Question:

Which of the following statements is true?
1. The widespread use of picture archive and communications systems (PACS) has resulted in a decrease in the number of reported incidental findings on lumbar MRI examinations.
2. Incidental detection of certain diseases before onset of symptoms, e.g. renal cell carcinoma, may increase survival chances.
3. It is sufficient to report all incidental findings on lumbar MRI examinations, without further communication.
4. Unlike lumbar imaging, there has not been any recent noticeable change in the number of incidental findings in examinations of other parts of the body.
5. All of the above.





Answer:

The correct answer for the question "Which of the following statements is true?" is:

2. Incidental detection of certain diseases before onset of symptoms, e.g. renal cell carcinoma, may increase survival chances.



Explanation

The study by Konnak et al shows data supporting increased survival in patients whose renal cell tumors were discovered incidentally. Incidental findings have increased in number with the introduction of PACS systems, both in spine and brain imaging. Some incidental findings, such as the presence of a fetus, may require immediate communication with the referring physician, especially if intravenous contrast is being considered.

 



From the manuscript:
Extraspinal findings on lumbar spine MR imaging
Radiology Case. 2009 Aug; 3(8):5-13


This article belongs to the Neuro section.




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From the manuscript

Extraspinal findings on lumbar spine MR imaging

Free full text article: Extraspinal findings on lumbar spine MR imaging

Abstract
Interpretation of radiologic studies requires vigilance on the part of the radiologist to identify findings and abnormalities outside the region of interest. In the case of routine lumbar spine MRI for low back pain, many extraspinal abnormalities can often be identified. Some of these findings may account for low back pain. Other findings are incidental, but may have significant clinical implications, and are important to recognize. We present twenty-four examples of incidental findings from lumbar spine MRI examinations. The findings involve various organ systems, covering a broad range of clinical urgency.






References



1. Konnak JW, Grossman HB. Renal cell carcinoma as an incidental finding. Journal of Urology 1985; 134(6):1094-6.
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2. Frager DH, Elkin CM, Kansler F, Mendelsohn SL, Leeds NE. Extraspinal abnormalities identified on lumbar spine CT. Neuroradiology 1986; 28 (1): 58-60.
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3. Wagner SC, Morrison WB, Carrino JA, Schweltzer ME, Nothnagel H. Picture Archiving and Communication System: Effect on Reporting of Incidental Findings. Radiology 2002; 225: 500-505.
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4. Green L. PACS: effect on incidental findings. Radiology Management 2004; 26(1):26-29.
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5. Vernooij MW. Incidental findings on brain MRI in the general population. N Engl J Med 2007; 357: 1821-8.
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