jay Giedd
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Paul Shilling
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Natasha Wade
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Kristina Uban
- Department of Public Health, University of California, Irvine
| | - Frank Haist
- Department of Psychiatry and Center for Human Development, University of California, San Diego, La Jolla
| | - Charles Heyser
- Center for Human Development, University of California, San Diego, La Jolla
| | - Clare Palmer
- Center for Human Development, University of California, San Diego, La Jolla
| | - Joshua Kuperman
- Department of Radiology, University of California, San Diego, La Jolla
| | - John Hewitt
- Institute for Behavioral Genetics, University of Colorado, Boulder
| | - Linda Cottler
- Department of Epidemiology, University of Florida, Gainesville
| | - Amal Isaiah
- Department of Otorhinolaryngology/Head and Neck Surgery and Pediatrics, University of Maryland School of Medicine, Baltimore
| | - Linda Chang
- Departments of Radiology and Neurology, University of Maryland, Baltimore
| | - Sarah Edwards
- Department of Psychiatry, University of Maryland, Baltimore
| | - Thomas Ernst
- Department of Radiology, University of Maryland, Baltimore
| | - Mary Heitzeg
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - Leon Puttler
- Department of Psychiatry, University of Michigan, Ann Arbor
| | | | - William Iacono
- Department of Psychology, University of Minnesota, Minneapolis
| | - Monica Luciana
- Department of Psychology, University of Minnesota, Minneapolis
| | - Duncan Clark
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Claudiu Schirda
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John Foxe
- Department of Neuroscience, University of Rochester Medical Center, Rochester, New York
| | - Edward Freedman
- Department of Neuroscience, University of Rochester Medical Center, Rochester, New York
| | - Michael Mason
- Center for Behavioral Health Research, University of Tennessee, Knoxville
| | - Erin McGlade
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City
| | - Perry Renshaw
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City
| | | | | | | | - Bader Chaarani
- Department of Psychiatry, University of Vermont, Burlington
| | | | - Masha Ivanova
- Department of Psychiatry, University of Vermont, Burlington
| | - Krista Lisdahl
- Department of Psychiatry, University of Vermont, Burlington
| | - Elizabeth Do
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond
| | - Hermine Maes
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond
| | - Ryan Bogdan
- Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, Missouri
| | - Andrey Anokhin
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Nico Dosenbach
- Department of Neurology, Washington University in St Louis, St Louis, Missouri
| | - Paul Glaser
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Andrew Heath
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Betty J Casey
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Dylan Gee
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Hugh P Garavan
- Department of Psychiatry, University of Vermont, Burlington
| | - Gaya Dowling
- Division of Extramural Research, National Institute on Drug Abuse/National Institutes of Health, Bethesda, Maryland
| | - Sandra Brown
- Department of Psychiatry and Psychology, University of California, San Diego, La Jolla
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Mughal Z, Charlton AR, Clark M. The Prevalence of Incidental Mastoid Opacification and the Need for Intervention: A Meta-Analysis. Laryngoscope 2021; 132:422-432. [PMID: 33881186 DOI: 10.1002/lary.29581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS The increasing use of cross-sectional imaging has led to the predicament of incidental mastoid opacification (IMO). We investigated the prevalence of IMO and the clinical need for ENT assessment or intervention when identified. STUDY DESIGN Systematic review and meta-analysis. METHODS The PRISMA statement standards were used to search electronic databases including Medline, Embase, PubMed, and Web of Science. The selection criteria were mastoid opacification found on computed tomography (CT) or magnetic resonance imaging (MRI) as incidental findings. RESULTS A total of 16 studies were identified for qualitative analysis and 15 for quantitative analysis, mainly retrospective. The pooled prevalence of IMO in 246,288 patients was 8.4% (95% CI 5.5-12.0). The prevalence of IMO was significantly higher in studies with children (17.2%, 95% CI 10.9-24.6) than those with adults (6.1%, 95% CI 3.3-9.6); smaller sample size studies (12.4%, 95% CI 8.1-17.3) compared to larger sample size studies (4.1%, 95% CI 1.5-7.8); and when IMO was detected by viewing images (14.5%, 95% CI 9.9-19.8) compared to reading reports (3.5%, 95% CI 1.3-6.6). Imaging modality was not a significant moderator due to similar IMO rate on CT (8.6%, 95% CI 1.8-19.7) and MRI (10.4%, 95% CI 4.9-17.6). Nine studies reported on clinical outcomes of patients with IMO, and none reliably reported any cases of clinical mastoiditis. CONCLUSIONS The term "mastoiditis" on radiology reports based on IMO does not indicate a clinical diagnosis of mastoiditis, although the current body of evidence is limited. Otolaryngology review is suggested if clinical correlation detects otological signs or symptoms. LEVEL OF EVIDENCE NA. Laryngoscope, 2021.
