Prevalence Of Incidental Findings Research Articles

MP20: Prevalence of incidental findings on chest computed tomography in patients with suspected pulmonary embolism in the ED

Introduction: Computed tomographic pulmonary angiograms (CTPAs) are often ordered to evaluate pulmonary embolism (PE) in the emergency department (ED). However, these studies often yield alternative diagnoses and report incidental findings that lead to additional unnecessary investigations. Our objective was to assess the prevalence and significance of such findings and their implications in patient management. Methods: This is a retrospective cohort study of adults presenting to two tertiary care EDs in 2015, being evaluated with CTPA for PE. Data was extracted by two reviewers from electronic CT records with inter-rater reliability reported using kappa statistic. We measured prevalence of PE, incidental findings and alternative diagnoses with data reported as mean and standard deviation (SD). Univariate analyses were performed with t-test for continuous variables and Mantel-Haenszel test for categorical variables. A sample size of 770 was calculated based on an expected difference in prevalence between significant and non-significant incidental findings of 80% (α=5%, Power=90%). Results: A total of 1629 studies were included (mean 62 yrs, SD 16.7, 56.9% female, median CTAS score 2, 45.2% admitted). PE was found in 233 (14.3%) patients. 173 (10.6%) studies had a finding of an alternative diagnosis, the majority being pulmonary infiltrates (n=130, 75.1%). In patients who underwent both CTPA and chest x-ray (CXR), CXRs alone would have led to the same alternative diagnosis in 116 (77.1%) patients. A total of 223 (13.6%) patients had an incidental finding; the majority included pulmonary nodules (n=83, 37.2%) and adenopathy (n=26, 11.6%). Only 26 (17.1%) incidental findings were significant; most common included pulmonary nodules (n=6, 3.9%) and masses (n=7, 4.6%) that lead to newly identified and biopsied lung cancer diagnoses. Incidental findings led to an additional 301 follow-up CTs with a yield of significant result of 9.2% (n=48 CTs). Conclusion: Chest CTs ordered in the ED for clinical suspicion of PE is equally as likely to identify alternative diagnoses or incidental findings as PE. The majority of incidental findings are non-significant and result in an increased use of CT. CXRs should routinely be ordered prior to further investigation for PE with chest CT to reduce unnecessary testing and thus time and cost to the system.

Incidental findings on brain MRI of cognitively normal first-degree descendants of patients with Alzheimer's disease: a cross-sectional analysis from the ALFA (Alzheimer and Families) project

ObjectivesTo describe the prevalence of brain MRI incidental findings (IF) in a cohort of cognitively normal first-degree descendants of patients with Alzheimer's disease (AD).DesignCross-sectional observational study.SettingAll scans were obtained with...

Extraspinal Incidental Findings at Lumbar Spine Magnetic Resonance Imaging in Two Hospitals: Prevalence and Clinical Importance

Objective: To assess the importance of incidental extraspinal findings on Magnetic Resonance Imaging of the lumbar spine in two hospital facilities. Materials and Methods: It was a descriptive and retrospective study from November 2015 to March 2016. The records of patients who had done a Magnetic Resonance Imaging (MRI) scan of the lumbar spine were re-read in search of incidental findings. The incidental findings found were classified using Colonography Reporting and Data System(C-RADS) classification of extracolonic lesions to assess clinical significance. The prevalence of incidental findings was calculated for each facility, as well as the distribution according to age, the organs involved and the clinical importance. A non-detection rate was calculated by confronting the findings of the study with the original reports. Results: The prevalence of incidental findings was respectively 33% (19 out of 36) in Jordan Medical Center (JMC) in Yaounde and 27.74% (106 out of 292) in Jacques Monod Hospital. The extraspinal incidental findings were classified mainly as extracolonic 2 (E2): 58% in each facility. The percentage detection of incidental findings was 5% at JMS and 1.7% at Jacques Monod Hospital. Conclusion: Extraspinal incidental findings are frequent in both hospitals. However, the rate of detection remains very low.

