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Published on: December 19, 2019
Incidental findings associated with magnetic resonance imaging of the brachial plexus
Antonia R Perumal1, Ugonna Angel Anyamele1, Rayna K Bhogal1
1Faculty of Medicine and Health Sciences, University of Leeds, Leeds, UK.
Objective:
The identification and management of incidental findings is becoming increasingly problematic, particularly in relation to brachial plexus imaging because the prevalence is unknown. Therefore, we aimed to estimate the prevalence of incidental findings in symptomatic patients undergoing MRI of the brachial plexus.
Methods:
This retrospective cohort study included all children and adults who underwent MRI over a 12-year period, in a tertiary care centre in the UK. An incidental finding was any abnormality which was not a direct injury to or disease-process of the brachial plexus. An "incidentaloma" was defined by the need for further investigation or treatment. Multivariable logistic regression was used to estimate the odds ratio (OR) of an "incidentaloma". To estimate which factors were associated with the incident rate ratio (IRR) of incidental findings, multivariable Poisson regression was used.
Results:
Overall, 502 scans (72%) reported incidental anomalies. Although the number of MRIs performed per annum increased by 23%, the prevalence of "incidentalomas" remained static (p = 0.766). Musculoskeletal incidental findings were the most prevalent (63%) and when identified, there were a median of 3 incidental anomalies per patient. Overall, 125 (18%) anomalies were "incidentalomas" which required further investigation or treatment. The odds of having further investigation or treatment was strongly related to the frequency of incidental findings [adjusted OR 1.16 (95% CI 1.08, 1.24)] and when a tumour was identified [adjusted OR 2.86 (95% CI 1.81, 4.53)]. The number of incidental findings recorded per scan increased when trainees co-reported with consultants [adjusted IRR 0.36 (95% CI 0.05, 0.67)] and in the presence of a tumour [adjusted IRR 0.39 (95% CI 0.28, 0.49)].
Conclusions:
The prevalence of clinically important incidental findings on brachial plexus MRI is lower than organ-specific imaging, but still 18% of scans identified an 'incidentaloma' which required further investigation or treatment.
Advances In Knowledge:
This cohort study shows that approximately 1 in 5 symptomatic patients undergoing a brachial plexus MRI had a clinically important incidental findings, which required further investigation or treatment. This information can be used to inform patients consenting to clinical or research imaging.
Insights
Approximately 18% of brachial plexus MRI scans reveal clinically significant incidental findings requiring further investigation. This prevalence highlights the importance of managing these incidentalomas in patient care and imaging consent processes.
Area of Science:
- Radiology and Medical Imaging
- Neurology
- Musculoskeletal Imaging
Background:
- The increasing use of brachial plexus MRI presents challenges in identifying and managing incidental findings.
- The prevalence of incidental findings in brachial plexus imaging is not well-established, complicating clinical management.
- Incidentalomas, defined by the need for further investigation or treatment, are a growing concern in diagnostic imaging.
Purpose of the Study:
- To estimate the prevalence of incidental findings in symptomatic patients undergoing brachial plexus MRI.
- To identify factors associated with the occurrence and clinical significance of incidental findings.
- To inform patient consent and clinical management strategies for brachial plexus imaging.
Main Methods:
- Retrospective cohort study of 502 patients undergoing brachial plexus MRI over 12 years at a UK tertiary care center.
- Incidental findings were defined as abnormalities unrelated to direct brachial plexus injury or disease.
- Multivariable logistic and Poisson regression analyses were used to determine odds and incident rate ratios.
Main Results:
- 72% of scans reported incidental anomalies, with musculoskeletal findings being the most common (63%).
- 18% of anomalies were classified as "incidentalomas" requiring further investigation or treatment.
- The odds of requiring further investigation were linked to the frequency of incidental findings and tumor identification.
Conclusions:
- Clinically significant incidental findings on brachial plexus MRI occur in 18% of symptomatic patients.
- The prevalence of "incidentalomas" remained static despite an increase in MRI scans performed.
- This data is crucial for patient counseling regarding potential incidental findings during brachial plexus MRI.
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