Incidental findings in lumbar spine MRI: their prevalence and potential impact on patient management

Prevalence of Incidental Extraspinal Findings on MR Imaging of the Lumbar Spine in Adults: A Systematic Review and Meta-analysis

BACKGROUND

Low back pain is common worldwide. MR imaging may identify extraspinal findings that are not related to the proposed clinical question. The prevalence of extraspinal incidental findings and their clinical significance has not been well-established.

PURPOSE

This review aimed to evaluate the prevalence of extraspinal findings on MR imaging of the lumbar spine in adults and the prevalence of clinically significant incidental findings.

DATA SOURCES

A systematic search of MEDLINE and EMBASE was performed, including studies published before June 14, 2023.

STUDY SELECTION

Studies presenting a prevalence of extraspinal findings in patients 16 years of age or older were included.

DATA ANALYSIS

A random effects meta-analysis was used to generate composite prevalence measures of extraspinal findings, patients with extraspinal findings, and clinically significant findings.

DATA SYNTHESIS

Sixteen studies were included in this meta-analysis, with a total of 19,593 patients and 6,006 extraspinal incidental findings. The overall prevalence of extraspinal findings was 19.9% (95% CI, 11.1%-30.7%). Overall, 26.7% of patients had an extraspinal finding identified (95% CI, 14.8%-40.6%). The most common subgroup of extraspinal findings was genitourinary findings in males (27.1%; 95% CI, 25.6%-28.8%). Data from 8 studies demonstrated the prevalence of clinically significant findings at 5.4% (95% CI, 3.2%-8.1%).

LIMITATIONS

Retrospective populations with small numbers of participants in clinically relevant subgroups may result in heterogeneity and imprecision within composite outcome measures.

CONCLUSIONS

Extraspinal findings are common, detected in more than one-quarter of patients. Five percent of findings are clinically significant and may require further action.

Complete Resolution of Refractory Axial Low Back Pain After Myomectomy

ABSTRACT

We present a case of a 39-yr-old woman with a 3-mo history of axial low back pain who was found to have a 3.8-cm uterine fibroid, which was initially thought to be an incidental finding. Her low back pain failed to respond to conservative management, and she was eventually referred to gynecology. Her pain subsequently resolved after myomectomy. To the best of our knowledge, complete resolution of low back pain after myomectomy has not been previously described in the literature. Although uterine fibroids are commonly noted on imaging, they are often ignored. We encourage clinicians to consider fibroids as pain generators, especially when treating patients with refractory axial low back pain.

Applying Implementation Science Principles to Systematize High-Quality Care for Potentially Significant Imaging Findings

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.

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

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

Magnetic resonance imaging of the female pelvis after Cesarean section: a pictorial review

The rate of Cesarean sections (C-sections) in Poland increased from 21.7% in 2001 to 43.85% in 2017 even though the Polish Society of Gynecologists and Obstetricians highlights the negative consequences of C-section for both mother and child and recommends to make every possible effort to reduce its percentage, following the World Health Organization recommendations. There is a long list of possible complications related to the uterine scar after C-section, including uterine scar dehiscence, uterine rupture, abdominal and pelvic adhesions, uterine synechiae, ectopic pregnancy, anomalous location of the placenta, placental invasion, and—rarely—vesicouterine or uterocutaneous fistulas. Ultrasound (US) remains the first-line modality; however, its strong operator- and equipment dependence and other limitations require further investigations in some cases. Magnetic resonance imaging (MRI) is the second-line tool which is supposed to confirm, correct, or complete the sonographic diagnosis thanks to its higher tissue resolution and bigger field of view. This article will discuss the spectrum of C-section complications in the MR image-rich form and will provide a systematic discussion of the possible pathology that can occur, showing comprehensive anatomical insight into the pelvis after C-section thanks to MRI that facilitates clinical decisions.