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Affiliation(s)
- Zahir Mughal
- Department of ENT, Warwick Hospital, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Alexander Rowan Charlton
- Department of ENT, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Matthew Clark
- Department of ENT, Gloucestershire Royal Hospital, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
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Kanayama K, Oba J, Yoshii K, Tomioka Y, Kurita M, Miyamoto S, Okazaki M. Potentially serious incidental findings on medical imaging in plastic surgery patients: A single-institution retrospective cohort study. J Plast Reconstr Aesthet Surg 2021; 74:2776-2820. [PMID: 33972200 DOI: 10.1016/j.bjps.2021.03.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/23/2021] [Accepted: 03/18/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Koji Kanayama
- Department of Plastic, Reconstructive and Aesthetic Surgery, the University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan.
| | - Jun Oba
- Department of Plastic, Reconstructive and Aesthetic Surgery, the University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Kengo Yoshii
- Department of Plastic, Reconstructive and Aesthetic Surgery, the University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Yoko Tomioka
- Department of Plastic, Reconstructive and Aesthetic Surgery, the University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Masakazu Kurita
- Department of Plastic, Reconstructive and Aesthetic Surgery, the University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Shimpei Miyamoto
- Department of Plastic, Reconstructive and Aesthetic Surgery, the University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Mutsumi Okazaki
- Department of Plastic, Reconstructive and Aesthetic Surgery, the University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
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Dennis A, Wamil M, Alberts J, Oben J, Cuthbertson DJ, Wootton D, Crooks M, Gabbay M, Brady M, Hishmeh L, Attree E, Heightman M, Banerjee R, Banerjee A. Multiorgan impairment in low-risk individuals with post-COVID-19 syndrome: a prospective, community-based study. BMJ Open 2021; 11:e048391. [PMID: 33785495 PMCID: PMC8727683 DOI: 10.1136/bmjopen-2020-048391] [Citation(s) in RCA: 225] [Impact Index Per Article: 75.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To assess medium-term organ impairment in symptomatic individuals following recovery from acute SARS-CoV-2 infection. DESIGN Baseline findings from a prospective, observational cohort study. SETTING Community-based individuals from two UK centres between 1 April and 14 September 2020. PARTICIPANTS Individuals ≥18 years with persistent symptoms following recovery from acute SARS-CoV-2 infection and age-matched healthy controls. INTERVENTION Assessment of symptoms by standardised questionnaires (EQ-5D-5L, Dyspnoea-12) and organ-specific metrics by biochemical assessment and quantitative MRI. MAIN OUTCOME MEASURES Severe post-COVID-19 syndrome defined as ongoing respiratory symptoms and/or moderate functional impairment in activities of daily living; single-organ and multiorgan impairment (heart, lungs, kidneys, liver, pancreas, spleen) by consensus definitions at baseline investigation. RESULTS 201 individuals (mean age 45, range 21-71 years, 71% female, 88% white, 32% healthcare workers) completed the baseline assessment (median of 141 days following SARS-CoV-2 infection, IQR 110-162). The study population was at low risk of COVID-19 mortality (obesity 20%, hypertension 7%, type 2 diabetes 2%, heart disease 5%), with only 19% hospitalised with COVID-19. 42% of individuals had 10 or more symptoms and 60% had severe post-COVID-19 syndrome. Fatigue (98%), muscle aches (87%), breathlessness (88%) and headaches (83%) were most frequently reported. Mild organ impairment was present in the heart (26%), lungs (11%), kidneys (4%), liver (28%), pancreas (40%) and spleen (4%), with single-organ and multiorgan impairment in 70% and 29%, respectively. Hospitalisation was associated with older age (p=0.001), non-white ethnicity (p=0.016), increased liver volume (p<0.0001), pancreatic inflammation (p<0.01), and fat accumulation in the liver (p<0.05) and pancreas (p<0.01). Severe post-COVID-19 syndrome was associated with radiological evidence of cardiac damage (myocarditis) (p<0.05). CONCLUSIONS In individuals at low risk of COVID-19 mortality with ongoing symptoms, 70% have impairment in one or more organs 4 months after initial COVID-19 symptoms, with implications for healthcare and public health, which have assumed low risk in young people with no comorbidities. TRIAL REGISTRATION NUMBER NCT04369807; Pre-results.
