Orme Nicholas M, Fletcher Joel G, Siddiki Hassan A, Harmsen W Scott, O'Byrne Megan M, Port John D, Tremaine William J, Pitot Henry C, McFarland Elizabeth G, Robinson Marguerite E, Koenig Barbara A, King Bernard F, Wolf Susan M
Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Arch Intern Med. 2010 Sep 27;170(17):1525-32. doi: 10.1001/archinternmed.2010.317.
Little information exists concerning the frequency and medical significance of incidental findings (IFs) in imaging research.
Medical records of research participants undergoing a research imaging examination interpreted by a radiologist during January through March 2004 were reviewed, with 3-year clinical follow-up. An expert panel reviewed all IFs generating clinical action to determine medical benefit/burden on the basis of predefined criteria. The frequency of IFs that generated further clinical action was estimated by modality, body part, age, and sex, along with net medical benefit or burden.
Of 1426 research imaging examinations, 567 (39.8%) had at least 1 IF (1055 total). Risk of an IF increased significantly by age (odds ratio [OR], 1.5; 95% confidence interval, 1.4-1.7 per decade increase). Abdominopelvic computed tomography generated more IFs than other examinations (OR, 18.9 vs ultrasonography; 9.2% with subsequent clinical action), with computed tomography of the thorax and magnetic resonance imaging of the head next (OR, 11.9 and 5.9; 2.8% and 2.2% with action, respectively). Of the 567 examinations with an IF, 35 (6.2%) generated clinical action, resulting in clear medical benefit in 1.1% (6 of 567) and clear medical burden in 0.5% (3 of 567). Medical benefit/burden was usually unclear (26 of 567 [4.6%]).
Frequency of IFs in imaging research examinations varies significantly by imaging modality, body region, and age. Research imaging studies at high risk for generating IFs can be identified. Routine evaluation of research images by radiologists may result in identification of IFs in a high number of cases and subsequent clinical action to address them in a small but significant minority. Such clinical action can result in medical benefit to a small number of patients.
关于影像研究中偶然发现（IFs）的频率及其医学意义，目前所知甚少。
回顾了2004年1月至3月期间由放射科医生解读的研究影像检查的研究参与者的病历，并进行了3年的临床随访。一个专家小组审查了所有引发临床行动的IFs，以根据预定义标准确定医学益处/负担。通过检查方式、身体部位、年龄和性别估计引发进一步临床行动的IFs的频率，以及净医学益处或负担。
在1426例研究影像检查中，567例（39.8%）至少有1个IF（共1055个）。IF的风险随年龄显著增加（优势比[OR]，1.5；95%置信区间，每增加十岁为1.4 - 1.7）。腹盆腔计算机断层扫描产生的IFs比其他检查更多（与超声相比，OR为18.9；后续临床行动的比例为9.2%），其次是胸部计算机断层扫描和头部磁共振成像（OR分别为11.9和5.9；行动比例分别为2.8%和2.2%）。在567例有IF的检查中，35例（6.2%）引发了临床行动，其中1.1%（567例中的6例）有明确的医学益处，0.5%（567例中的3例）有明确的医学负担。医学益处/负担通常不明确（567例中的26例[4.6%]）。
影像研究检查中IFs的频率因影像检查方式、身体区域和年龄而异。可以识别出产生IFs风险较高的研究影像研究。放射科医生对研究影像进行常规评估可能会在大量病例中识别出IFs，并随后在一小部分但相当数量的病例中采取临床行动来处理它们。这种临床行动可为少数患者带来医学益处。
