Research cardiac magnetic resonance imaging in end stage renal disease - incidence, significance and implications of unexpected incidental findings

Abstract

ObjectivesLeft ventricular mass (LVM) at cardiac magnetic resonance imaging (CMR) is a frequent end point in clinical trials in nephrology. Trial participants with end stage renal disease (ESRD) may have a greater frequency of incidental findings (IF). We retrospectively investigated prevalence of IF in previous research CMR and reviewed their subsequent impact on participants.MethodsBetween 2002 and 2006, 161 ESRD patients underwent CMR in a transplant assessment study. Images were used to assess LV mass and function. In the current study a radiologist reviewed the scans for IF. Review of patient records determined the subsequent clinical significance of IF.ResultsThere were 150 IF in 95 study participants. Eighty-four (56 %) were new diagnoses. One hundred and two were non-cardiac. Fifteen were suspicious of malignancy. There was a clinically significant IF for 14.9 % of the participants. In six cases earlier identification of an IF may have improved quality of life or survival.ConclusionsWithout radiology support clinically important IF may be missed on CMR. Patients undergoing CMR in trials should be counselled about the frequency and implications of IF. Patients with ESRD have a higher prevalence of IF than reported in other populations. Nephrology studies require mechanisms for radiologist reporting and strategies for dealing with IF.Key Points • Incidental findings on research cardiac magnetic resonance imaging can have significant consequences. • We considered incidental findings in historical renal cardiac resonance imaging clinical trials. • Incidental findings are common and important in the chronic kidney disease population. • Without radiology support, clinically significant incidental findings may be missed on imaging. • Study protocols, approvals and consent processes should take account of possible findings.

Myocardial changes on 3T cardiovascular magnetic resonance imaging in response to haemodialysis with fluid removal

“…The cohort is representative of the wider dialysis population with high prevalence of comorbidity and no changes to their prescribed dialysis session. The number of clinically relevant incidental findings that were identified is striking but is in keeping with previous reports [47]. Fluid assessment was comprehensive and CMR scans were performed utilising state-of-theart hardware and software.…”

Characterizing Cardiac Involvement in Chronic Kidney Disease Using CMR—a Systematic Review

“…While this is not directly relevant to characterizing myocardial disease involvement, we felt this is an important point to discuss in view of increased use of CMR in studies in patients with CKD. Recently, a paper reported the incidence of non-cardiac findings in a CKD stage 5 population as being seven times greater than what was previously reported in an all-comers CMR study [ 14 , 64 ]. While this study was limited by its retrospective nature, researchers utilizing CMR in renal populations should consider its findings seriously.…”