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Affiliation(s)
| | - Malgorzata Wamil
- Department of Cardiology, Great Western Hospital Foundation NHS Trust, Swindon, UK
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Jude Oben
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Institute for Liver and Digestive Health, University College London, London, UK
| | - Daniel J Cuthbertson
- Institute of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
| | - Dan Wootton
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- Department of Respiratory Research, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Michael Crooks
- Department of Respiratory Medicine, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
- Institute of Clinical and Applied Health Research, University of Hull, Hull, UK
| | - Mark Gabbay
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Michael Brady
- Perspectum, Oxford, UK
- Department of Oncology, University of Oxford, Oxford, UK
| | | | | | - Melissa Heightman
- Department of Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Amitava Banerjee
- Department of Medicine, University College London Hospitals NHS Foundation Trust, London, UK
- Institute of Health Informatics, University College London, London, UK
- Department of Cardiology, Barts Health NHS Trust, London, UK
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Geyer PE, Mann SP, Treit PV, Mann M. Plasma Proteomes Can Be Reidentifiable and Potentially Contain Personally Sensitive and Incidental Findings. Mol Cell Proteomics 2021; 20:100035. [PMID: 33444735 PMCID: PMC7950134 DOI: 10.1074/mcp.ra120.002359] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/02/2020] [Accepted: 12/14/2020] [Indexed: 12/12/2022] Open
Abstract
The goal of clinical proteomics is to identify, quantify, and characterize proteins in body fluids or tissue to assist diagnosis, prognosis, and treatment of patients. In this way, it is similar to more mature omics technologies, such as genomics, that are increasingly applied in biomedicine. We argue that, similar to those fields, proteomics also faces ethical issues related to the kinds of information that is inherently obtained through sample measurement, although their acquisition was not the primary purpose. Specifically, we demonstrate the potential to identify individuals both by their characteristic, individual-specific protein levels and by variant peptides reporting on coding single nucleotide polymorphisms. Furthermore, it is in the nature of blood plasma proteomics profiling that it broadly reports on the health status of an individual-beyond the disease under investigation. Finally, we show that private and potentially sensitive information, such as ethnicity and pregnancy status, can increasingly be derived from proteomics data. Although this is potentially valuable not only to the individual, but also for biomedical research, it raises ethical questions similar to the incidental findings obtained through other omics technologies. We here introduce the necessity of-and argue for the desirability for-ethical and human-rights-related issues to be discussed within the proteomics community. Those thoughts are more fully developed in our accompanying manuscript. Appreciation and discussion of ethical aspects of proteomic research will allow for deeper, better-informed, more diverse, and, most importantly, wiser guidelines for clinical proteomics.
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Affiliation(s)
- Philipp E Geyer
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany; Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Copenhagen, Denmark; OmicEra Diagnostics GmbH, Planegg, Germany.
| | - Sebastian Porsdam Mann
- Department of Media, Cognition and Communication, University of Copenhagen, Copenhagen, Denmark; Uehiro Center for Practical Ethics, Oxford University, Oxford, UK
| | - Peter V Treit
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Matthias Mann
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany; Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Copenhagen, Denmark.
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Graham M, Hallowell N, Savulescu J. A Just Standard: The Ethical Management of Incidental Findings in Brain Imaging Research. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2021; 49:269-281. [PMID: 34924060 PMCID: PMC8242825 DOI: 10.1017/jme.2021.38] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Neuroimaging research regularly yields "incidental findings": observations of potential clinical significance in healthy volunteers or patients, but which are unrelated to the purpose or variables of the study.
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Georgiou M, McAnena L, Michaelides M, Reddy MA. Incidental unilateral idiopathic maculopathy in children. J AAPOS 2020; 24:357.e1-357.e6. [PMID: 33248251 PMCID: PMC8020732 DOI: 10.1016/j.jaapos.2020.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/28/2020] [Accepted: 08/05/2020] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the clinical findings and differential diagnosis of incidental unilateral discoid maculopathy in a case series of children. METHODS The medical records and retinal imaging of children referred to a single center for flat, well circumscribed, hypopigmented discoid macular lesion in the left eye were reviewed retrospectively. RESULTS Three children (age range, 4-11 years; 2 female), with no subjective ophthalmic complaints, were referred for investigation of a flat, well-circumscribed, hypopigmented discoid macular lesion in the left eye. Case 1 had a history of viral mesenteric adenitis, and case 2 had a history of hand, foot, and mouth disease. For case 3, no previous history of systemic viral infection was established. Snellen visual acuity was 20/20 for all 3 children. The lesion was located superior to the fovea for case 1 and centered to the fovea for cases 2 and 3, all in the left eye. In all 3 patients, hyperautofluorescent changes were noted around the edges of the lesion, which was roughly discoid. OCT showed subtle changes of the interdigitation zone and retinal pigment epithelium (RPE) for cases 1 and 2. In case 3 the presence of hyperreflective, hypertrophic tissue at the level of the interdigitation zone and/or the RPE was noted. CONCLUSIONS In these 3 children with subclinical, unilateral discoid maculopathy sharing common features and identified incidentally, previous viral illness may have been causative. These cases may represent resolved unilateral acute idiopathic maculopathy.
