Incidence and evaluation of incidental abnormal bone marrow signal on magnetic resonance imaging
Gunjan L Shah1, Aaron S Rosenberg2, Jamie Jarboe3
1Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, P.O. Box 298, New York, NY 10065, USA.
Purpose:
The increased use of magnetic resonance imaging (MRI) has resulted in reports of incidental abnormal bone marrow (BM) signal. Our goal was to determine the evaluation of an incidental abnormal BM signal on MRI and the prevalence of a subsequent oncologic diagnosis.
Methods:
We conducted a retrospective cohort study of patients over age 18 undergoing MRI between May 2005 and October 2010 at Tufts Medical Center (TMC) with follow-up through November 2013. The electronic medical record was queried to determine imaging site, reason for scan, evaluation following radiology report, and final diagnosis.
Results:
49,678 MRIs were done with 110 patients meeting inclusion criteria. Twenty two percent underwent some evaluation, most commonly a complete blood count, serum protein electrophoresis, or bone scan. With median follow-up of 41 months, 6% of patients were diagnosed with malignancies including multiple myeloma, non-Hodgkins lymphoma, metastatic non-small cell lung cancer, and metastatic adenocarcinoma. One patient who had not undergone evaluation developed breast cancer 24 months after the MRI.
Conclusions:
Incidentally noted abnormal or heterogeneous bone marrow signal on MRI was not inconsequential and should prompt further evaluation.
Insights
Incidental abnormal bone marrow (BM) signals on MRI scans are significant. Further medical evaluation is recommended due to a notable prevalence of subsequent oncologic diagnoses in patients with these findings.
Area of Science:
- Radiology
- Oncology
- Hematology
Background:
- Magnetic resonance imaging (MRI) is increasingly used, leading to more incidental findings.
- Abnormal bone marrow (BM) signal on MRI can be detected incidentally.
Purpose of the Study:
- To evaluate the follow-up care for incidental abnormal bone marrow (BM) signals on MRI.
- To determine the incidence of subsequent oncologic diagnoses in patients with incidental abnormal BM signals.
Main Methods:
- Retrospective cohort study of patients over 18 years old who underwent MRI.
- Data collected from electronic medical records, including imaging site, scan reason, evaluation, and diagnosis.
- Follow-up conducted through November 2013.
Main Results:
- 110 patients met inclusion criteria from 49,678 MRIs.
- Only 22% of patients received further evaluation, commonly blood tests or bone scans.
- 6% of patients were diagnosed with malignancies, including multiple myeloma and lymphoma, within a median follow-up of 41 months.
Conclusions:
- Incidental abnormal or heterogeneous bone marrow (BM) signal on MRI is clinically significant.
- These findings warrant further medical investigation to rule out serious conditions.
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