SC24.02 Radiological Techniques for the Evaluation of Pulmonary Nodules

Radiologic Techniques for the Evaluation of Pulmonary Nodules The incidental detection of pulmonary nodules has increased with improved CT technology and thin section imaging techniques.1,2 Adding to this increased detection of nodules is the heightened interest in the purposeful search for nodules such as in oncology patients and lung cancer screening programs. The management of CT detected nodules is a subject of much debate and dependent upon the clinical setting. For instance, in a lung cancer screening setting, there has been a large volume of investigation of solid, semi-solid and ground glass nodules that is the foundation of management recommendations such as LungRads.3 In patients with a known malignancy, there is minimal literature on management recommendations and thus more influenced by pulmonary metastatic potential of the malignancy and clinician experience.4 Finally incidentally detected nodule management is greatly influenced by cancer risk factors and nodule texture; for these situations, the Fleischner criteria have been the most widely used and accepted management guidelines.5 The radiologic evaluation of nodules most often utilizes conventional imaging techniques of chest radiographs, computed tomography (CT), PET/CT. Occasionally MRI and ultrasound may be employed. Most recent changes involve risk stratification, computer software applications to enhance nodule analysis such as nodule enhancement patterns, volumetric computations, and texture analysis.6-8 Future directions include incorporation of genomics into imaging as well as radiomic analysis and machine learning.9,10 This presentation will review the highlights of the radiologic methods for evaluating pulmonary nodules with a focus on current guidelines and future directions. 1. Frank L, Quint LE. Chest CT incidentalomas: thyroid lesions, enlarged mediastinal lymph nodes, and lung nodules. Cancer imaging : the official publication of the International Cancer Imaging Society 2012;12:41-8. 2. Jacobs PC, Mali WP, Grobbee DE, van der Graaf Y. Prevalence of incidental findings in computed tomographic screening of the chest: a systematic review. Journal of computer assisted tomography 2008;32:214-21. 3. Lung CT Screening Reporting and Data Systen (Lung-RADS). 2014. (Accessed March 27, 2015, at www.acr.org/Quality-Safety/Resources/LungRADS) 4. Munden RF, Erasmus JJ, Wahba H, Fineberg NS. Follow-up of small (4 mm or less) incidentally detected nodules by computed tomography in oncology patients: a retrospective review. J Thorac Oncol 2010;5:1958-62. 5. McMahon PM, Meza R, Plevritis SK, et al. Comparing benefits from many possible computed tomography lung cancer screening programs: extrapolating from the National Lung Screening Trial using comparative modeling. PloS one 2014;9:e99978. 6. McWilliams A, Tammemagi MC, Mayo JR, et al. Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med 2013;369:910-9. 7. Revel MP, Merlin A, Peyrard S, et al. Software volumetric evaluation of doubling times for differentiating benign versus malignant pulmonary nodules. AJR Am J Roentgenol 2006;187:135-42. 8. Talwar A, Gleeson FV, Rahman NM, Pickup L, Gooding M, Kadir T. A Review Of The Use Of Computer Aided Texture Analysis For Pulmonary Nodules Classification. American journal of respiratory and critical care medicine 2015;191. 9. El-Zein RA, Lopez MS, D'Amelio AM, Jr., et al. The cytokinesis-blocked micronucleus assay as a strong predictor of lung cancer: extension of a lung cancer risk prediction model. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 2014;23:2462-70. 10. Gillies RJ, Kinahan PE, Hricak H. Radiomics: Images Are More than Pictures, They Are Data. Radiology 2016;278:563-77. Radiomics, Incidental, nodules, CT

Cross-sectional study on incidental spinal findings in magnetic resonance imaging lumbar spine of patients with low back pain