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Affiliation(s)
- Michalis Georgiou
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, United Kingdom
| | - Lisa McAnena
- Royal London Hospital, Whitechapel, London, United Kingdom
| | - Michel Michaelides
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, United Kingdom.
| | - M Ashwin Reddy
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, United Kingdom; Royal London Hospital, Whitechapel, London, United Kingdom
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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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Psychological Burden in Meningioma Patients under a Wait-and-Watch Strategy and after Complete Resection Is High-Results of a Prospective Single Center Study. Cancers (Basel) 2020; 12:cancers12123503. [PMID: 33255551 PMCID: PMC7761113 DOI: 10.3390/cancers12123503] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 11/26/2022] Open
Abstract
Simple Summary Asymptomatic meningiomas are found in 1–2% of cranial MRIs. Most of them demonstrate no or minimal growth and are observed with follow-up imaging. However, the patients face a diagnosis of a brain tumor. So far, there is no established distress screening for such patients. In this study, we evaluated the psychological burden of patients with small asymptomatic meningiomas and compared it with patients after complete meningioma resection and excellent postoperative outcome. We found a high prevalence of anxiety and depression symptoms in both study groups. This demonstrates that even patients with benign asymptomatic intracranial tumors might be under significant distress and need psychooncological support. Abstract The diagnosis of intracranial meningiomas as incidental findings is increasing by growing availability of MRI diagnostics. However, the psychological distress of patients with incidental meningiomas under a wait-and-watch strategy is unknown. Therefore, we aimed to compare the psychosocial situation of meningioma patients under wait-and-watch to patients after complete resection to bridge this gap. The inclusion criteria for the prospective monocenter study were either an incidental meningioma under a wait-and-watch strategy or no neurologic deficits after complete resection. Sociodemographic, clinical, and health-related quality of life and clinical data were assessed. Psychosocial factors were measured by the Distress Thermometer (DT), Hospital Anxiety and Depression Scale (HADS), Brief Fatigue Inventory (BFI), and the Short Form (SF-36). A total of 62 patients were included (n = 51 female, mean age 61 (SD 13) years). According to HADS, the prevalence of anxiety was 45% in the postoperative and 42% in the wait-and-watch group (p = 0.60), and depression was 61% and 87%, respectively (p = 0.005). In total, 43% of patients under wait-and-watch and 37% of patients in the postoperative group scored ≥6 on the DT scale. SF-36 scores were similar in all categories except general health (p = 0.005) and physical component aggregate score (43.7 (13.6) vs. 50.5 (9.5), (p = 0.03), both lower in the wait-and-watch group. Multivariate analysis revealed the wait-and-watch strategy was associated with a 4.26-fold higher risk of a pathological depression score based on HADS (p = 0.03). This study demonstrates a high prevalence of psychological distress in meningioma patients. Further evaluation is necessary to identify the patients in need of psychooncological support.
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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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Lutkenhoff ES, Shrestha V, Ruiz Tejeda J, Real C, McArthur DL, Duncan D, La Rocca M, Garner R, Toga AW, Vespa PM, Monti MM. Early brain biomarkers of post-traumatic seizures: initial report of the multicentre epilepsy bioinformatics study for antiepileptogenic therapy (EpiBioS4Rx) prospective study. J Neurol Neurosurg Psychiatry 2020; 91:1154-1157. [PMID: 32848013 PMCID: PMC7572686 DOI: 10.1136/jnnp-2020-322780] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 06/22/2020] [Accepted: 07/08/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) causes early seizures and is the leading cause of post-traumatic epilepsy. We prospectively assessed structural imaging biomarkers differentiating patients who develop seizures secondary to TBI from patients who do not. DESIGN Multicentre prospective cohort study starting in 2018. Imaging data are acquired around day 14 post-injury, detection of seizure events occurred early (within 1 week) and late (up to 90 days post-TBI). RESULTS From a sample of 96 patients surviving moderate-to-severe TBI, we performed shape analysis of local volume deficits in subcortical areas (analysable sample: 57 patients; 35 no seizure, 14 early, 8 late) and cortical ribbon thinning (analysable sample: 46 patients; 29 no seizure, 10 early, 7 late). Right hippocampal volume deficit and inferior temporal cortex thinning demonstrated a significant effect across groups. Additionally, the degree of left frontal and temporal pole thinning, and clinical score at the time of the MRI, could differentiate patients experiencing early seizures from patients not experiencing them with 89% accuracy. CONCLUSIONS AND RELEVANCE Although this is an initial report, these data show that specific areas of localised volume deficit, as visible on routine imaging data, are associated with the emergence of seizures after TBI.
