Incidental extracardiac findings on cardiac MR: Systematic review and meta-analysis

Dunet, Vincent; Schwitter, Juerg; Meuli, Reto

doi:10.1002/jmri.25053

Cited by 27 publications

(16 citation statements)

References 22 publications

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“…We included 20 systematic reviews from 7098 references identified from our database search (fig 1). 7 8 9 28 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 These 20 systematic reviews included 240 primary studies and 627 073 patients. Fifteen systematic reviews provided data to quantify the prevalence of detecting incidentalomas7 8 9 28 30 31 32 33 34 35 36 37 38 39 45 (table 1), whereas 18 provided data to quantify the outcomes of incidentalomas7 8 9 28 30 31 32 33 34 35 38 39 40 41 42 43 44 45 (table 2) (13 provided both).…”

Section: Resultsmentioning

confidence: 99%

Prevalence and outcomes of incidental imaging findings: umbrella review

O’Sullivan

Muntinga

Grigg

et al. 2018

BMJ

224

175

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ObjectiveTo provide an overview of the evidence on prevalence and outcomes of incidental imaging findings. DeSiGNUmbrella review of systematic reviews. Data SOurceSSearches of MEDLINE, EMBASE up to August 2017; screening of references in included papers. eliGibility criteria Criteria included systematic reviews and meta-analyses of observational studies that gave a prevalence of incidental abnormalities ("incidentalomas"). An incidental imaging finding was defined as an imaging abnormality in a healthy, asymptomatic patient or an imaging abnormality in a symptomatic patient, where the abnormality was not apparently related to the patient's symptoms. Primary studies that measured the prevalence of incidentalomas in patients with a history of malignancy were also considered in sensitivity analyses. reSultS 20 systematic reviews (240 primary studies) were identified from 7098 references from the database search. Fifteen systematic reviews provided data to quantify the prevalence of incidentalomas, whereas 18 provided data to quantify the outcomes of incidentalomas (13 provided both). The prevalence of incidentalomas varied substantially between imaging tests; it was less than 5% for chest computed tomography for incidental pulmonary embolism in patients with and without cancer and whole body positron emission tomography (PET) or PET/computed tomography (for patients with and without cancer). Conversely, incidentalomas occurred in more than a third of images in cardiac magnetic resonance imaging (MRI), chest computed tomography (for incidentalomas of thorax, abdomen, spine, or heart), and computed tomography colonoscopy (for extracolonic incidentalomas). Intermediate rates occurred with MRI of the spine (22%) and brain (22%). The rate of malignancy in incidentalomas varied substantially between organs; the prevalence of malignancy was less than 5% in incidentalomas of the brain, parotid, and adrenal gland. Extra-colonic, prostatic, and colonic incidentalomas were malignant between 10% and 20% of the time, whereas renal, thyroid, and ovarian incidentalomas were malignant around a quarter of the time. Breast incidentalomas had the highest percentage of malignancy (42%, 95% confidence interval 31% to 54%). Many assessments had high between-study heterogeneity (15 of 20 metaanalyses with I 2 >50%).cONcluSiONS There is large variability across different imaging techniques both in the prevalence of incidentalomas and in the prevalence of malignancy for specific organs. This umbrella review will aid clinicians and patients weigh up the pros and cons of requesting imaging scans and will help with management decisions after an incidentaloma diagnosis. Our results can underpin the creation of guidelines to assist these decisions.

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Section: Resultsmentioning

confidence: 99%

Prevalence and outcomes of incidental imaging findings: umbrella review

O’Sullivan

Muntinga

Grigg

et al. 2018

BMJ

224

175

View full text Add to dashboard Cite

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“…Sohns et al [ 10 ] reported in 234 cMRI studies a slightly higher rate of extracardiac findings (26% of 854 patients), almost comparable with the prevalence in Irwin et al's work [ 9 ] (21.4% of 714 patients). A recent systematic review and meta-analysis of 12 studies including data from 7,062 patients demonstrated pooled prevalence of incidental extracardiac findings of 35% [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Incidental Extracardiac Findings and Their Characterization on Cardiac MRI

