1Assistant Professor, Department of Radiology, Neurology Research Center, Kerman University of Medical Sciences, Kerman, Ira
2Professor, Department of Neurology, Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
3Assistant Professor, Department of Community Medicine, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
4Resident, Department of Radiology, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
Background & Aims: Low back pain is one of the most common problems and a symptom-related reason for visits to a physician, and one of the important causes of disability. It may also impose great costs on the individual and the health system. Most patients with back pain will recover within 4 to 6 weeks. One of the best paraclinical diagnostic methods is magnetic resonance imaging (MRI), which may result in incidental findings of great importance to the patient. Methods: In this cross-sectional study, all cases in which lumbosacral MRI was performed due to back pain were investigated in terms of incidental findings. Results: The MR images of 854 patients in 2012 were studied. Among these patients, 40.3% (344) were male and 59.7% (510) were female. Mean age of patients was 43.05 years with median of 42 years. The incidental findings were observed in 29.7% (254) of cases who had no clinical symptoms and were not investigated by the physician. Abnormal incidental findings were observed in 9.5% (81) of male and 20.2% (173) of female patients; this difference was significant (P = 0.001). The prevalence of incidental findings was significantly higher in men of above 42 years of age (P = 0.001), but this difference was not significant in female patients (P = 0.513). In total, the prevalence of incidental findings was higher in ages above 42 (P = 0.004). The most prevalent incidental findings were, respectively, renal cysts (11.5%), retroflection of uterus (5.7%), and ovarian cyst (4.3%). Life threatening findings were aortic disorders (n=11, 11.3 %) and important lesions (n=28, 3.3%) requiring investigation. Conclusion: Incidental findings in MRI are important and since they might be the origin of pain or health threatening, require further evaluation.
Andersson GB. Epidemiological features of chronic low-back pain. Lancet 1999; 354(9178): 581-5.
Hart LG, Deyo RA, Cherkin DC. Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a U.S. national survey. Spine (Phila Pa 1976) 1995; 20(1): 11-9.
Thornbury JR, Fryback DG, Turski PA, Javid MJ, McDonald JV, Beinlich BR, et al. Disk-caused nerve compression in patients with acute low-back pain: diagnosis with MR, CT myelography, and plain CT. Radiology 1993; 186(3): 731-8.
Waddell G. 1987 Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain. Spine (Phila Pa 1976) 1987; 12(7): 632-44.
Frymoyer JW. Back pain and sciatica. N Engl J Med 1988; 318(5): 291-300.
Green L. PACS: effect on incidental findings. Radiol Manage 2004; 26(1): 26-9.
Wagner SC, Morrison WB, Carrino JA, Schweitzer ME, Nothnagel H. Picture archiving and communication system: effect on reporting of incidental findings. Radiology 2002; 225(2): 500-5.
Gundry CR, Fritts HM. Magnetic resonance imaging of the musculoskeletal system. Part 8. The spine, section 1. Clin Orthop Relat Res 1997; (338): 275-87.
Berns DH, Blaser SI, Modic MT. Magnetic resonance imaging of the spine. Clin Orthop Relat Res 1989; (244): 78-100.
Fu CJ, Chen HW, Wu CT, Chen LH, Wong YC, Wang LJ, et al. Extraspinal Malignancies Found Incidentally on Lumbar Spine MRI: Prevalence and Etiologies. J Radiol Sci 2013; 38: 85-91.
Qureshi B. Incidental findings. Br Dent J 2006; 201(11): 689.
Youserm D, Huang T, Loevner LA, Langlotz CP. Clinical and economic impact of incidental thyroid lesions found with CT and MR. Am J Neuroradiol 1997; 18(1423): 8.
Salam M, Joori M, Al-Baldawi DS. Extraspinal incidental? ndings of spinal MRI. J Fac Med Baghdad 2013; 55(3): 219-23.
Carey TS, Garrett J. Patterns of ordering diagnostic tests for patients with acute low back pain. The North Carolina back pain project. Ann Intern Med 1996; 125(10): 807-14.
Keller RB, Atlas SJ, Soule DN, Singer DE, Deyo RA. Relationship between rates and outcomes of operative treatment for lumbar disc herniation and spinal stenosis. J Bone Joint Surg Am 1999; 81(6): 752-62.
Park HJ, Jeon YH, Rho MH, Lee EJ, Park NH, Park SI, et al. Incidental findings of the lumbar spine at MRI during herniated intervertebral disk disease evaluation. AJR Am J Roentgenol 2011; 196(5): 1151-5.
Quattrocchi CC, Giona A, Di Martino AC, Errante Y, Scarciolla L, Mallio CA, et al. Extra-spinal incidental findings at lumbar spine MRI in the general population: a large cohort study. Insights Imaging 2013; 4(3): 301-8.
Deyo RA, Weinstein JN. Low back pain. N Engl J Med 2001; 344(5): 363-70.
Gebara NV, Meltzer DE. Extraspinal findings on lumbar spine MR imaging. J Radiol Case Rep 2009; 3(8): 5-13.
Park HJ, Jeon YH, Rho MH, Lee EJ, Park NH, Park S, et al. Incidental findings of the lumbar spine at MRI during herniated intervertebral disk disease evaluation. American Journal of Roentgenology 2011; 196(5): 1151-5.
Booth TC, Jackson A, Wardlaw JM, Taylor SA, Waldman AD. Incidental findings found in "healthy" volunteers during imaging performed for research: current legal and ethical implications. Br J Radiol 2010; 83(990): 456-65.
Colletti PM. Incidental findings on cardiac imaging. AJR Am J Roentgenol 2008; 191(3): 882-4.