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Affiliation(s)
- Evan S Lutkenhoff
- Psychology, University of California Los Angeles, Los Angeles, California, USA.,Brain Injury Research Center (BIRC), Neurosurgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Vikesh Shrestha
- Brain Injury Research Center (BIRC), Neurosurgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Jesus Ruiz Tejeda
- Brain Injury Research Center (BIRC), Neurosurgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Courtney Real
- Brain Injury Research Center (BIRC), Neurosurgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - David L McArthur
- Brain Injury Research Center (BIRC), Neurosurgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Dominique Duncan
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Marianna La Rocca
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Rachael Garner
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Arthur W Toga
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Paul M Vespa
- Brain Injury Research Center (BIRC), Neurosurgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.,Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States
| | - Martin M Monti
- Psychology, University of California Los Angeles, Los Angeles, California, USA .,Brain Injury Research Center (BIRC), Neurosurgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
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Claeys KG, Goosens V. Whole-body muscle magnetic resonance imaging in patients with muscle symptoms: incidental findings and outcomes. Eur J Neurol 2020; 28:323-330. [PMID: 32892468 DOI: 10.1111/ene.14503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/05/2020] [Accepted: 08/26/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Whole-body muscle magnetic resonance imaging (MRI) has become widely used for diagnostic workup in patients with muscle diseases. The prevalence of incidental findings in diagnostic whole-body muscle MRI is unknown. Here, the prevalence and outcomes of incidentalomas in whole-body muscle MRI in a large cohort of patients with muscle symptoms were studied. METHODS Two hundred and six patients who consulted at our neuromuscular clinic with muscle weakness and/or myalgia and/or increased serum creatine kinase and in whom a whole-body muscle MRI was performed between January 2016 and March 2020 were included. RESULTS Whole-body muscle MRI revealed at least one incidentaloma in 132 patients (64.1%), with mean age at MRI examination 50.4 years (19-74 years). Most of the incidental findings were benign. However, diagnostic examinations were indicated in 16.3% of the incidentalomas, treatment was needed in 4.7% and, in retrospect, symptoms related to the incidental findings were identified in 14.3%. Three malignant (glioblastoma multiforme, renal cell carcinoma and hepato-splenomegaly related to a lymphoma) and one precancerous (low-grade appendiceal mucinous neoplasm) incidental findings were identified. In one patient an abdominal aortic aneurysm was detected and in another a large cerebral arteriovenous malformation. In 1.2% of the incidentalomas, i.e. periventricular white matter lesions (LAMA2 mutations) and fibrous dysplasia (ANO5 mutations), an indirect link with the muscle disease could be established. CONCLUSIONS It is concluded that incidental findings in diagnostic whole-body muscle MRI in patients with muscle symptoms occur frequently. Most of them are benign, but in some timely detecting the incidentaloma leads to early treatment and can thus impact prognosis.
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Affiliation(s)
- K G Claeys
- Department of Neurology, Neuromuscular Reference Centre, University Hospitals Leuven, Leuven, Belgium.,Laboratory for Muscle diseases and Neuropathies, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - V Goosens
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
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42
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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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Poon MTC, Sudlow CLM, Figueroa JD, Brennan PM. Longer-term (≥ 2 years) survival in patients with glioblastoma in population-based studies pre- and post-2005: a systematic review and meta-analysis. Sci Rep 2020; 10:11622. [PMID: 32669604 PMCID: PMC7363854 DOI: 10.1038/s41598-020-68011-4] [Citation(s) in RCA: 151] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/25/2020] [Indexed: 02/06/2023] Open
Abstract
Translation of survival benefits observed in glioblastoma clinical trials to populations and to longer-term survival remains uncertain. We aimed to assess if ≥ 2-year survival has changed in relation to the trial of radiotherapy plus concomitant and adjuvant temozolomide published in 2005. We searched MEDLINE and Embase for population-based studies with ≥ 50 patients published after 2002 reporting survival at ≥ 2 years following glioblastoma diagnosis. Primary endpoints were survival at 2-, 3- and 5-years stratified by recruitment period. We meta-analysed survival estimates using a random effects model stratified according to whether recruitment ended before 2005 (earlier) or started during or after 2005 (later). PROSPERO registration number CRD42019130035. Twenty-three populations from 63 potentially eligible studies contributed to the meta-analyses. Pooled 2-year overall survival estimates for the earlier and later study periods were 9% (95% confidence interval [CI] 6-12%; n/N = 1,488/17,507) and 18% (95% CI 14-22%; n/N = 5,670/32,390), respectively. Similarly, pooled 3-year survival estimates increased from 4% (95% CI 2-6%; n/N = 325/10,556) to 11% (95% CI 9-14%; n/N = 1900/16,397). One study with a within-population comparison showed similar improvement in survival among the older population. Pooled 5-year survival estimates were 3% (95% CI 1-5%; n/N = 401/14,919) and 4% (95% CI 2-5%; n/N = 1,291/28,748) for the earlier and later periods, respectively. Meta-analyses of real-world data suggested a doubling of 2- and 3-year survival in glioblastoma patients since 2005. However, 5-year survival remains poor with no apparent improvement. Detailed clinically annotated population-based data and further molecular characterization of longer-term survivors may explain the unchanged survival beyond 5 years.
