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Published in: European Radiology 3/2013

01-03-2013 | Magnetic Resonance

Potentially relevant incidental findings on research whole-body MRI in the general adult population: frequencies and management

Authors: Katrin Hegenscheid, Rebecca Seipel, Carsten O. Schmidt, Henry Völzke, Jens-Peter Kühn, Reiner Biffar, Heyo K. Kroemer, Norbert Hosten, Ralf Puls

Published in: European Radiology | Issue 3/2013

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Abstract

Objectives

To report the frequencies of potentially relevant incidental findings in the general adult population and to develop a protocol for their management in whole-body magnetic resonance imaging (wb-MRI).

Methods

A total of 2,500 adult subjects (1,271 women, 1,229 men; mean age 53 years) from the population-based Study of Health in Pomerania underwent standardised wb-MRI. Additionally, 1,129 participants received contrast-enhanced cardiac MRI, 619 men received MR angiography and 544 women received MR mammography. Two independent residents performed first-line reading. A third reader resolved disagreements. An interdisciplinary advisory board decided about disclosure.

Results

There were 1,330 incidental findings of potential clinical relevance in 904 subjects (36.2 %). Nine findings (0.4 %) required immediate referral. In total, 1,052 findings (79.1 %) were confirmed by the advisory board and disclosed to 787 participants (31.5 %). The abdominal organs (6.8 %), the urinary tract (6.8 %) and the skeletal system (6.0 %) were affected most often. While 383 findings (36.4 %) were indicated as benign and 62 (5.9 %) as malignant, most abnormalities, 607 (57.7 %), were of an unclear nature.

Conclusions

Potentially relevant incidental findings are very common in wb-MRI research but the nature of these findings remains unclear in most cases. This requires dedicated management to protect subjects’ welfare and research integrity.

