Incidental findings in whole-body MR imaging of a population-based cohort study: Frequency, management and psychosocial consequences

Abstract Magnetic resonance imaging (MRI) yields numerous tumor-related incidental findings (IFs) which may trigger diagnostics such as biopsies. To clarify these effects, we studied how whole-body MRI IF disclosure in a population-based cohort affected biopsy frequency and the detection of malignancies. Laboratory disclosures were also assessed. Data from 6753 participants in the Study of Health in Pomerania (SHIP) examined between 2008 and 2012 were utilized. All underwent laboratory examinations and 3371 (49.9%) a whole-body MRI. Electronic biopsy reports from 2002 to 2017 were linked to participants and assigned to outcome categories. Biopsy frequency 2 years pre- and post-SHIP was investigated using generalized estimating equations with a negative-binomial distribution. Overall 8208 IFs (laboratory findings outside reference limits: 6839; MRI: 1369) were disclosed to 4707 participants; 2271 biopsy reports belonged to 1200 participants (17.8%). Of these, 938 biopsies occurred pre-SHIP; 1333 post-SHIP (event rate/100 observation years = 6.9 [95% CI 6.5; 7.4]; 9.9 [9.3; 10.4]). Age, cancer history, recent hospitalization, female sex, and IF disclosure were associated with higher biopsy rates. Nonmalignant biopsy results increased more in participants with disclosures (post-/pre-SHIP rate ratio 1.39 [95% CI 1.22; 1.58]) than without (1.09 [95% CI 0.85; 1.38]). Malignant biopsy results were more frequent post-SHIP (rate ratio 1.74 [95% CI 1.27; 2.42]). Biopsies increased after participation in a population-based cohort study with MRI and laboratory IF disclosure. Most biopsies resulted in no findings and few malignancies were diagnosed, indicating potential overtesting and overdiagnosis. A more restrictive policy regarding IF disclosure from research findings is required.

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SHIP-MR and Radiology: 12 Years of Whole-Body Magnetic Resonance Imaging in a Single Center

Healthcare ◽

10.3390/healthcare10010033 ◽

2021 ◽

Vol 10 (1) ◽

pp. 33

Author(s):

Norbert Hosten ◽

Robin Bülow ◽

Henry Völzke ◽

Martin Domin ◽

Carsten Oliver Schmidt ◽

...

Keyword(s):

Mr Imaging ◽

Population Based ◽

Scientific Output ◽

Control Measures ◽

Whole Body ◽

Body Parts ◽

Scientific Publications ◽

Scientific Outputs ◽

Northeastern Germany ◽

The Brain

The Study of Health in Pomerania (SHIP), a population-based study from a rural state in northeastern Germany with a relatively poor life expectancy, supplemented its comprehensive examination program in 2008 with whole-body MR imaging at 1.5 T (SHIP-MR). We reviewed more than 100 publications that used the SHIP-MR data and analyzed which sequences already produced fruitful scientific outputs and which manuscripts have been referenced frequently. Upon reviewing the publications about imaging sequences, those that used T1-weighted structured imaging of the brain and a gradient-echo sequence for R2* mapping obtained the highest scientific output; regarding specific body parts examined, most scientific publications focused on MR sequences involving the brain and the (upper) abdomen. We conclude that population-based MR imaging in cohort studies should define more precise goals when allocating imaging time. In addition, quality control measures might include recording the number and impact of published work, preferably on a bi-annual basis and starting 2 years after initiation of the study. Structured teaching courses may enhance the desired output in areas that appear underrepresented.

