Incidental findings detected on magnetic resonance imaging scans of the cervical, thoracic and lumbar spine of patients prediagnosed with discopathy

Abstract

Objective: To determine the frequency and types of incidental findings on magnetic resonance imaging (MRI) scans of the cervical, thoracic, and lumbar spine in patients with intervertebral discopathy. Patients and Methods: This retrospective study included 1000 patients (513 females and 487 males, with a mean age of 50.5 years) with clinically suspected intervertebral discopathy who underwent MRI. Any abnormal findings and congenital anomalies/anatomical variations unrelated to the primary complaint were referred to as incidental findings. Frequency distributions of the assessed imaging characteristics were calculated. Results: Of the 1000 patients, 192 (19.2%) patients were presented with incidental findings. The positive findings in the thoracic spine (26%) were higher than those in the lumbar (19.8%) and cervical spine (13.7%). The study found vertebral haemangioma to be the most common finding, followed by Schmorl’s nodes in the thoracic and lumbar spine. Thyroid nodules constituted the most common finding in the cervical spine, followed by vertebral haemangioma. Renal cysts in the thoracic and lumbar spine and thyroid nodules in the cervical spine were the most frequent extraspinal findings. Conclusion: Incidental findings are commonly detected during MRI examination of intervertebral discs, and most are benign findings. However, incidental findings including clinically essential findings can alter the patient’s treatment or affect the patient’s life. Therefore, it is crucial to systematically evaluate MRIs without focusing solely on the spine and report incidental findings detected on MRI.

Keywords

• Incidental findings
• Magnetic resonance imaging
• Discopathy

References

1. [1] Wagner SC, Morrison WB, Carrino JA, Schweitzer ME, Nothnagel H. Picture archiving and communication system: effect on reporting of incidental findings. Radiology 2002; 225: 500-5. doi:10.1148/radiol.225.201.1731
2. [2] Yap KKH, Ramaseshan G, Sutherland T, Shafik‐Eid R, Taubman K, Schlicht S. Prevalence of incidental or unexpected findings on low‐dose CT performed during routine SPECT/ CT nuclear medicine studies. J Med Imaging Radiat Oncol 2015; 59: 26-33. doi:10.1111/1754-9485.12254
3. [3] Kamath S, Jain N, Goyal N, Mansour R, Mukherjee K. Incidental findings on MRI of the spine. Clin Radiol 2009; 64: 353-61. doi: 10.1016/j.crad.2008.09.010
4. [4] Park H-J, Jeon Y-H, Rho M-H, et al. Incidental findings of the lumbar spine at MRI during herniated intervertebral disk disease evaluation. Am J Roentgenol 2011; 196: 1151-5. doi: 10.2214/AJR.10.5457.
5. [5] Cieszanowski A, Maj E, Kulisiewicz P, et al. Non-contrastenhanced whole-body magnetic resonance imaging in the general population: the incidence of abnormal findings in patients 50 years old and younger compared to older subjects. PLoS One 2014; 9: e107840. doi: 10.1371/journal. pone.0107840
6. [6] Zidan MM, Hassan IA, Elnour AM, et al. Extraspinal incidental findings on routine MRI of Cervical spine. Glob Adv Res J Med Med Sci 2017; 6: 234-9. http://garj.org/garjmms
7. [7] Zidan MM, Hassan IA, Elnour AM, et al. Incidental extraspinal findings in the thoracic spine during magnetic resonance imaging of intervertebral discs. J Clin Imag Sci 2019; 9. doi: 10.25259/JCIS_50_2019
8. [8] Quattrocchi CC, Giona A, Di Martino AC, et al. Extraspinal incidental findings at lumbar spine MRI in the general population: a large cohort study. Insights into Imag 2013; 4: 301-8. doi: 10.1007/s13244.013.0234-z

9. [9] Levine D, Brown DL, Andreotti RF, et al. Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology 2010; 256: 943-54. doi: 10.1097/ RUQ.0b013e3181f09099
10. [10] Eroğlu A, Yılmaz İ. Lomber Diskopatili Hastalarda Lomber Spinal MR İncelemede Görülen Rastlantısal Lezyonlar. Pamukkale Tıp Dergisi 2018 ;11: 309-13. doi.org/10.31362/ patd.451713
11. [11] Ibrahim H, Elsadawy MEI. Incidental findings in lumbar spine MRI: their prevalence and potential impact on patient management. Egyp J Radiol and Nuclear Med 2019; 50: 1-5. doi:10.1186/s43055.019.0059-y
12. [12] Sobhan M, Samiee M, Asgari Y, Ahmadi M. Incidental findings of the lumbar spine at MRI in patients diagnosed with discopathy. Int J Med Imag 2016; 4: 44. doi: 10.11648/j. ijmi.20160405.12
13. [13] Barzin M, Maleki I. Incidence of vertebral hemangioma on spinal magnetic resonance imaging in Northern Iran. PJBS 2009; 12: 542-4. doi: 10.3923/pjbs.2009.542.544
14. [14] Langdown AJ, Grundy JR, Birch NC. The clinical relevance of Tarlov cysts. Clinical Spine Surg 2005; 18: 29-33. doi: 10.1097/01.bsd.000.013.3495.78245.71
15. [15] Tuncel SA, Çaglı B, Tekataş A, Kırıcı MY, Ünlü E, Gençhellaç H. Extraspinal incidental findings on routine MRI of lumbar spine: prevalence and reporting rates in 1278 patients. Korean J Radiol 2015; 16: 866-73. doi: 10.3348/kjr.2015.16.4.866
16. [16] Zeh OF, Goujou EG, Awana AP, et al. Extraspinal incidental findings at lumbar spine magnetic resonance imaging in two hospitals: Prevalence and clinical importance. Open J Radiol 2017; 7: 241-8. doi: 10.4236/ojrad.2017.74026
17. [17] Dilli A, Ayaz UY, Turanlı S, et al. Incidental extraspinal findings on magnetic resonance imaging of intervertebral discs. Arc Med Sci 2014; 10: 757. doi: 10.5114/aoms.2014.44868
18. [18] Natsis K, Piagkou M, Skotsimara A, Protogerou V, Tsitouridis I, Skandalakis P. Horseshoe kidney: a review of anatomy and pathology. Surg Radiol Anat 2014; 36: 517-26. doi: 10.1007/ s00276.013.1229-7
19. [19] Green L. PACS: effect on incidental findings. Radiol Man 2004; 26: 26-9. PMID: 14994834
20. [20] Ezzat S, Sarti DA, Cain DR, Braunstein GD. Thyroid incidentalomas: prevalence by palpation and ultrasonography. Arch Int Med 1994; 154: 1838-40. doi: 10.1001/ archinte.154.16.1838
21. [21] Ramadorai UE, Hire JM, DeVine JG. Magnetic resonance imaging of the cervical, thoracic, and lumbar spine in children: spinal incidental findings in pediatric patients. Glob Spine J 2014; 4: 223-8. doi: 10.1055/s-0034.138.7179.