Gravina

Stoppino

Casavecchia

et al. 2017

BioMed Research International

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Background Cardiac magnetic resonance imaging (cMRI) has recently emerged as a new noninvasive imaging modality that offers superior structural and functional assessment of the heart. cMRI benefits from a large field of view but, consequently, may capture incidental extracardiac findings (IEFs). We aimed to evaluate the frequency and significance of IEFs reported from clinically indicated cMRI scans. Methods 742 consecutive patients (402 males and 340 females) referred to the Cardiac Magnetic Resonance Center of our University Hospital between January 2015 and December 2016 for clinically indicated cMRI were retrospectively enrolled for the evaluation of IEF prevalence and relevance. The median age of the subjects was 51 years (range: 5–85 years). Results A significant number of patients who underwent cMRI had incidental and clinically significant IEFs (2% of the population, 11.4% of cases). cMRI allowed a correct diagnosis in 116/131 cases with a diagnostic accuracy value of 88.5%. Conclusions IEFs on cMRI are not uncommon and lesions with mild or no clinical significance represent the most frequent findings. cMRI can characterize incidental findings with high accuracy in most cases.

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“…Clinicians and researchers should therefore anticipate incidental findings and develop appropriate policies for managing them, taking into account their expected prevalence and clinical severity. 7 Existing data on the prevalence of incidental findings from systematic reviews of MRI of one body region, 8 patient populations undergoing MRI, 9 or apparently asymptomatic people imaged by another modality, 10 are not generalisable to brain and body MRI of apparently asymptomatic people. Here, asymptomatic people are defined as community dwelling individuals not selected for imaging on the basis of symptoms, risk factors, or disease.…”

Section: Introductionmentioning

confidence: 99%

Potentially serious incidental findings on brain and body magnetic resonance imaging of apparently asymptomatic adults: systematic review and meta-analysis

Gibson

Paúl

Chappell

et al. 2018

BMJ

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ObjectivesTo determine prevalence and types of potentially serious incidental findings on magnetic resonance imaging (MRI) in apparently asymptomatic adults, describe factors associated with potentially serious incidental findings, and summarise information on follow-up and final diagnoses.DesignSystematic review and meta-analyses.Data sourcesCitation searches of relevant articles and authors’ files in Medline and Embase (from inception to 25 April 2017).Review methodsEligible studies included prevalence and types of incidental findings detected among apparently asymptomatic adults undergoing MRI of the brain, thorax, abdomen, or brain and body. Data on study population and methods, prevalence and types of incidental findings, and final diagnoses were extracted. Pooled prevalence was estimated by random effects meta-analysis, and heterogeneity by τ2 statistics.Main outcome measuresPrevalence of potentially serious incidental findings on MRI of the brain, thorax, abdomen, and brain and body.ResultsOf 5905 retrieved studies, 32 (0.5%) met the inclusion criteria (n=27 643 participants). Pooled prevalence of potentially serious incidental findings was 3.9% (95% confidence interval 0.4% to 27.1%) on brain and body MRI, 1.4% (1.0% to 2.1%) on brain MRI, 1.3% (0.2% to 8.1%) on thoracic MRI, and 1.9% (0.3% to 12.0%) on abdominal MRI. Pooled prevalence rose after including incidental findings of uncertain potential seriousness (12.8% (3.9% to 34.3%), 1.7% (1.1% to 2.6%), 3.0% (0.8% to 11.3%), and 4.5% (1.5% to 12.9%), respectively). There was generally substantial heterogeneity among included studies. About half the potentially serious incidental findings were suspected malignancies (brain, 0.6% (95% confidence interval 0.4% to 0.9%); thorax, 0.6% (0.1% to 3.1%); abdomen, 1.3% (0.2% to 9.3%); brain and body, 2.3% (0.3% to 15.4%)). There were few informative data on potential sources of between-study variation or factors associated with potentially serious incidental findings. Limited data suggested that relatively few potentially serious incidental findings had serious final diagnoses (48/234, 20.5%).ConclusionsA substantial proportion of apparently asymptomatic adults will have potentially serious incidental findings on MRI, but little is known of their health consequences. Systematic, long term follow-up studies are needed to better inform on these consequences and the implications for policies on feedback of potentially serious incidental findings.Systematic review registrationProspero CRD42016029472.

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Incidental extracardiac findings on cardiac MR: Systematic review and meta-analysis

Abstract: Major IEFs may be found in 12% of patients undergoing cardiac MR examination and change the management in 1% of patients. Readers' training for the evaluation of noncardiac structures increases reported prevalence.

Cited by 27 publications

References 22 publications

Prevalence and outcomes of incidental imaging findings: umbrella review

Prevalence and outcomes of incidental imaging findings: umbrella review

Incidental Extracardiac Findings and Their Characterization on Cardiac MRI

Potentially serious incidental findings on brain and body magnetic resonance imaging of apparently asymptomatic adults: systematic review and meta-analysis

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