Abstract Title
Incidental Extraspinal Findings in the Thoracic Spine during Magnetic Resonance Imaging of Intervertebral Discs

Authors

Mogahid M.A Zidan
Ikhlas A. Hassan
Abdelrahaman M. Elnour
Mustafa Z. Mahmoud
Mohammed A. Alghamdi
Mohammed Salih
Mona Elhaj
Wadah M. Ali

Theme

Diagnostic & Interventional Radiology

INSTITUTION

Al-Ghad International Colleges for Applied Medical Sciences ,MIT Department,Abha,Saudi Arabia
University of Jeddah, Department of Medical Imaging and Radiation Sciences
Prince Sattam bin Abdulaziz University,College of Applied Medical Sciences,Radiology Department

Background

Incidental findings (IFs) are asymptomatic abnormalities other than expected pathologies, found during radiological examinations. In recent years, improves in the digital evaluation of radiological imaging (e.g., high magnification zoom, the ability to focus on individual images, and digital archiving) have improved detection limit of incidental lesions.[1] Magnetic resonance imaging (MRI) of the thoracic spine is performed to test patients with back pain. The images for reporting are magnified around the vertebral column, cropping out much of the structure within the thoracic cavity. While this gives an excellent delineation of spinal pathologies, it results in the exclude of important extraspinal pathologies from the final data set.[2] Given the simplicity of providing a wide field of view (FOV) reconstructions that encompass these structures; the authors have examined the incidence and type of extraspinal incidental findings reported by a wide FOV review. This study was designed with an aim to determine the frequencies of incidental extraspinal findings in the thoracic spine on MRI of the intervertebral discs of the thoracic spine. The authors wish to present the prevalence of these IFs and to stress their clinical significance too.

Summary of Work

Objective: The purpose of this study was to determine the frequency of incidental extraspinal findings in the thoracic spine on magnetic resonance imaging (MRI).

Materials and Methods: A total of 120 thoracic spine MRI patients were prospectively examined in the period extending from August 2018 to April 2019. Both 1.5 and 0.35 Tesla MRI systems (Toshiba and Siemens Medical system) were applied to investigate patients with suspected intervertebral disc abnormalities at three MRI diagnostic centers in Khartoum, Sudan.

Results: Out of the 120  patients, incidental extraspinal findings were found in 16  patients (13.3%). Various incidental findings (IFs) were seen, including renal cysts, liver mass, thyroid goiter, and pleural effusion. Out of these IFs, 37.5% were considered clinically significant.

Conclusions: Various IFs were identified during a routine thoracic spine MRI, and approximately one-third of them were clinically significant. Therefore, it is essential for the reporting radiologists to pay attention to extraspinal findings while reporting thoracic spine MRI to avoid missing clinically significant findings.

Summary of Results

In this study, the mean age of the patients with IFs was 40.69 ± 19.8 years old, ranged between 3 and 80 years. IFs were found in 13.3% of 120  patients with prevalence among women of 37.5% and 62.5% for men. Table 1 shows the prevalence of IFs according to patient gender. The percentage of significance IFs was 37.5%, including 2  (12.5%) patients with thyroid goiter, 1  (6.25%) patient presented with a liver mass, and 3  (18.75%) conditions of hydronephrosis.

Figure  1 presents the incidence of Ifs according to age group, where IFs were frequently presented in the age group of 21–40 years rather than other age groups.

The prevalence of IFs, according to the organs, is cited in Table 2. It should be noted that renal cyst (3.3%) was the commonly detected pathology during an MRI of the intervertebral discs of the thoracic spine.

 

Conclusion

The authors determined that the IFs were frequently observed during a routine thoracic spine MRI, and many of these findings were clinically significant. However, IFs including clinically relevant findings were occasionally omitted from formal radiological reports.

Take-home Messages

The INCIDENTAL FINDINGS may be more significant than the problems being evaluated and can have significant impact on patient management and medicolegal implications to the radiologist.

Acknowledgement

The authors would like to thank Mr. Ahmed Fadlula Musa, Mr. Mohammed Hashim, Mr. Tarig Haga, Mr. Rafat Abdalla, and Mr. Almoutasm Bellah, the staff of the MRI diagnostic centers of Alzaytouna Specialist Hospital, Dar Al Elaj Specialized Hospital, and El Nilein Medical Diagnostic Centre, Khartoum, Sudan, without whom this study would not have been possible.

References

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.

2. Sutherland T, Chock JM, Stephens N. Incidental extra spinal findings at CT lumbar spine on wide field of view reconstructions. J Spine Neurosurg 2013;2:4.

Background
Summary of Work
Summary of Results

A 6 year old, male with history of back pain in thoracic area.
MRI Findings:

  • A small amount of effusion accumulates in the posterior aspect of the chest.
  • The accumulation of fluid is appear hyperintense in T2 weighted image (A) and hypointense in T1 weighted image (B) (arrow).

Incidental findings:

  • Plural effusion

A 51 years old, male with history of neck pain.
MRI Findings:

  • Thyroid with slight dimensional increase, but relatively homogeneous.

Incidental findings:

  • Thyroidal Goiter
Conclusion
Take-home Messages
Acknowledgement
References
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