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Affiliation(s)
- Michael T C Poon
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Brain Tumour Centre of Excellence, Cancer Research UK Edinburgh Centre, University of Edinburgh, Edinburgh, UK
| | - Cathie L M Sudlow
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Brain Tumour Centre of Excellence, Cancer Research UK Edinburgh Centre, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, Edinburgh BioQuarter, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Jonine D Figueroa
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Brain Tumour Centre of Excellence, Cancer Research UK Edinburgh Centre, University of Edinburgh, Edinburgh, UK
| | - Paul M Brennan
- Brain Tumour Centre of Excellence, Cancer Research UK Edinburgh Centre, University of Edinburgh, Edinburgh, UK.
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, Edinburgh BioQuarter, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
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44
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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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45
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Whole-body magnetic resonance imaging: Incidental findings in paediatric and adult populations. Eur J Radiol 2020; 130:109156. [PMID: 32645680 DOI: 10.1016/j.ejrad.2020.109156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/31/2020] [Accepted: 06/27/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE To determine the prevalence and characterise the significance of incidental findings on whole-body MRI in paediatric and adult populations. METHODS A retrospective, single-institution study over a period of 8 years. The study population comprised 325 paediatric (0-18 yrs) patients and 148 adults (19-40 yrs) referred to a specialist musculoskeletal oncology centre, who underwent whole-body MRI for a range of pathological indications. Incidental findings were recorded according to pathology (musculoskeletal or non-musculoskeletal), site and clinical relevance. RESULTS Eighty-seven of 325 (26.8 %) paediatric patients and 51 of 148 (35.8 %) adults had incidental findings detected on whole-body MRI. The most common site was the musculoskeletal system, and within this location the lower limbs. Eighty-nine percent of incidental findings in paediatric patients and 79 % of incidental findings in adults were classified as being of either minor or no clinical significance. CONCLUSION Incidental findings are common in paediatric and adult patients undergoing whole-body MRI, and are most frequently found in the lower limbs. The overwhelming majority are of minor clinical significance.
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Lanfranconi S, Scola E, Bertani GA, Zarino B, Pallini R, d'Alessandris G, Mazzon E, Marino S, Carriero MR, Scelzo E, Faragò G, Castori M, Fusco C, Petracca A, d'Agruma L, Tassi L, d'Orio P, Lampugnani MG, Nicolis EB, Vasamì A, Novelli D, Torri V, Meessen JMTA, Al-Shahi Salman R, Dejana E, Latini R. Propranolol for familial cerebral cavernous malformation (Treat_CCM): study protocol for a randomized controlled pilot trial. Trials 2020; 21:401. [PMID: 32398113 PMCID: PMC7218540 DOI: 10.1186/s13063-020-4202-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 02/24/2020] [Indexed: 12/21/2022] Open
Abstract
Background Cerebral cavernous malformations (CCMs) are vascular malformations characterized by clusters of enlarged leaky capillaries in the central nervous system. They may result in intracranial haemorrhage, epileptic seizure(s), or focal neurological deficits, and potentially lead to severe disability. Globally, CCMs represent the second most common intracranial vascular malformation in humans, and their familial form (FCCMs) accounts for one-fifth of cases. Neurosurgical excision, and perhaps stereotactic radiosurgery, is the only available therapeutic option. Case reports suggest that propranolol might modify disease progression. Methods Treat_CCM is a prospective, randomized, open-label, blinded endpoint (PROBE), parallel-group trial involving six Italian clinical centres with central reading of brain magnetic resonance imaging (MRI) and adverse events. Patients with symptomatic FCCMs are randomized (2:1 ratio) either to propranolol (40–80 mg twice daily) in addition to standard care or to standard care alone (i.e. anti-epileptic drugs or headache treatments). The primary outcome is intracranial haemorrhage or focal neurological deficit attributable to CCMs. The secondary outcomes are MRI changes over time (i.e. de novo CCM lesions, CCM size and signal characteristics, iron deposition, and vascular leakage as assessed by quantitative susceptibility mapping and dynamic contrast enhanced permeability), disability, health-related quality of life, depression severity, and anxiety (SF-36, BDI-II, State-Trait Anxiety Inventory). Discussion Treat_CCM will evaluate the safety and efficacy of propranolol for CCMs following promising case reports in a randomized controlled trial. The direction of effect on the primary outcome and the consistency of effects on the secondary outcomes (even if none of them yield statistically significant differences) of this external pilot study may lead to a larger sample size in a definitive phase 2 trial. Trial registration ClinicalTrails.gov, NCT03589014. Retrospectively registered on 17 July 2018.
