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Extra-spinal incidental findings at lumbar spine MRI in the general population: a large cohort study
Carlo Cosimo Quattrocchi1, Alessandro Giona, Alberto Corrado Di Martino
1Diagnostic Imaging, Università Campus Bio-Medico di Roma, via Alvaro del Portillo, 21, 00128, Rome, Italy, c.quattrocchi@unicampus.it.
Objective:
To determine the prevalence of clinically and non-clinically relevant extra-spinal incidental findings (IF) in patients undergoing magnetic resonance imaging (MRI) of the lumbar spine and to evaluate the rate of undetected findings in archived radiological reports.
Methods:
A retrospective search of patients undergoing lumbar spine MRI from January 2006 to December 2010 was conducted. By means of randomisation, we retrospectively reviewed 3,000 lumbar spine MRI examinations. Extra-spinal abnormalities were classified according to a modified CT Colonography Reporting and Data System (C-RADS). We retrospectively compared our structured approach with the archived MRI reports as it regarded the detection of extra-spinal IF to estimate non-detection rates.
Results:
By means of the structured approach used, extra-spinal findings were detected in 2,060 (68.6 %) of the 3,000 lumbar spine MRI examinations; 362 (17.6 %) patients had indeterminate or clinically important findings (E3 and E4) requiring clinical correlation or further evaluation. After review of the original archived radiological reports, potentially important C-RADS E3 and E4 extra-spinal IF were respectively reported in 47 of the 265 (17.7 %) and in 8 of 74 (10.8 %) patients.
Conclusions:
Our study shows that incidental extra-spinal findings at conventional lumbar spine MRI are common but underestimated in radiological reports.
Insights
Incidental extra-spinal findings are common during lumbar spine MRI scans, with many clinically important abnormalities often missed in routine radiological reports. This highlights a need for improved detection and reporting of these unexpected discoveries.
Area of Science:
- Radiology
- Medical Imaging
- Diagnostic Medicine
Background:
- Lumbar spine magnetic resonance imaging (MRI) is frequently performed for spinal conditions.
- Extra-spinal incidental findings (IF) can occur but their prevalence and detection rates are not well-characterized.
- Archived reports may underestimate the significance of these incidental findings.
Purpose of the Study:
- To determine the prevalence of clinically and non-clinically relevant extra-spinal incidental findings (IF) in patients undergoing lumbar spine MRI.
- To evaluate the rate of undetected extra-spinal IF in archived radiological reports.
- To assess the clinical significance of these findings using a standardized classification system.
Main Methods:
- Retrospective review of 3,000 lumbar spine MRI examinations from January 2006 to December 2010.
- Randomized review of MRI examinations to identify extra-spinal abnormalities.
- Classification of abnormalities using a modified CT Colonography Reporting and Data System (C-RADS).
- Comparison of structured review findings with archived radiological reports to determine non-detection rates.
Main Results:
- Extra-spinal findings were detected in 68.6% of lumbar spine MRIs.
- Clinically important findings (C-RADS E3 and E4) were present in 17.6% of patients.
- Potentially important extra-spinal IF (E3 and E4) were reported in only 17.7% and 10.8% of relevant cases, respectively, in archived reports.
Conclusions:
- Incidental extra-spinal findings are highly prevalent in lumbar spine MRI examinations.
- Current radiological reporting underestimates the detection of clinically significant extra-spinal incidental findings.
- Improved structured reporting and review are necessary to ensure adequate detection and clinical correlation of these findings.
