Alphs Hannah H, Schwartz Brian S, Stewart Walter F, Yousem David M
Department of Radiology and Radiological Science, Johns Hopkins Hospital, Phipps Building, Room B112, 600 N. Wolfe St., Baltimore, MD 21287, USA.
AJR Am J Roentgenol. 2006 Oct;187(4):1043-7. doi: 10.2214/AJR.05.0421.
The expanding use of MRI in large-scale epidemiologic studies of CNS outcomes has led to increasing concern for the consistent handling of incidental findings. Our purpose is to identify the prevalence of incidental neuroradiologic abnormalities in an adult population with past occupational exposure to lead who underwent brain MRI as part of a large, longitudinal cohort study.
Structural MR images obtained for the research study were reviewed by a neuroradiologist on an ongoing basis for findings of clinical concern. The subjects were recruited as part of a longitudinal research study designed to examine the effects of past lead exposure on CNS structures. The cohort examined consisted of 589 men who previously worked at an organolead manufacturing facility and had a wide range of lead exposure durations and intensities. MR images were also reviewed from 67 population-based control subjects from the same study who had no history of occupational lead exposure.
Incidental findings were detected in 84% (548/656) of research subjects. Of the 548 subjects with abnormalities, 30% (167) required no referral, 51% (280) required routine referral, 17% (93) required urgent referral, and 1.5% (8) required immediate referral. Incidental findings of all categories were observed in a larger percentage of older subjects, aged 60 years and above. Using multivariable logistic regression analysis, we found that age (p < 0.0001), but not lead history, was associated with an increased risk of incidental neuroradiologic abnormalities.
In the population examined, there was a high prevalence of incidental brain and head and neck abnormality. Of particular concern were the serious health problems observed requiring urgent or immediate referral in 18.5% of the subjects. These findings underscore the need for radiologists to evaluate the anatomic images generated by research studies, particularly those with an older population base.
磁共振成像（MRI）在中枢神经系统结局的大规模流行病学研究中的应用不断扩大，这引发了人们对偶然发现的一致处理的日益关注。我们的目的是确定在一项大型纵向队列研究中，接受脑部MRI检查的既往有职业性铅暴露史的成年人群中偶然神经放射学异常的患病率。
一名神经放射科医生持续审查为该研究获取的结构MRI图像，以查找具有临床意义的发现。这些受试者是作为一项纵向研究的一部分招募的，该研究旨在检查既往铅暴露对中枢神经系统结构的影响。所检查的队列包括589名曾在有机铅制造工厂工作的男性，他们有广泛的铅暴露持续时间和强度范围。还审查了来自同一研究的67名无职业性铅暴露史的基于人群的对照受试者的MRI图像。
在84%（548/656）的研究受试者中检测到偶然发现。在548名有异常的受试者中，30%（167名）无需转诊，51%（280名）需要常规转诊，17%（93名）需要紧急转诊，1.5%（8名）需要立即转诊。在60岁及以上的老年受试者中，各类偶然发现的比例更高。使用多变量逻辑回归分析，我们发现年龄（p < 0.0001）而非铅暴露史与偶然神经放射学异常风险增加相关。
在所检查的人群中，脑部以及头颈部偶然异常的患病率很高。特别令人担忧的是，18.5%的受试者出现了需要紧急或立即转诊的严重健康问题。这些发现强调了放射科医生评估研究产生的解剖图像的必要性，特别是对于老年人群为主的研究。