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Affiliation(s)
- Silvia Lanfranconi
- Department of Neurology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Padiglione Monteggia-piano 3, Via Francesco Sforza 35, 20122, Milan, Italy.
| | - Elisa Scola
- Department of Neuroradiology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Giulio Andrea Bertani
- Department of Neurosurgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Barbara Zarino
- Department of Neurosurgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Roberto Pallini
- Department of Neurosurgery, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Giorgio d'Alessandris
- Department of Neurosurgery, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Emanuela Mazzon
- IRCCS Centro Neurolesi "Bonino Pulejo", Contrada Casazza, 98124, Messina, Italy
| | - Silvia Marino
- IRCCS Centro Neurolesi "Bonino Pulejo", Contrada Casazza, 98124, Messina, Italy
| | - Maria Rita Carriero
- Cerebrovascular Disease Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Giovanni Celoria 11, 20133, Milan, Italy
| | - Emma Scelzo
- Cerebrovascular Disease Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Giovanni Celoria 11, 20133, Milan, Italy
| | - Giuseppe Faragò
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Giovanni Celoria 11, 20133, Milan, Italy
| | - Marco Castori
- Division of Medical Genetics, Fondazione IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini 2, 71013, San Giovanni Rotondo, Italy
| | - Carmela Fusco
- Division of Medical Genetics, Fondazione IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini 2, 71013, San Giovanni Rotondo, Italy
| | - Antonio Petracca
- Division of Medical Genetics, Fondazione IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini 2, 71013, San Giovanni Rotondo, Italy
| | - Leonardo d'Agruma
- Division of Medical Genetics, Fondazione IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini 2, 71013, San Giovanni Rotondo, Italy
| | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Centre, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy
| | - Piergiorgio d'Orio
- "Claudio Munari" Epilepsy Surgery Centre, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy
| | - Maria Grazia Lampugnani
- Laboratory of Vascular Biology, IFOM, Firc Institute for Molecular Oncology, Via Adamello 16, 20139, Milan, Italy
| | - Enrico Bjorn Nicolis
- Laboratory of Cardiovascular Clinical Pharmacology, Mario Negri Institute for Pharmacological Research-IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
| | - Antonella Vasamì
- Laboratory of Cardiovascular Clinical Pharmacology, Mario Negri Institute for Pharmacological Research-IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
| | - Deborah Novelli
- Laboratory of Cardiovascular Clinical Pharmacology, Mario Negri Institute for Pharmacological Research-IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
| | - Valter Torri
- Laboratory of Research Methodology, Mario Negri Institute for Pharmacological Research-IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
| | - Jennifer Marie Theresia Anna Meessen
- Laboratory of Cardiovascular Clinical Pharmacology, Mario Negri Institute for Pharmacological Research-IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
| | - Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, University of Edinburgh, Little France Crescent 49, Edinburgh, EH16 4SB, UK
| | - Elisabetta Dejana
- Laboratory of Vascular Biology, IFOM, Firc Institute for Molecular Oncology, Via Adamello 16, 20139, Milan, Italy
| | - Roberto Latini
- Laboratory of Cardiovascular Clinical Pharmacology, Mario Negri Institute for Pharmacological Research-IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
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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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Glasmacher SA, Thomas HS, Stirland L, Wilkinson T, Lumsden J, Langlands G, Waddell B, Holloway G, Thompson G, Pal S. Incidental Findings Identified on Head MRI for Investigation of Cognitive Impairment: A Retrospective Review. Dement Geriatr Cogn Disord 2019; 48:123-130. [PMID: 31805574 DOI: 10.1159/000503956] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 10/03/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Incidental findings are common in presumed healthy volunteers but are infrequently studied in patients in a clinical context. OBJECTIVE To determine the prevalence, nature, and management implications of incidental findings on head MRI in patients presenting with cognitive symptoms, and to quantify and describe unexpected MRI abnormalities that are of uncertain relevance to the patient's cognitive symptoms. METHODS A single-centre retrospective review of patients attending a regional early-onset cognitive disorders clinic between March 2012 and October 2018. Medical records of consecutive patients who underwent head MRI were reviewed. Unexpected MRI findings were classified according to their severity and likelihood of being incidental. Markers of small vessel disease and cerebral atrophy were excluded. RESULTS Records of 694 patients were reviewed (median age 60 years, 49.9% female), of whom 514 (74.1%) underwent head MRI. 54% of the patients received a diagnosis of a neurodegenerative disorder. Overall 111 incidental findings were identified in 100 patients of whom 18 patients (3.5%, 95% CI 2.2-5.6%) had 18 incidental findings classified as requiring additional medical evaluation. 82 patients (16%, 95% CI 13.0-19.5%) had 93 incidental findings without clearly defined diagnostic consequences. 17 patients (3.3%) underwent further investigations, 14 patients (2.7%) were referred to another specialist clinic and 3 patients (0.6%) were treated surgically. Two patients had MRI findings of uncertain relevance to their cognitive symptoms, necessitating prolonged clinic follow-up. CONCLUSION Incidental findings are common in patients with cognitive impairment from this large clinic-based series; however, few required additional medical evaluation. These data could help inform discussions between clinicians and people with cognitive symptoms regarding the likelihood and potential implications of incidental imaging findings.