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Prostate cancer and occupational exposure to whole-body vibration in a national population-based cohort study

American Journal of Industrial Medicine ◽

10.1002/ajim.22354 ◽

2014 ◽

Vol 57 (8) ◽

pp. 896-905 ◽

Cited By ~ 6

Author(s):

Marcella K. Jones ◽

M. Anne Harris ◽

Paul A. Peters ◽

Michael Tjepkema ◽

Paul A. Demers

Keyword(s):

Prostate Cancer ◽

Cohort Study ◽

Occupational Exposure ◽

Whole Body Vibration ◽

Population Based ◽

Whole Body ◽

Body Vibration ◽

National Population

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Effects of whole-body MRI on outpatient health service costs: a general-population prospective cohort study in Mecklenburg-Vorpommern, Germany

BMJ Open ◽

10.1136/bmjopen-2021-056572 ◽

2022 ◽

Vol 12 (1) ◽

pp. e056572

Author(s):

Carsten Oliver Schmidt ◽

Elizabeth Sierocinski ◽

Sebastian Baumeister ◽

Katrin Hegenscheid ◽

Henry Völzke ◽

...

Keyword(s):

Cohort Study ◽

General Population ◽

Health Service ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Population Based ◽

Whole Body ◽

Service Utilisation ◽

Specialist Care ◽

Whole Body Mri

ObjectiveWhole-body MRI (wb-MRI) is increasingly used in research and screening but little is known about the effects of incidental findings (IFs) on health service utilisation and costs. Such effects are particularly critical in an observational study. Our principal research question was therefore how participation in a wb-MRI examination with its resemblance to a population-based health screening is associated with outpatient service costs.DesignProspective cohort study.SettingGeneral population Mecklenburg-Vorpommern, Germany.ParticipantsAnalyses included 5019 participants of the Study of Health in Pomerania with statutory health insurance data. 2969 took part in a wb-MRI examination in addition to a clinical examination programme that was administered to all participants. MRI non-participants served as a quasi-experimental control group with propensity score weighting to account for baseline differences.Primary and secondary outcome measuresOutpatient costs (total healthcare usage, primary care, specialist care, laboratory tests, imaging) during 24 months after the examination were retrieved from claims data. Two-part models were used to compute treatment effects.ResultsIn total, 1366 potentially relevant IFs were disclosed to 948 MRI participants (32% of all participants); most concerned masses and lesions (769 participants, 81%). Costs for outpatient care during the 2-year observation period amounted to an average of €2547 (95% CI 2424 to 2671) for MRI non-participants and to €2839 (95% CI 2741 to 2936) for MRI participants, indicating an increase of €295 (95% CI 134 to 456) per participant which corresponds to 11.6% (95% CI 5.2% to 17.9%). The cost increase was sustained rather than being a short-term spike. Imaging and specialist care related costs were the main contributors to the increase in costs.ConclusionsCommunicated findings from population-based wb-MRI substantially impacted health service utilisation and costs. This introduced bias into the natural course of healthcare utilisation and should be taken care for in any longitudinal analyses.

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Vertebral Bone Marrow Fat Is independently Associated to VAT but Not to SAT: KORA FF4—Whole-Body MR Imaging in a Population-Based Cohort

Nutrients ◽

10.3390/nu12051527 ◽

2020 ◽

Vol 12 (5) ◽

pp. 1527 ◽

Cited By ~ 1

Author(s):

Dunja Hasic ◽

Roberto Lorbeer ◽

Robert C. Bertheau ◽

Jürgen Machann ◽

Susanne Rospleszcz ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Bone Marrow ◽