Background: Incidental finding is an observation, not related to the current medical problem. Various incidental findings can be seen in the lumbar spine (LS) magnetic resonance imaging (MRI) taken for evaluation of low back pain. Aims: To evaluate and analyze the spinal incidental findings in MRI LS of patients with low backache. Settings and Design: A retrospective, cross-sectional analytical study. Materials and Methods: All patients (n = 1269, males: 578, females: 691; mean age: 45 ± 15 years) with low backache, who underwent MRI of the LS at a tertiary care hospital in South India, during a period from January 2011 to August 2015. Two radiologists evaluated these examinations for the presence of incidental findings in consensus. We included fatty vertebral hemangioma (FVH), fatty filum terminale (FFT), extraspinal synovial cyst (SC), Tarlov cyst (TC), enostosis, and limbus vertebrae. Statistical Analysis Used: Calculated the prevalence of incidental findings and analyzed the relationship of these incidental findings with patient demographics. Results: Overall, incidental spinal findings were present in 390 patients (30.7%). FVH was the most common incidental finding (n = 205 patients, 16.16%), followed by extraspinal SC (n = 130 patients, 10.2%), and FFT (114 patients, 9%). A pattern of increasing frequency with age noted in the FVH (P = 0.001), TC (P = 0.017), and enostosis (P = 0.008). There was no significant sex predilection for the incidental findings. Conclusion: Incidental findings are common in LS MRI. Understanding on the nature and prevalence of these lesions is essential for the radiologist, for optimal reporting and for the clinician in appropriate interpretation of radiological reports.

Should incidental findings in diagnostic imaging be reported?

Recent improvements in image quality have contributed to an increasing number of incidental findings (IF). Also called as "incidentalomas", this generic term refers to an entity discovered unexpectedly on an imaging examination performed for other reason. Commonly, normal variants, minor developmental anomalies and imaging artifacts are described as potential pathology. Some IF were reported in magnetic resonance imaging (MRI) exam of temporomandibular joint (TMJ), including IF in the brain, maxillary sinus, ethmoidal cells, mastoid cells, salivary glands, muscles. The aim of this study is to evaluate the prevalence of IF on MRI of TMJ from Japanese patients. An image archive from 872 patients referred to MRI evaluation due to TMJ symptomatology was assessed. Three experienced radiologists evaluated all images, and the final diagnosis was achieved by consensus. The data regarding IF was recorded, considering only tumor and tumor-like lesions. A total of 12 (1.38%) of tumor and tumor-like lesions were observed from all 872 MRI exams evaluated. The most frequent lesion was arachnoid cyst (0.45%), followed by neoplastic lesions (0.22%). The question "should every IF be reported?" is still difficult to answer. Relevant IF are rare, and radiologists are expected to be reasonable: think about the adverse effects of reporting an IF, and, based on their own judgment, choose for a positive or a negative answer.

Incidental cone beam computed tomographic findings among Taibah University patients, KSA: A retrospective study.

ObjectivesThe aim of this study was to retrospectively evaluate the prevalence, type, and location of incidental findings by cone beam computed tomography (CBCT) scans. This study was performed to diagnose dental problems in the female population at Taibah University Dental Clinics (TUDC), KSA.MethodsA series of 150 consecutive CBCT scans were identified between January 2014 and February 2016. The record was retrieved from the Carestream (CS) R4 Clinical and Practice Management Software database of TUDC. We retrospectively assessed them for incidental findings and then summarized and categorized them into five anatomical regions: nasopharyngeal airway, temporomandibular joint (TMJ), paranasal sinuses, dental findings, and alveolar bone region. We then analysed the frequency and percentage of findings in each category.ResultsA total of 248 incidental findings were reported in 83 of 90 scans (2.76 findings/scan). The prevalence of all incidental findings was 92.2%. The most common incidental findings were located in the paranasal sinuses and alveolar area, each representing about a quarter (27.4%) of all of the findings. Other common findings were in the TMJ (22.9%), followed by those in the nasopharyngeal airway (10.9%), dental area (10.5%), and others (0.8%).ConclusionThis study confirms the high prevalence of incidental maxillofacial findings as shown by CBCT scans in a sample of female patients at TUDC. This emphasizes the need to thoroughly examine CBCT volumes for clinically significant findings inside and beyond the region of interest for the benefit of patients and the protection of practitioners.