Key Points

Whole-body MRI (wb-MRI) research generates numerous incidental findings.
Potentially relevant incidental findings are found in 32 % of participants.
Some body regions generate many more incidental findings than others.
The nature of incidental findings remains unclear in most cases.
Managing incidental findings by an interdisciplinary voluntary advisory board is feasible.
Appendix
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Literature
1.
go back to reference Hofman A, Breteler M, van Duijn C et al (2007) The Rotterdam Study: objectives and design update. Eur J Epidemiol 22:819–829PubMedCrossRef Hofman A, Breteler M, van Duijn C et al (2007) The Rotterdam Study: objectives and design update. Eur J Epidemiol 22:819–829PubMedCrossRef
2.
go back to reference Turkbey E, McClelland R, Kronmal R et al (2010) The impact of obesity on the left ventricle: the Multi-Ethnic Study of Atherosclerosis (MESA). JACC Cardiovasc Imaging 3:266–274PubMedCrossRef Turkbey E, McClelland R, Kronmal R et al (2010) The impact of obesity on the left ventricle: the Multi-Ethnic Study of Atherosclerosis (MESA). JACC Cardiovasc Imaging 3:266–274PubMedCrossRef
3.
go back to reference Jefferson A, Himali J, Beiser A et al (2010) Cardiac index is associated with brain aging: the Framingham Heart Study. Circulation 122:690–697PubMedCrossRef Jefferson A, Himali J, Beiser A et al (2010) Cardiac index is associated with brain aging: the Framingham Heart Study. Circulation 122:690–697PubMedCrossRef
4.
go back to reference Qiu C, Cotch MF, Sigurdsson S et al (2010) Cerebral microbleeds, retinopathy, and dementia: the AGES-Reykjavik Study. Neurology 75:2221–2228PubMedCrossRef Qiu C, Cotch MF, Sigurdsson S et al (2010) Cerebral microbleeds, retinopathy, and dementia: the AGES-Reykjavik Study. Neurology 75:2221–2228PubMedCrossRef
5.
go back to reference Booth TC, Jackson A, Wardlaw JM, Taylor SA, Waldman AD (2010) Incidental findings found in “healthy” volunteers during imaging performed for research: current legal and ethical implications. Br J Radiol 83:456–465PubMedCrossRef Booth TC, Jackson A, Wardlaw JM, Taylor SA, Waldman AD (2010) Incidental findings found in “healthy” volunteers during imaging performed for research: current legal and ethical implications. Br J Radiol 83:456–465PubMedCrossRef
6.
go back to reference Vernooij M, Ikram M, Tanghe H et al (2007) Incidental findings on brain MRI in the general population. N Engl J Med 357:1821–1828PubMedCrossRef Vernooij M, Ikram M, Tanghe H et al (2007) Incidental findings on brain MRI in the general population. N Engl J Med 357:1821–1828PubMedCrossRef
7.
go back to reference Yue N, Elster A, Jungreis C, O’Leary D, Poirier V (1997) Clinically serious abnormalities found incidentally at MR imaging of the brain: data from the Cardiovascular Health Study. Radiology 202:41–46PubMed Yue N, Elster A, Jungreis C, O’Leary D, Poirier V (1997) Clinically serious abnormalities found incidentally at MR imaging of the brain: data from the Cardiovascular Health Study. Radiology 202:41–46PubMed
8.
go back to reference Katzman G, Dagher A, Patronas N (1999) Incidental findings on brain magnetic resonance imaging from 1000 asymptomatic volunteers. JAMA 282:36–39PubMedCrossRef Katzman G, Dagher A, Patronas N (1999) Incidental findings on brain magnetic resonance imaging from 1000 asymptomatic volunteers. JAMA 282:36–39PubMedCrossRef
9.
go back to reference Wolf SM, Lawrenz FP, Nelson CA et al (2008) Managing incidental findings in human subjects research: analysis and recommendations. J Law Med Ethics 36:211 Wolf SM, Lawrenz FP, Nelson CA et al (2008) Managing incidental findings in human subjects research: analysis and recommendations. J Law Med Ethics 36:211
10.
go back to reference Illes J, Kirschen MP, Edwards E et al (2008) Practical approaches to incidental findings in brain imaging research. Neurology 70:384–390PubMedCrossRef Illes J, Kirschen MP, Edwards E et al (2008) Practical approaches to incidental findings in brain imaging research. Neurology 70:384–390PubMedCrossRef
11.
go back to reference Booth TC, Waldman AD, Wardlaw JM, Taylor SA, Jackson A (2011) Management of incidental findings during imaging research in “healthy” volunteers: current UK practice. Br J Radiol 85:11–21PubMedCrossRef Booth TC, Waldman AD, Wardlaw JM, Taylor SA, Jackson A (2011) Management of incidental findings during imaging research in “healthy” volunteers: current UK practice. Br J Radiol 85:11–21PubMedCrossRef
