Incidental findings associated with MRI of the hand and wrist
Megan A Beese1, Prasant Gurung1, Jack A Hall2
1Department of Plastic, Reconstructive and Hand Surgery, Leeds Teaching Hospitals Trust, Leeds, LS1 3EX, United Kingdom.
Objectives:
To identify the prevalence of incidentalomas and incidental findings in symptomatic patients undergoing MRI of the hand or wrist.
Methods:
This retrospective cross-sectional study included all children and adults who completed MRI of the hand or wrist over a 14-year period in a single UK tertiary centre. An incidental finding was any abnormality (structural or signal-based), suspected injury or disease-process that was not already established or suspected. Incidentalomas were defined as incidental findings requiring further investigation or treatment. Marginal standardisation was used to explore relationships between prognostic factors and outcomes.
Results:
Overall, 490 out of 2138 (22.9%) scans contained 1 or more incidental anomalies and 67 (3.1%) had at least 1 incidentaloma. The risk of incidentalomas doubled (risk ratio (RR), 1.93; 95% CI, 1.01 to 3.70) when reported by a trainee and reviewed by a consultant compared to a consultant alone; increased by 12% (RR, 1.12; 95% CI, 0.98 to 1.28) per additional decade of life; and were less likely (RR, 0.34; 95% CI, 0.12 to 0.94) when contrast was used. Three incidentalomas were found to be malignant (3.3%).
Conclusions:
The risk of incidentalomas and incidental findings in MRI of the hand and wrist is lower than solid organs. Our data may be used to inform patients about the risks of imaging and allow health services to plan the capacity and capability to deal with such events.
Advances In Knowledge:
One in 4 hand or wrist MRIs yields an incidental finding and out of these, around 1 in 7 required further action.
Insights
Magnetic Resonance Imaging (MRI) of the hand or wrist reveals incidental findings in about one in four patients. Approximately one in seven of these incidental findings, or incidentalomas, require further medical attention.
Area of Science:
- Radiology
- Medical Imaging
- Musculoskeletal System
Background:
- Incidental findings on medical imaging are common.
- Understanding the prevalence of incidentalomas in hand and wrist MRI is crucial for patient management and healthcare resource planning.
Purpose of the Study:
- To determine the prevalence of incidentalomas and incidental findings in patients undergoing MRI of the hand or wrist.
- To identify factors influencing the occurrence of these findings.
Main Methods:
- Retrospective cross-sectional study of 2138 hand or wrist MRIs over 14 years.
- Defined incidental findings as any unestablished abnormality and incidentalomas as those requiring further investigation.
- Used marginal standardization to analyze prognostic factors.
Main Results:
- 22.9% of scans had incidental anomalies; 3.1% had incidentalomas.
- Incidentaloma risk was higher when reported by trainees versus consultants (RR 1.93) and increased with age.
- Contrast use was associated with lower incidentaloma risk (RR 0.34).
- 3.3% of incidentalomas were malignant.
Conclusions:
- The incidence of incidentalomas and findings in hand/wrist MRI is lower than in solid organs.
- Findings can inform patients about imaging risks and aid health service capacity planning.
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