Tuesday, September 28, 2010

Not Unexpected Surprises

In a recent Nature paper they talk about he"surprises" that radiologists find on "normal" people when imaging studies are performed in the course of research.

The article states:

People may volunteer for a study simply to advance science, but a large fraction of them could wind up receiving unnerving news. A paper published today reports finding that 40% of participants in imaging experiments had clinical anomalies beyond the scope of the investigation, and that, of these cases, 6% provoked subsequent medical intervention.

This is hardly surprising. Consider two simple cases:

1. Ovarian Mass in Elderly: Many older women may have benign ovarian masses, of say 1-2 mm in diameter and a CA125 well below 5. Not really a surprise but it then requires frequent monitoring.

2. Thyroid masses are also often found in the elderly and they show no vascularization on ultrasound. They then should be checked with some moderate frequency.

The list then goes on.

The article continues:

Aberrations were most common in computed tomography (CT) examinations of the abdomen, pelvis and thorax, followed by magnetic resonance imaging (MRI) scans of the head. With CT scans of the abdomen and pelvis, about 60% revealed abnormalities such as hardening of the arteries, pouches in the colon and cysts in the kidneys, and 9% led to the individual receiving medical attention. Meanwhile, with MRI scans of the head, more than 40% showed defects, and 2% led to further assessment. By contrast, ultrasonography, plain-film radiography and nuclear medicine tests prompted no follow-ups. Only 1% of examinations with incidental findings led to follow-up procedures that clearly helped patients.

CT tends to catch everything and the kitchen sink and once found, even if there are no symptoms, it must be followed and followed oftentimes aggressively. This is an interesting study which raises more questions regarding the cost effectiveness of imaging.