Adipose Tissue ◽

Cardiovascular Risk ◽

Mr Imaging ◽

Cardiovascular Risk Factors ◽

Population Based ◽

Lipid Lowering ◽

Whole Body

The objective of the current study was to assess the relationship of bone marrow adipose tissue (BMAT) content to abdominal fat depots, including visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), as well as cardiovascular risk factors (CVRF) beyond physical activity in a population-based cohort study undergoing whole-body magnetic resonance (MR) imaging. Subjects of the Cooperative Health Research in the Augsburg Region (KORA) FF4 study without known cardiovascular disease underwent fat fraction quantification in vertebrae (BMATL1/L2) via a 2-point T1-weighted volumetric interpolated breath-hold examination (VIBE) Dixon sequence. The same MR sequence was applied to quantify VAT and SAT volume. Subjects’ characteristics, including physical activity, were determined through standardized exams and self-assessment questionnaires. Univariate and multivariate linear regression were applied. In the cohort of 378 subjects (56 ± 9.1years; 42.1% female), BMATL1/L2 was 54.3 ± 10.1%, VAT was 4.54 ± 2.71 L, and SAT was 8.10 ± 3.68 L. VAT differed significantly across BMATL1/L2 tertiles (3.60 ± 2.76 vs. 4.92 ± 2.66 vs. 5.11 ± 2.48; p < 0.001), there was no significant differences for SAT (p = 0.39). In the fully adjusted model, VAT remained positively associated with BMATL1/L2 (β = 0.53, p = 0.03). Furthermore, BMATL1/L2 was associated with age (β = 5.40 per 10-years, p < 0.001), hemoglobin A1c (HbA1c; β = 1.55 per 1%, p = 0.04), lipids (β = 0.20 per 10 mg/dL triglycerides; β = 0.40 per 10 mg/dL low-density lipoprotein (LDL); β =−3.21 lipid-lowering medication; all p < 0.05), and less physical activity (β = 3.7 “no or nearly no exercise” as compared to “≥2 h per week, regularly”, p = 0.003); gender was not significantly different (p = 0.57). In the population-based cohort, VAT but not SAT were associated with higher BMATL1/L2 independently of physical activity and other cardiovascular risk factors. Further, BMATL1/L2 increased with older age, less physical activity, higher HbA1c, and increased lipids but decreased with lipid-lowering medication.

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Pulmonary Function and Abdominal Adiposity: Associations based on Whole-Body MR Imaging in a Population-based Cohort

10.1055/s-0040-1703139 ◽

2020 ◽

Author(s):

R von Krüchten ◽

S Rospleszcz ◽

S Karrasch ◽

H Schulz ◽

A Peters ◽

...

Keyword(s):

Mr Imaging ◽

Pulmonary Function ◽

Population Based ◽

Whole Body ◽

Abdominal Adiposity

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Recall accuracy of notifications about incidental findings from an MRI examination: results from a population-based study

Journal of Epidemiology & Community Health ◽

10.1136/jech-2019-212824 ◽

2020 ◽

pp. jech-2019-212824

Author(s):

Katharina Piontek ◽

Adrian Richter ◽

Katrin Hegenscheid ◽

Jean-Francois Chenot ◽

Carsten Oliver Schmidt

Keyword(s):

Predictive Value ◽

False Positive ◽

Incidental Findings ◽

False Negative ◽

Population Based ◽

Whole Body ◽

Population Based Study ◽

Recall Accuracy ◽

Whole Body Mri ◽

Self Reports

BackgroundSelf-reports of medical findings are indispensable in clinical practice and research but subject to recall bias. We analysed the recall accuracy of notifications about incidental findings (IFs) from a whole-body MRI examination and assessed determinants of recall error.MethodsData from 3746 participants of a postal follow-up survey conducted on average 2.47 years after examination in the population-based Study of Health in Pomerania were analysed. Among those, 2185 (58.3%) underwent whole-body MRI at baseline, and findings of potential clinical relevance were disclosed in standardised postal letters. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated to determine the accuracy of self-reports. Poisson regression analysis was conducted to analyse predictors for false-positive and false-negative recall.ResultsAn IF was disclosed to 622 (28.5%) individuals; 81.5% had tumour relevance. The overall sensitivity and PPV of participants’ self-reports were 80% and 60%, respectively. PPvs were higher among women, better educated and married participants and among those with good verbal memory. Among MRI participants, lower educational level was associated with a higher risk of false-positive recall (risk ratio (RR) 1.44, 95% CI 1.01 to 2.03), while increasing age was associated with a higher risk of false-negative recall (RR 1.64, 95% CI 1.33 to 2.01).ConclusionsMost participants correctly recalled disclosed IFs. However, the probability of an event in case of a positive recall is barely above 50%. Therefore, relying on subjects’ recall of disclosed IFs will lead to a relevant proportion of errors. Clinicians and researchers should be aware of this problem and of participants’ characteristics which may moderate the probability of correct decisions based on recalled findings.

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