Incidental findings discovered during imaging: implications for general practice

Whether they are called incidentalomas, unexpected findings, or VOMIT (‘victims of modern imaging technology’),1 the issue surrounding incidental findings (IFs) discovered during radiological imaging will affect the future of medical practice and needs to be addressed. IFs are those findings that are discovered by chance in the context of radiological diagnostics which can potentially affect the health of an individual (if not already a patient, they may now have become one). IFs can of course be life-saving but they can also be harmful to the ‘patient.’ It is not uncommon for a minor developmental anomaly, normal variant, or physiological feature to be identified as pathology on imaging.2 A seemingly harmful lesion can lead to lifelong follow-up, further imaging and appointments, unwarranted treatment, and even radical surgery, only for the pathology to turn out to be benign. Furthermore, IFs can incur unnecessary financial costs, waste time, provoke anxiety (for patients and clinicians), and can have serious implications for the ‘patient’ regarding future medical and life insurance.3 While it can be argued that the harmful discovery of an IF is unintentional, the prevalence of IFs and their potential for harm is known a priori. If we are to first do no harm, should we change our mindset and start thinking of IFs as possible side effects of a medical procedure? Indeed, some even propose that consent should be obtained from ‘patients’ prior to imaging.4 From 1980 to 2010 the numbers of CT scans performed increased from 80 million per year in the …

Research cardiac magnetic resonance imaging in end stage renal disease - incidence, significance and implications of unexpected incidental findings

ObjectivesLeft ventricular mass (LVM) at cardiac magnetic resonance imaging (CMR) is a frequent end point in clinical trials in nephrology. Trial participants with end stage renal disease (ESRD) may have a greater frequency of incidental findings (IF). We retrospectively investigated prevalence of IF in previous research CMR and reviewed their subsequent impact on participants.MethodsBetween 2002 and 2006, 161 ESRD patients underwent CMR in a transplant assessment study. Images were used to assess LV mass and function. In the current study a radiologist reviewed the scans for IF. Review of patient records determined the subsequent clinical significance of IF.ResultsThere were 150 IF in 95 study participants. Eighty-four (56 %) were new diagnoses. One hundred and two were non-cardiac. Fifteen were suspicious of malignancy. There was a clinically significant IF for 14.9 % of the participants. In six cases earlier identification of an IF may have improved quality of life or survival.ConclusionsWithout radiology support clinically important IF may be missed on CMR. Patients undergoing CMR in trials should be counselled about the frequency and implications of IF. Patients with ESRD have a higher prevalence of IF than reported in other populations. Nephrology studies require mechanisms for radiologist reporting and strategies for dealing with IF.Key Points• Incidental findings on research cardiac magnetic resonance imaging can have significant consequences.• We considered incidental findings in historical renal cardiac resonance imaging clinical trials.• Incidental findings are common and important in the chronic kidney disease population.• Without radiology support, clinically significant incidental findings may be missed on imaging.• Study protocols, approvals and consent processes should take account of possible findings.

Incidentalome from Genomic Sequencing: A Barrier to Personalized Medicine?

BackgroundIn Western cohorts, the prevalence of incidental findings (IFs) or incidentalome, referring to variants in genes that are unrelated to the patient's primary condition, is between 0.86% and 8.8%. However, data on prevalence and type of IFs in Asian population is lacking. MethodsIn 2 cohorts of individuals with genomic sequencing performed in Singapore (total n=377), we extracted and annotated variants in the 56 ACMG-recommended genes and filtered these variants based on the level of pathogenicity. We then analyzed the precise distribution of IFs, class of genes, related medical conditions, and potential clinical impact. ResultsWe found a total of 41,607 variants in the 56 genes in our cohort of 377 individuals. After filtering for rare and coding variants, we identified 14 potential variants. After reviewing primary literature, only 4 out of the 14 variants were classified to be pathogenic, while an additional two variants were classified as likely pathogenic. Overall, the cumulative prevalence of IFs (pathogenic and likely pathogenic variants) in our cohort was 1.6%. ConclusionThe cumulative prevalence of IFs through genomic sequencing is low and the incidentalome may not be a significant barrier to implementation of genomics for personalized medicine.

Incidental findings on chest computed tomography are common and linked to inflammation in HIV-infected adults.

