Incidental findings in imaging research: evaluating incidence, benefit, and burden.
Incidental findings in imaging research: evaluating incidence, benefit, and burden.
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DOI：
10.1001/archinternmed.2010.317
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发表时间：
2010-09-27
影响因子：
--
通讯作者：
Wolf, Susan M.
中科院分区：
文献类型：
--
作者：
Orme, Nicholas M.;Fletcher, Joel G.;Siddiki, Hassan A.;Harmsen, W. Scott;O'Byrne, Megan M.;Port, John D.;Tremaine, William J.;Pitot, Henry C.;McFarland, Elizabeth G.;Robinson, Marguerite E.;Koenig, Barbara A.;King, Bernard F.;Wolf, Susan M.
关于在广泛的成像模式和身体区域的成像研究过程中识别出的具有临床意义的偶然发现（IF）的频率，信息很少。估计研究成像IF产生进一步临床行动的频率，以及识别这些IF的医疗受益/负担。对2004年第一季度接受研究成像检查的受试者进行回顾性审查，该检查由放射科医生解释为IF，并进行了3年临床随访。专家小组审查了产生临床行动的IF，以根据预定义的标准确定医疗受益/负担。（1）按治疗方式、身体部位、年龄、性别列出的导致进一步临床行动的IF频率，和（2）导致明确医疗获益或负担的IF频率。1376例患者接受了1426项研究性成像检查。40%（567/1426）的检查至少有一个IF（共1055个）。IF风险随年龄增长而显著增加（OR=1.5; [1.4-1.7=95% C.I.]每十年增加）。腹盆CT产生的IF多于其他检查（与超声相比，OR=18.9;后续临床行动为9.2%），其次是CT胸部和MR脑部（OR=11.9和5.9;行动分别为2.8%和2.2%）。总体而言，6.2%的检查（35/567）具有IF产生的临床行动，导致1.1%（6/567）的明确医疗受益和0.5%（3/567）的明确医疗负担。在大多数情况下，医疗受益/负担不明确（4.6%; 26/567）。影像学研究检查中IF的频率因成像方式、身体部位和年龄而异。可以识别出产生IF的高风险研究成像研究。放射科医生对研究图像的常规评价可能导致在大量病例中识别出IF，并随后采取临床措施解决数量少得多的IF。这样的临床作用可以对少数患者产生医疗益处。
Little information exists concerning the frequency of clinically significant incidental findings (IFs) identified in the course of imaging research across a broad spectrum of imaging modalities and body regions. To estimate the frequency with which research imaging IFs generate further clinical action, and the medical benefit/burden of identifying these IFs. Retrospective review of subjects undergoing a research imaging exam that was interpreted by a radiologist for IFs in the first quarter of 2004, with 3-year clinical follow-up. An expert panel reviewed IFs generating clinical action to determine medical benefit/burden based on predefined criteria. Frequency of (1) IFs that generated further clinical action by modality, body part, age, gender, and (2) IFs resulting in clear medical benefit or burden. 1376 patients underwent 1426 research imaging studies. 40% (567/1426) of exams had at least one IF (1055 total). Risk of an IF increased significantly by age (OR=1.5; [1.4–1.7=95% C.I.] per decade increase). Abdominopelvic CT generated more IFs than other exams (OR=18.9 compared with ultrasound; 9.2% with subsequent clinical action), with CT Thorax and MR brain next (OR=11.9 and 5.9; 2.8% and 2.2% with action, respectively). Overall 6.2% of exams (35/567) with an IF generated clinical action, resulting in clear medical benefit in 1.1% (6/567) and clear medical burden in 0.5% (3/567). In most instances, medical benefit/burden was unclear (4.6%; 26/567). The frequency of IFs in imaging research exams varies significantly by imaging modality, body region and age. Research imaging studies at high risk for generating IFs can be identified. Routine evaluation of research images by radiologists may result in identification of IFs in a substantial number of cases and subsequent clinical action to address them in much smaller number. Such clinical action can result in medical benefit to a small number of patients.
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