12.
go back to reference Fenchel M, Requardt M, Tomaschko K et al (2005) Whole-body MR angiography using a novel 32-receiving-channel MR system with surface coil technology: first clinical experience. J Magn Reson Imaging 21:596–603PubMedCrossRef Fenchel M, Requardt M, Tomaschko K et al (2005) Whole-body MR angiography using a novel 32-receiving-channel MR system with surface coil technology: first clinical experience. J Magn Reson Imaging 21:596–603PubMedCrossRef
13.
go back to reference Schmidt G, Baur-Melnyk A, Herzog P (2005) High-resolution whole-body magnetic resonance image tumor staging with the use of parallel imaging versus dual-modality positron emission tomography-computed tomography: experience on a 32-channel system. Invest Radiol 40:743–753PubMedCrossRef Schmidt G, Baur-Melnyk A, Herzog P (2005) High-resolution whole-body magnetic resonance image tumor staging with the use of parallel imaging versus dual-modality positron emission tomography-computed tomography: experience on a 32-channel system. Invest Radiol 40:743–753PubMedCrossRef
15.
go back to reference Thomson V, Pialat J-B, Gay F et al (2008) Whole-body MRI for metastases screening: a preliminary study using 3D VIBE sequences with automatic subtraction between noncontrast and contrast enhanced images. Am J Clin Oncol 31:285–292PubMedCrossRef Thomson V, Pialat J-B, Gay F et al (2008) Whole-body MRI for metastases screening: a preliminary study using 3D VIBE sequences with automatic subtraction between noncontrast and contrast enhanced images. Am J Clin Oncol 31:285–292PubMedCrossRef
16.
go back to reference Völzke H, Alte D, Schmidt CO et al (2011) Cohort profile: the study of health in Pomerania. Int J Epidemiol 40:294–307PubMedCrossRef Völzke H, Alte D, Schmidt CO et al (2011) Cohort profile: the study of health in Pomerania. Int J Epidemiol 40:294–307PubMedCrossRef
17.
go back to reference Hegenscheid K, Kühn JP, Völzke H, Biffar R, Hosten N, Puls R (2009) Whole-body magnetic resonance imaging of healthy volunteers: pilot study results from the population-based SHIP study. Rofo 181:748–759PubMedCrossRef Hegenscheid K, Kühn JP, Völzke H, Biffar R, Hosten N, Puls R (2009) Whole-body magnetic resonance imaging of healthy volunteers: pilot study results from the population-based SHIP study. Rofo 181:748–759PubMedCrossRef
18.
19.
go back to reference American College of Radiology (2003) Breast Imaging-Reporting and Data System (BI-RADS) MRI atlas, 1st edn. American College of Radiology, Reston American College of Radiology (2003) Breast Imaging-Reporting and Data System (BI-RADS) MRI atlas, 1st edn. American College of Radiology, Reston
20.
go back to reference Gluecker TM, Johnson CD, Wilson LA et al (2003) Extracolonic findings at CT colonography: evaluation of prevalence and cost in a screening population. Gastroenterology 124:911–916PubMedCrossRef Gluecker TM, Johnson CD, Wilson LA et al (2003) Extracolonic findings at CT colonography: evaluation of prevalence and cost in a screening population. Gastroenterology 124:911–916PubMedCrossRef
21.
go back to reference Kim DH, Pickhardt PJ, Taylor AJ et al (2007) CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med 357:1403–1412PubMedCrossRef Kim DH, Pickhardt PJ, Taylor AJ et al (2007) CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med 357:1403–1412PubMedCrossRef
22.
go back to reference Pickhardt P, Choi J, Hwang I et al (2003) Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 349:2191–2200PubMedCrossRef Pickhardt P, Choi J, Hwang I et al (2003) Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 349:2191–2200PubMedCrossRef
23.
go back to reference Yee J, Kumar NN, Godara S et al (2005) Extracolonic abnormalities discovered incidentally at CT colonography in a male population. Radiology 236:519–526PubMedCrossRef Yee J, Kumar NN, Godara S et al (2005) Extracolonic abnormalities discovered incidentally at CT colonography in a male population. Radiology 236:519–526PubMedCrossRef
24.
go back to reference Zalis ME, Barish MA, Choi JR et al (2005) CT colonography reporting and data system: a consensus proposal. Radiology 236:3–9PubMedCrossRef Zalis ME, Barish MA, Choi JR et al (2005) CT colonography reporting and data system: a consensus proposal. Radiology 236:3–9PubMedCrossRef
