Findings on brain MRI from research studies of occupational exposure to known neurotoxicants
Findings on brain MRI from research studies of occupational exposure to known neurotoxicants
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DOI：
10.2214/ajr.05.0421
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发表时间：
2006-10-01
影响因子：
5
通讯作者：
Yousem, David M.
中科院分区：
文献类型：
--
作者：
Alphs, Hannah H.;Schwartz, Brian S.;Yousem, David M.
目标。MRI在中枢神经系统结果的大规模流行病学研究中的广泛应用，导致人们越来越关注对偶然发现的一致处理。我们的目的是在一项大型纵向队列研究中，确定曾因职业接触铅而接受脑MRI检查的成年人群中偶发神经放射学异常的患病率。材料和方法。为研究获得的结构MR图像由神经放射学家在持续的基础上审查临床关注的发现。受试者被招募作为纵向研究的一部分，旨在检查过去铅暴露对中枢神经系统结构的影响。该队列包括589名以前在有机铅制造工厂工作的男性，他们的铅暴露时间和强度范围很广。同时对67名无职业性铅暴露史的对照人群的磁共振图像进行了回顾。在84%（548/656）的研究对象中发现了偶然发现。548例异常患者中，30%（167例）不需要转诊，51%（280例）需要常规转诊，17%（93例）需要紧急转诊，1.5%（8例）需要立即转诊。在60岁及以上的老年受试者中观察到所有类别的偶然发现的比例较大。通过多变量logistic回归分析，我们发现年龄（p < 0.0001）与偶发神经放射学异常的风险增加相关，而与铅史无关。在被检查的人群中，偶发脑和头颈部异常的发生率很高。特别令人关注的是，在18.5%的受试者中观察到需要紧急或立即转诊的严重健康问题。这些发现强调了放射科医生评估研究产生的解剖图像的必要性，特别是那些人口基数较大的研究。
OBJECTIVE. The expanding use of MRI in large-scale epidemiologic studies of CNS outcomes has led to increasing concern for the consistent handling of incidental findings. Our purpose is to identify the prevalence of incidental neuroradiologic abnormalities in an adult population with past occupational exposure to lead who underwent brain MRI as part of a large, longitudinal cohort study.MATERIALS AND METHODS. Structural MR images obtained for the research study were reviewed by a neuroradiologist on an ongoing basis for findings of clinical concern. The subjects were recruited as part of a longitudinal research study designed to examine the effects of past lead exposure on CNS structures. The cohort examined consisted of 589 men who previously worked at an organolead manufacturing facility and had a wide range of lead exposure durations and intensities. MR images were also reviewed from 67 population-based control subjects from the same study who had no history of occupational lead exposure.RESULTS. Incidental findings were detected in 84% (548/656) of research subjects. Of the 548 subjects with abnormalities, 30% (167) required no referral, 51% (280) required routine referral, 17% (93) required urgent referral, and 1.5% (8) required immediate referral. Incidental findings of all categories were observed in a larger percentage of older subjects, aged 60 years and above. Using multivariable logistic regression analysis, we found that age (p < 0.0001), but not lead history, was associated with an increased risk of incidental neuroradiologic abnormalities.CONCLUSION. In the population examined, there was a high prevalence of incidental brain and head and neck abnormality. Of particular concern were the serious health problems observed requiring urgent or immediate referral in 18.5% of the subjects. These findings underscore the need for radiologists to evaluate the anatomic images generated by research studies, particularly those with an older population base.