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Affiliation(s)
| | - Hannah Sam Thomas
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Lucy Stirland
- Division of Psychiatry, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh, United Kingdom
| | - Tim Wilkinson
- Centre for Clinical Brain Sciences, Chancellor's Building, Edinburgh, United Kingdom
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Jane Lumsden
- Centre for Clinical Brain Sciences, Chancellor's Building, Edinburgh, United Kingdom
| | - Gavin Langlands
- Centre for Clinical Brain Sciences, Chancellor's Building, Edinburgh, United Kingdom
| | - Briony Waddell
- Department of Neurology, Ninewells Hospital, Dundee, United Kingdom
| | - Guy Holloway
- Department of Old Age Psychiatry, NHS Lothian, Morningside, Royal Edinburgh Hospital, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Gerard Thompson
- Centre for Clinical Brain Sciences, Chancellor's Building, Edinburgh, United Kingdom
| | - Suvankar Pal
- Centre for Clinical Brain Sciences, Chancellor's Building, Edinburgh, United Kingdom,
- Anne Rowling Regenerative Neurology Clinic, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom,
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Dangouloff-Ros V, Roux CJ, Boulouis G, Levy R, Nicolas N, Lozach C, Grevent D, Brunelle F, Boddaert N, Naggara O. Incidental Brain MRI Findings in Children: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2019; 40:1818-1823. [PMID: 31624116 DOI: 10.3174/ajnr.a6281] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/03/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND The detection of incidental findings on children's brain MR imaging poses various practical issues because the life-long implications of such findings may be profound. PURPOSE Our aim was to assess the prevalence and characteristics of incidental brain MR imaging findings in children. DATA SOURCES Electronic databases (PubMed, EMBASE, and Cochrane) were searched for articles published between 1985 to July 2018, with the following search terms: "incidental," "findings," "brain," "MR imaging." STUDY SELECTION Inclusion criteria were the following: 1) patients younger than 21 years of age, 2) healthy children without any clinical condition, 3) MR images obtained with at least a 1.5T magnet, 4) original articles, and 5) a methodologic quality score of ≥10. DATA ANALYSIS Two observers independently extracted data and assessed data quality and validity. The number and type of incidental findings were pooled. Heterogeneity was assessed using the Cochran Q statistic and the I2 statistic. DATA SYNTHESIS Seven studies were included, reporting 5938 children (mean age, 11.3 ± 2.8 years). Incidental findings were present in 16.4% (99% CI, 9.8-26.2; Q = 117.5, I2= 94.9%) of healthy children, intracranial cysts being the most frequent (10.2%, 99% CI, 3.1-28.5; Q = 306.4, I2 = 98.0%). Nonspecific white matter hyperintensities were reported in 1.9% (99% CI, 0.2-16.8; Q = 73.6, I2 = 94.6%), Chiari 1 malformation was found in 0.8% (99% CI, 0.5-1.3; Q = 7.6, I2 = 60.5%), and intracranial neoplasms were reported in 0.2% (99% CI, 0.1-0.6; Q = 3.4, I2 = 12.3%). In total, the prevalence of incidental findings needing follow-up was 2.6% (99% CI, 0.5-11.7; Q = 131.2, I2 = 95.4%). Incidental findings needing specific treatment were brain tumors (0.2%) and cavernomas (0.2%). LIMITATIONS Limitations were no age stratification or ethnicity data and variation in the design of included studies. CONCLUSIONS The prevalence of incidental findings is much more frequent in children than previously reported in adults, but clinically meaningfull incidental findings were present in <1 in 38 children.
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Affiliation(s)
- V Dangouloff-Ros
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - C-J Roux
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - G Boulouis
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
- Neuroradiology Department (G.B., O.N.), Centre Hospitalier Sainte-Anne, Paris, France
| | - R Levy
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - N Nicolas
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - C Lozach
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - D Grevent
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - F Brunelle
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - N Boddaert
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - O Naggara
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
- Neuroradiology Department (G.B., O.N.), Centre Hospitalier Sainte-Anne, Paris, France
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50
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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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