25.
go back to reference Illes J, Kirschen M, Karetsky K, Kelly M, Saha A, Desmond J, Raffin T, Glover G, Atlas S (2004) Discovery and disclosure of incidental findings in neuroimaging research. J Magn Reson Imaging 20:743–747PubMedCrossRef Illes J, Kirschen M, Karetsky K, Kelly M, Saha A, Desmond J, Raffin T, Glover G, Atlas S (2004) Discovery and disclosure of incidental findings in neuroimaging research. J Magn Reson Imaging 20:743–747PubMedCrossRef
26.
go back to reference Illes J, Kirschen M, Edwards E et al (2006) Ethics. Incidental findings in brain imaging research. Science 311:783–784PubMedCrossRef Illes J, Kirschen M, Edwards E et al (2006) Ethics. Incidental findings in brain imaging research. Science 311:783–784PubMedCrossRef
27.
go back to reference Kim B, Illes J, Kaplan R, Reiss A, Atlas S (2002) Incidental findings on pediatric MR images of the brain. AJNR Am J Neuroradiol 23:1674–1677PubMed Kim B, Illes J, Kaplan R, Reiss A, Atlas S (2002) Incidental findings on pediatric MR images of the brain. AJNR Am J Neuroradiol 23:1674–1677PubMed
28.
go back to reference Kumra S, Ashtari M, Britt Anderson B et al (2006) Ethical and practical considerations in the management of incidental findings in pediatric MRI studies. J Am Acad Child Adolesc Psychiatry 45:1000–1006PubMedCrossRef Kumra S, Ashtari M, Britt Anderson B et al (2006) Ethical and practical considerations in the management of incidental findings in pediatric MRI studies. J Am Acad Child Adolesc Psychiatry 45:1000–1006PubMedCrossRef
29.
go back to reference Furtado CD, Aguirre DA, Sirlin CB et al (2005) Whole-body CT screening: spectrum of findings and recommendations in 1192 patients. Radiology 237:385–394PubMedCrossRef Furtado CD, Aguirre DA, Sirlin CB et al (2005) Whole-body CT screening: spectrum of findings and recommendations in 1192 patients. Radiology 237:385–394PubMedCrossRef
30.
go back to reference Morin SHX, Cobbold JFL, Lim AKP et al (2009) Incidental findings in healthy control research subjects using whole-body MRI. Eur J Radiol 72:529–533PubMedCrossRef Morin SHX, Cobbold JFL, Lim AKP et al (2009) Incidental findings in healthy control research subjects using whole-body MRI. Eur J Radiol 72:529–533PubMedCrossRef
31.
go back to reference Schmidt GP, Schoenberg SO, Schmid R et al (2007) Screening for bone metastases: whole-body MRI using a 32-channel system versus dual-modality PET-CT. Eur Radiol 17:939–949PubMedCrossRef Schmidt GP, Schoenberg SO, Schmid R et al (2007) Screening for bone metastases: whole-body MRI using a 32-channel system versus dual-modality PET-CT. Eur Radiol 17:939–949PubMedCrossRef
32.
go back to reference Regier M, Schwarz D, Henes FO (2011) Diffusion-weighted MR-imaging for the detection of pulmonary nodules at 1.5 Tesla: intraindividual comparison with multidetector computed tomography. J Med Imaging Radiat Oncol 55:266–274PubMedCrossRef Regier M, Schwarz D, Henes FO (2011) Diffusion-weighted MR-imaging for the detection of pulmonary nodules at 1.5 Tesla: intraindividual comparison with multidetector computed tomography. J Med Imaging Radiat Oncol 55:266–274PubMedCrossRef
33.
go back to reference Ladd S, Debatin J, Stang A et al (2007) Whole-body MR vascular screening detects unsuspected concomitant vascular disease in coronary heart disease patients. Eur Radiol 17:1035–1045PubMedCrossRef Ladd S, Debatin J, Stang A et al (2007) Whole-body MR vascular screening detects unsuspected concomitant vascular disease in coronary heart disease patients. Eur Radiol 17:1035–1045PubMedCrossRef
34.
go back to reference Jhaveri KS, Wong F, Ghai S, Haider MA (2006) Comparison of CT histogram analysis and chemical shift MRI in the characterization of indeterminate adrenal nodules. AJR Am J Roentgenol 187:1303–1308PubMedCrossRef Jhaveri KS, Wong F, Ghai S, Haider MA (2006) Comparison of CT histogram analysis and chemical shift MRI in the characterization of indeterminate adrenal nodules. AJR Am J Roentgenol 187:1303–1308PubMedCrossRef
35.
go back to reference Kuhl C (2007) The current status of breast MR imaging. Part I. Choice of technique, image interpretation, diagnostic accuracy, and transfer to clinical practice. Radiology 244:356–378PubMedCrossRef Kuhl C (2007) The current status of breast MR imaging. Part I. Choice of technique, image interpretation, diagnostic accuracy, and transfer to clinical practice. Radiology 244:356–378PubMedCrossRef
