From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
Departments of Radiology (P.A.R., LB.E., A.S.F., V.P., H.A.R.).
AJNR Am J Neuroradiol. 2023 Apr;44(4):417-423. doi: 10.3174/ajnr.A7821. Epub 2023 Mar 16.
Incidental findings are discovered in neuroimaging research, ranging from trivial to life-threatening. We describe the prevalence and characteristics of incidental findings from 16,400 research brain MRIs, comparing spontaneous detection by nonradiology scanning staff versus formal neuroradiologist interpretation.
We prospectively collected 16,400 brain MRIs (7782 males, 8618 females; younger than 1 to 94 years of age; median age, 38 years) under an institutional review board directive intended to identify clinically relevant incidental findings. The study population included 13,150 presumed healthy volunteers and 3250 individuals with known neurologic diagnoses. Scanning staff were asked to flag concerning imaging findings seen during the scan session, and neuroradiologists produced structured reports after reviewing every scan.
Neuroradiologists reported 13,593/16,400 (83%) scans as having normal findings, 2193/16,400 (13.3%) with abnormal findings without follow-up recommended, and 614/16,400 (3.7%) with "abnormal findings with follow-up recommended." The most common abnormalities prompting follow-up were vascular (263/614, 43%), neoplastic (130/614, 21%), and congenital (92/614, 15%). Volunteers older than 65 years of age were significantly more likely to have scans with abnormal findings (< .001); however, among all volunteers with incidental findings, those younger than 65 years of age were more likely to be recommended for follow-up. Nonradiologists flagged <1% of MRIs containing at least 1 abnormality reported by the neuroradiologists to be concerning enough to warrant further evaluation.
Four percent of individuals who undergo research brain MRIs have an incidental, potentially clinically significant finding. Routine neuroradiologist review of all scans yields a much higher rate of significant lesion detection than selective referral from nonradiologists who perform the examinations. Workflow and scan review processes need to be carefully considered when designing research protocols.
神经影像学研究中会发现偶然发现，从微不足道到危及生命。我们描述了从 16400 项研究性脑部 MRI 中偶然发现的频率和特征，比较了非放射科扫描人员自发检测与正式神经放射科医生解释之间的差异。
我们根据机构审查委员会的指令前瞻性地收集了 16400 例脑部 MRI（7782 名男性，8618 名女性；年龄 1 岁至 94 岁；中位数年龄 38 岁），旨在识别具有临床意义的偶然发现。研究人群包括 13150 名假定健康志愿者和 3250 名已知神经诊断患者。扫描人员被要求标记在扫描过程中发现的可疑影像表现，神经放射科医生在审查完每一个扫描后会生成结构化报告。
神经放射科医生报告 16400 例（83%）扫描结果正常，2193 例（13.3%）扫描结果异常，但无需进一步随访，614 例（3.7%）扫描结果“异常，需要随访”。最常见的需要随访的异常包括血管性（263/614，43%）、肿瘤性（130/614，21%）和先天性（92/614，15%）病变。年龄大于 65 岁的志愿者更有可能出现异常扫描（<.001）；然而，在所有偶然发现异常的志愿者中，年龄小于 65 岁的患者更有可能被推荐进行随访。非放射科医生仅标记不到 1%的 MRI，这些 MRI 含有至少 1 项被神经放射科医生报告为足以进行进一步评估的异常。
4%接受研究性脑部 MRI 的个体有偶然发现的潜在临床重要发现。常规由神经放射科医生审查所有扫描可显著提高显著病变检出率，而选择性参考进行检查的非放射科医生则无法达到该效果。在设计研究方案时，需要仔细考虑工作流程和扫描审查过程。
