Extraspinal findings prevalence and clinical significance in 4250 lumbar spine MRI exams

Abstract

To assess extraspinal findings (ESFs) prevalence in lumbar spine MRI, including clinically significant findings using a systematic approach, and to determine their reporting rate. Lumbar spine MRI scans were retrospectively reviewed over 18 months by two radiologists. Reading discrepancies were resolved by consensus. ESFs were classified according to the involved system, clinical diagnosis, and clinical significance. The reporting rate was estimated by referring to the original report. There were 1509 ESFs in 1322/4250 patients with a substantial agreement between the two radiologists (kappa = 0.8). Almost half (621/1322) were in the 45–60 age group. Females represented 56.6% (748/1322). 74.2% (1120/1509) of the ESFs involved the urinary system among which 79.6% (892/1120) were renal cysts. Clinically significant findings represented 8.7% (131/1509) among which hydronephrosis represented 23% (30/131). First time detected malignant lesions represented 4.6% (6/131). ESFs reporting rate was 47.3%. 58.8% of the clinically significant ESFs were not reported. ESFs prevalence was 31.1%. The Urinary system was the most commonly involved. Most ESFs were benign warranting no further workup. However, clinically significant ESF were not infrequently detected. More than half of the clinically significant findings were not reported. A systematic review of MRI images is highly recommended to improve patient’s outcome.

Readability of extraspinal organs on scout images of lumbar spine MRI according to different protocols

“…Scout images are an integral part of MRI for appropriate localization of regions of interest. Medico-legal and ethical debates continue as to whether scout images should be a standard part of imaging interpretation due to limited image quality [1,[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][19][20][21].…”

“…Several previous studies documented incidental extraspinal findings on lumbar spine MRI including scout images, even though they did not distinguish the prevalence of incidental extraspinal findings on between the uncropped routine sequences and scout images [ 1 , 3 , 12 , 13 , 16 ]. Wagner et al [ 1 ] noted that four cases of occult malignancies and one case of occult metastatic disease detected on coronal scout images.…”

“…Several previous studies have documented incidental findings on MRI scout images of various organs [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Although most incidental findings are benign and asymptomatic, some may be related to clinically significant diseases including malignant tumors [3,4,6,[9][10][11][12][13][14][15][16]. However, the image sequence, composition, and quality of scout images differ depending on the manufacturer or institutions because they are obtained at the discretion of technologists or with the default setting of MRI without a standard protocol.…”

Hallazgos extrarraquídeos en la realización de informes de resonancia magnética de la columna

“…Los hallazgos extrarraquídeos más frecuentes de la CD se enumeran en la tabla 3 (Figs. [7][8][9][10][11][12][13].…”

“…El conocimiento previo de la existencia de un hallazgo extrarraquídeo puede colaborar en: un tratamiento determinado, la instauración de una técnica quirúrgica específica o decidir mantener una conducta expectante. No existe un criterio de uniformidad para clasificar los hallazgos extrarraquídeos mediante RM; algunos trabajos de cohorte emplean la clasificación para hallazgos extracolónicos en la colonoscopia virtual mediante TC, conocido como C-RADS (Colonography Reporting and Data System) (Tabla 1) 6,9-11 , mientras que otros desalientan su implementación 7 .…”