Chest imaging is performed for a variety of reasons in HIV-infected adults. There are limited data on the prevalence of incidental findings, progression of these findings over time and the relationship with inflammation in antiretroviral therapy (ART)-treated HIV-infected adults. This study utilized data from a randomized clinical trial of rosuvastatin in HIV-infected adults on ART. Incidental findings were reported from chest computed tomography (CT) scans obtained for coronary artery calcium score at entry, week 48 and 96. Markers of immune activation and inflammation were measured concurrently. Poisson regression and generalized estimating equations were used. A total of 147 participants were enrolled. Median age was 46 years, 78% were male, 68% African American and 63% current smokers. At baseline, 57% of participants had at least one incidental lung finding (ILF) and four additional participants had at least one ILF by week 96. At baseline, older age, current smoking, lower nadir CD4+ T-cell count and low-density lipoprotein and higher lipoprotein-associated phospholipase A2 (Lp-PLA2) were independently associated with having a greater number of ILFs. In the longitudinal analyses, older age, lower nadir CD4+ T-cell count and higher baseline soluble tumour necrosis factor α-receptor I (sTNF-RI) were independently associated with having a greater number of ILFs over 96 weeks. Over half of participants had at least one incidental finding on chest CT. Beyond traditional factors of older age and smoking, lower nadir CD4+ T-cell count and higher markers of inflammation were associated with having a greater number of ILFs in HIV-infected adults on ART.

Incidental Findings on Brain MRI: Insight from HUNT MRI - A General Population Study

The aim of the study was to assess the prevalence of incidental findings on brain Magnetic Resonance Imaging (MRI) in a general population of middle aged adults. In addition, the clinical impact, follow up and postoperative outcome resulting from uncovering an incidental finding during a research study were examined. Brain MRI was performed in a general population as part of the Nord-Trondelag Health Study (HUNT), which is a multiphase, multipurpose health study on the inhabitant’s ≥13 years in the county of Nord-Trondelag, Norway. Only standard MRI exclusion criteria were applied to participant selection. In total, 1006 HUNT participants (530 women) between 50 and 66 years were included. The cohort was representative for the population, but participant versus nonparticipant assessment demonstrated a somewhat better health profile of those included in HUNT MRI. Scanning was performed on one 1.5T scanner with a comprehensive scan protocol, all scans were read by two senior neuroradiologists and presence of intracranial findings were evaluated based on patient hospital records and medical history obtained by phone interview. The prevalence of incidental findings on brain MRI was 29% and 15% of the relatively healthy, middle aged adults participating in HUNT MRI were referred to some type of follow-up. Acquired and developmental cerebrovascular pathologies (silent infarctions, excessive white matter hyperintensities relative to age, aneurysms, occlusion/stenosis of arteries, arteriovenous malformation, and cavernous hemangioma) were most common, followed by extra- and intra-axial brain tumors (meningioma, pituitary tumors, glioma or vestibular schwannoma). Intracranial intervention was performed 1.4% of the cohort with one postoperative deficit, giving a prevalence of 0.1% for a postoperative neurological deficit as a result of brain MRI in a research setting. Based on the HUNT MRI cohort, about 1 in 7 middle aged participants from the general population will require clinical follow up if undergoing brain MRI scanning in a research setting. Unrecognized excessive white matter hyperintensities and silent strokes were frequent findings, and demonstrate a significant potential for different types of measures aimed at preventing and/or ameliorating unidentified arteriosclerotic disease to maintain brain health in even quite healthy middle ages adults.

Incidental Findings on Cone Beam Computed Tomography Studies outside of the Maxillofacial Skeleton.