36.
go back to reference Kuhl CK, Mielcareck P, Klaschik S et al (1999) Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions? Radiology 211:101–110PubMed Kuhl CK, Mielcareck P, Klaschik S et al (1999) Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions? Radiology 211:101–110PubMed
37.
go back to reference Runge VM (2000) Safety of approved MR contrast media for intravenous injection. J Magn Reson Imaging 12:205–213PubMedCrossRef Runge VM (2000) Safety of approved MR contrast media for intravenous injection. J Magn Reson Imaging 12:205–213PubMedCrossRef
38.
go back to reference Council of Europe Steering Committee on Bioethics (2004) Additional protocol to the convention on human rights and biomedicine concerning biomedical research. Council of Europe Steering Committee on Bioethics, Strasbourg. Available via http://conventions.coe.int. Accessed 20 April 2012 Council of Europe Steering Committee on Bioethics (2004) Additional protocol to the convention on human rights and biomedicine concerning biomedical research. Council of Europe Steering Committee on Bioethics, Strasbourg. Available via http://​conventions.​coe.​int. Accessed 20 April 2012
39.
go back to reference Sweeney JP, Thornhill JA, Graiger R, McDermott TE, Butler MR (1996) Incidentally detected renal cell carcinoma: pathological features, survival trends and implications for treatment. Br J Urol 78:351–353PubMedCrossRef Sweeney JP, Thornhill JA, Graiger R, McDermott TE, Butler MR (1996) Incidentally detected renal cell carcinoma: pathological features, survival trends and implications for treatment. Br J Urol 78:351–353PubMedCrossRef
40.
go back to reference Kleinschmidt A (2007) Incidental neuroimaging findings: lessons from brain research in volunteers. Curr Opin Neurol 20:387–389PubMedCrossRef Kleinschmidt A (2007) Incidental neuroimaging findings: lessons from brain research in volunteers. Curr Opin Neurol 20:387–389PubMedCrossRef
41.
go back to reference Royal JM, Peterson BS (2008) The risks and benefits of searching for incidental findings in MRI research scans. J Law Med Ethics 36:305–314, 212PubMedCrossRef Royal JM, Peterson BS (2008) The risks and benefits of searching for incidental findings in MRI research scans. J Law Med Ethics 36:305–314, 212PubMedCrossRef
42.
go back to reference Orme N, Fletcher J, Siddiki H et al (2010) Incidental findings in imaging research: evaluating incidence, benefit, and burden. Arch Intern Med 170:1525–1532PubMedCrossRef Orme N, Fletcher J, Siddiki H et al (2010) Incidental findings in imaging research: evaluating incidence, benefit, and burden. Arch Intern Med 170:1525–1532PubMedCrossRef
43.
go back to reference Kirschen M, Jaworska A, Illes J (2006) Subjects’ expectations in neuroimaging research. J Magn Reson Imaging 23:205–209PubMedCrossRef Kirschen M, Jaworska A, Illes J (2006) Subjects’ expectations in neuroimaging research. J Magn Reson Imaging 23:205–209PubMedCrossRef
44.
go back to reference Quaid KA (1993) Psychological and ethical considerations in screening for disease. Am J Cardiol 72:64D–67DPubMedCrossRef Quaid KA (1993) Psychological and ethical considerations in screening for disease. Am J Cardiol 72:64D–67DPubMedCrossRef
45.
go back to reference Clayton EW (2008) Incidental findings in genetics research using archived DNA. J Law Med Ethics 36:212CrossRef Clayton EW (2008) Incidental findings in genetics research using archived DNA. J Law Med Ethics 36:212CrossRef
46.
go back to reference Clayton EW (2003) Ethical, legal, and social implications of genomic medicine. N Engl J Med 349:562–569PubMedCrossRef Clayton EW (2003) Ethical, legal, and social implications of genomic medicine. N Engl J Med 349:562–569PubMedCrossRef
Metadata
Title
Potentially relevant incidental findings on research whole-body MRI in the general adult population: frequencies and management
Authors
Katrin Hegenscheid
Rebecca Seipel
Carsten O. Schmidt
Henry Völzke
Jens-Peter Kühn
Reiner Biffar
Heyo K. Kroemer
Norbert Hosten
Ralf Puls
Publication date
01-03-2013
Publisher
Springer-Verlag
Published in
European Radiology / Issue 3/2013
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-012-2636-6

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