Objective. To define the presence and prevalence of incidental findings in and around the base of skull from large field-of-view CBCT of the maxillofacial region and to determine their clinical importance. Methods. Four hundred consecutive large fields of view CBCT scans viewed from January 1, 2007, to January 1, 2014, were retrospectively evaluated for incidental findings of the cervical vertebrae and surrounding structures. Findings were categorized into cervical vertebrae, intracranial, soft tissue, airway, carotid artery, lymph node, and skull base findings. Results. A total of 653 incidental findings were identified in 309 of the 400 CBCT scans. The most prevalent incidental findings were soft tissue calcifications (29.71%), followed by intracranial calcifications (27.11%), cervical vertebrae (20.06%), airway (11.49%), external carotid artery calcification (10.41%), lymph node calcification (0.77%), subcutaneous tissue calcification and calcified tendonitis of the longus colli muscle (0.3%), and skull base finding (0.15%). A significant portion of the incidental findings (31.24%) required referral, 17.76% required monitoring, and 51% did not require either. Conclusion. A comprehensive review of the CBCT images beyond the region of interest, especially incidental findings in the base of skull, cervical vertebrae, pharyngeal airway, and soft tissue, is necessary to avoid overlooking clinically significant lesions.

P7. Prospective analysis on brain Magnetic Resonance Imaging in children

Previous studies have addressed the prevalence of incidental findings in adult populations. There are few studies following paediatric patients, most of data were retrieved retrospectively. We conducted a prospective study to determine the prevalence of incidental, pathologic and normal findings in a symptomatic paediatric population. The subjects of this prospective single centre study are 436 children aged 0–18 years with clinical symptoms and subsequent first brain MRI. Normal, incidental as well as pathologic MRI findings are documented in association with age, gender, neurological examination and previous investigations (CCT, EEG). Secondary outcome parameters are defined as MRI results and their implications. Two board-certified radiologists prospectively analysed MR images without knowing the result from each other. The 436 patients with brain MRI were categorised into three groups as follows: 155 (35.5%) patients had normal findings, 163 (37.4%) had incidental findings and 118 (27.1%) had pathological findings in brain MRI. When adding patients with pathologic and incidental findings we report even more (47.9%). We analysed the correlation between neurologic examination and MRI result and it was significant ( p -value 0.0008). The p -value for concordance of both radiology reports was To our knowledge this is the first prospective paediatric study reporting the incidence of normal, pathologic and incidental findings in brain MRI in symptomatic children. Incidental findings are common in paediatric patients but we report the highest prevalence. Our data may help guiding management decision in a consistent and clinically appropriate manner.

Performance of a low-dose computed tomography (LDCT) lung cancer screening program: Findings from a registry study.

304 Background: Many centers are establishing LDCT lung cancer screening programs after the 2013 grade B recommendation from the United States Preventive Services Task Force (USPSTF). Uncertainty remains regarding the extent to which new programs will adhere to recommended selection criteria, as well as screening program performance. We analyzed adherence to selection criteria, rate of positive screens, and prevalence of incidental findings in a single-center LDCT screening registry study. Methods: We established a prospective, longitudinal registry study of patients undergoing LDCT screening at the Seattle Cancer Care Alliance. Baseline data include socio-demographic characteristics and eligibility for LDCT screening. We conduct chart reviews at 6 and 12 months to determine screening results (based on NLST definitions); lung cancer diagnosis; and incidental findings. Results: From August 2012 to April 2014, 62 out of 105 (59%) screened patients enrolled in the registry. Mean age is 62 years; 38 (61%) are male; 52 (84%) are white; mean household income is $97,363; 31 (50%) are current smokers; and 39 (63%) have a smoking history ≥ 30 pack-years. A total of 28 (45%), 31 (50%), and 31 (50%) of patients were eligible for screening based on criteria used in the NLST or recommended by the NCCN or USPSTF guidelines, respectively. Sixteen patients (26%) were not eligible for screening based on any of these criteria. For fourteen (88%) of these patients, LDCT screening was ordered by a primary care provider as opposed to a lung cancer specialist. Initial screening results were positive in 7 (13%) patients, with 1 patient diagnosed with lung cancer. At least one incidental finding was reported in 40 (74%) patients, including cardiac and pulmonary abnormalities in 28 (70%) and 25 (63%) patients. Conclusions: About one quarter of patients undergoing LDCT screening do not meet recommended criteria, with primary care providers most commonly ordering the LDCT screen for these patients. Primary care provider education may improve adherence to screening guidelines. Incidental findings were more frequently reported than in the NLST; their impact on healthcare outcomes and costs deserves further investigation.

Incidental Findings on Magnetic Resonance Imaging of the Spine in the Asymptomatic Pediatric Population: A Systematic Review

Study Design Systematic review. Clinical Question What is the prevalence of incidental magnetic resonance imaging (MRI) findings of the spine in asymptomatic pediatric patients? Methods Electronic databases and reference lists of key articles were searched up to December 15, 2013, to identify studies reporting the incidence or prevalence of incidental findings on MRI in asymptomatic pediatric patients. Athletes or children with a known history of trauma, infection, or congenital abnormalities were excluded. Results Seven publications, one prospective cohort, and six cross-sectional studies met the inclusion criteria. The most commonly reported findings on MRI were disc-related and included degenerative disc disease (seven studies, prevalence 19.6%), disc herniation/protrusion (four studies, 2.9%), disc height/narrowed disc space (two studies, 33.7%), and endplate changes (two studies, 5.3%). Other disc-related findings, reported by one study each, included bulging disc, abnormal nucleus shape, annular tear, high intensity zone, and nerve root compression, with prevalences ranging from 4.5 to 51.6%. Spondylolisthesis and spondylolysis were reported by one study each with a prevalence of 2.3 and 0%, respectively. Other findings reported included tumors and infections (one study, 0% for both) and Scheuermann-type changes (one study, 7.7%). Conclusions The prevalence of positive MRI findings in the asymptomatic pediatric population is higher than previously assumed, particularly in regard to disc morphology, highlighting the importance of correlating the history and physical examination to the MRI findings to avoid misdiagnosis or over-treatment in the pediatric population.

Incidental findings on cardiac computed tomography in incident hemodialysis patients: the predictors of arrhythmic and cardiovascular events in end-stage renal disease (PACE) study.

BackgroundThis is the first study that has examined non-cardiac incidental findings in research cardiac computed tomography (CT) of hemodialysis patients and their relationship with patient characteristics.MethodsWe performed a cross-sectional analysis in the Predictors of Arrhythmic and Cardiovascular Events in End-Stage Renal Disease (PACE) study, a prospective cohort study on incident hemodialysis patients. Non-cardiac structures in the cardiac CT scan were reviewed and evaluated. The type and frequencies of non-cardiac incidental CT findings were summarized. Univariate and multivariate logistic regression were performed to analyze the associations between gender, older age, obesity, history of cardiovascular disease (CVD), smoking status, history of chronic pulmonary disease and history of cancer with presence of any incidental CT findings and, separately, pulmonary nodules.ResultsAmong the 260 participants, a total of 229 non-cardiac incidental findings were observed in 145 participants (55.8% of all participants). Of these findings, pulmonary nodules were the most common incidental finding (24.2% of all findings), and 41.3% of them requiring further follow-up imaging per radiology recommendation. Vascular and gastrointestinal findings occurred in 11.8% and 15.3% of participants, respectively. Participants 65 years or older had a higher odds of any incidental findings (Odds Ratio (OR) =2.55; 95% Confidence Intervals (CI) 1.30, 4.99) and pulmonary nodules (OR = 4.80; 95% CI 2.51, 9.18). Prior history of CVD was independently and significantly associated with any incidental findings (OR = 2.00; 95% CI 1.19, 3.40); but not with the presence of pulmonary nodules.ConclusionsWe demonstrate that the prevalence of incidental findings by cardiac CT scanning is extremely high among patients on hemodialysis. Further investigations to follow-up on the high occurrence of incidental findings during our research study and potentially clinical studies raises important practical, ethical and medico-legal issues that need to be carefully considered in research projects using imaging studies.

The Prevalence of Incidental Findings in Multiple Sclerosis Patients

Incidental findings arising from imaging research have important implications for patient safety. Magnetic resonance imaging is widespread in multiple sclerosis (MS) studies and care, yet the prevalence rate of incidental findings in MS is poorly defined. The absence of such reports in the MS literature suggests that such findings may be deemed inappropriate for documentation in research publications, or possibly, not fully reported at all. We sought to document incidental findings from a study designed to detect features of chronic cerebrospinal venous insufficiency (CCSVI) in MS patients and control subjects. Magnetic resonance images were obtained as part of a prospective study conducted between October 2010 and September 2012. Patients with MS (relapsing-remitting, primary progressive, secondary progressive), clinically isolated syndromes, and neuromyelitis optica and age/sex-matched healthy controls were included. All images were reviewed by neuro-radiologists for quality-control purposes. Magnetic resonance imaging was successfully obtained in 166 participants (110 patients, 56 controls). Incidental abnormalities (n = 33) were detected in 15% of patients (n = 17) and 27% of controls (n = 15), comprising 19% overall (n = 32). The prevalence of incidental findings from the MS population was not significantly different from the control population. However, the overall prevalence was high and warrants a careful management strategy for future imaging studies.

Incidental findings on computed tomographic scans in patients with head trauma in Ilorin, Nigeria

Background/aims: The focus of computed tomography (CT) examination in patients with suspected traumatic brain injury (TBI) is to assess the damage to cranial structures as a result of trauma; however, sometimes findings unrelated to the chief complaint and not pertinent to the immediate patient care are discovered. These findings are classified as incidental findings. The aim of the study is to determine the prevalence of incidental findings discovered during CT examinations in patients with suspected TBI in our environment. Materials and Methods: A retrospective study of 551 patients with TBI, referred for CT examination at the Radiology Department of the University of Ilorin Teaching Hospital (UITH), Ilorin from January 2009-2013. Any non-traumatic findings on CT scan or findings that were not related to the chief complaint were considered incidental findings. Results: Incidental findings were seen in 19 (3.4%) patients, 12 (2.2%) males and 7 (1.2%) females. Enlarged cisterna magna was the commonest finding occurring in 5 (0.9%) patients. Meningiomas were the commonest incidental brain tumor found in 3 (0.54%) patients. Other incidental lesions include lacunar infarcts, arachnoid cyst, neuroglial cyst, and osseous lesions. Conclusion: Clinically serious incidental findings were mainly brain tumors. Visual abnormalities resulting from an incidental suprasellar meningioma may actually predispose to TBI as the patient was found to be responsible for the road traffic accident in which the head injury was sustained. However, larger studies involving many centers may be needed to correlate the role of serious incidental findings vis a vis predisposition to road traffic accidents.

Incidental findings on brain MR imaging in older community-dwelling subjects are common but serious medical consequences are rare: a cohort study.

ObjectivesIncidental findings in neuroimaging occur in 3% of volunteers. Most data come from young subjects. Data on their occurrence in older subjects and their medical, lifestyle and financial consequences are lacking. We determined the prevalence and medical consequences of incidental findings found in community-dwelling older subjects on brain magnetic resonance imaging.DesignProspective cohort observational study.SettingSingle centre study with input from secondary care.ParticipantsLothian Birth Cohort 1936, a study of cognitive ageing.Main Outcome MeasuresIncidental findings identified by two consultant neuroradiologists on structural brain magnetic resonance imaging at age 73 years; resulting medical referrals and interventions.Primary and Secondary Outcome MeasuresPrevalence of incidental findings by individual categories: neoplasms, cysts, vascular lesions, developmental, ear, nose or throat anomalies, by intra- and extracranial location; visual rating of white matter hyperintensities and brain atrophy.ResultsThere were 281 incidental findings in 223 (32%) of 700 subjects, including 14 intra- or extracranial neoplasms (2%), 15 intracranial vascular anomalies (2%), and 137 infarcts or haemorrhages (20%). Additionally, 153 had moderate/severe deep white matter hyperintensities (22%) and 176 had cerebral atrophy at, or above, the upper limit of normal (25%) compared with a normative population template. The incidental findings were unrelated to white matter hyperintensities or atrophy; about a third of subjects had both incidental findings and moderate or severe WMH and a quarter had incidental findings and atrophy. The incidental findings resulted in one urgent and nine non-urgent referrals for further medical assessment, but ultimately in no new treatments.ConclusionsIn community-dwelling older subjects, incidental findings, including white matter hyperintensities and atrophy, were common. However, many findings were not of medical importance and, in this age group, most did not result in further assessment and none in change of treatment.