Extraspinal incidental findings on cervical vertebrae magnetic resonance imaging

Yıl 2025, Cilt: 2 Sayı: 1, 58 - 66, 15.02.2025

Gökhan Tonkaz , Esra İbiş , Duygu Erkal , Mehmet Tonkaz , Tümay Bekci

https://doi.org/10.70058/cjm.1562420

Öz

Objective: Cervical magnetic resonance (MR) imaging is routinely employed for the assessment of cervical disc pathologies, the evaluation of the cervical spinal canal, and the detection of spinal lesions. The aim of this study was to determine the prevalence of extraspinal incidental findings in patients undergoing cervical MR imaging and to assess the reporting rates of these findings in archived radiologic reports.

Methods: A retrospective review was conducted of digital patient archives between January 2022 and December 2023, comprising 1,000 patients who underwent cervical MR imaging at our institution. Two radiologists jointly identified extraspinal incidental findings. This descriptive study analyzed images obtained using a 1.5 Tesla MR imaging system with standard neck coils, evaluating the prevalence and reporting frequency of incidental findings.

Results: Among 1,000 patients (580 males, 420 females, mean age: 49±31 years), extraspinal incidental findings were observed in 66.4% (n=664) of cases. The most frequent findings were thyroid nodules (13.8%, n=138), goiter (12.2%, n=122), and mucosal thickening of the paranasal sinuses (11.5%, n=115). Incidental findings were more prevalent in women and in the middle-aged group (35-59 years). Only 14.6% of the 664 incidental lesions were documented in radiology reports. These lesions exhibited variability in anatomical location.

Conclusions: This study demonstrates that extraspinal incidental findings are common in routine cervical MR imaging but are often overlooked in radiological reports. Given the potential clinical significance of these findings, their inclusion in reports is important for patient care and management.

Anahtar Kelimeler

Incidental findings, Cervical spine, Extraspinal findings, Magnetic resonance imaging, Radiological reporting.

Etik Beyan

Giresun Eğitim Ve Araştırma Hastanesi 20.11.2023/24 karar numarası ile Etik kuruldan kurum izni alındı. Yazarlar, bu makalede bildirilen çalışmayı etkileyebilecek bilinen hiçbir rekabet eden mali çıkarları veya kişisel ilişkileri olmadığını beyan etmektedir. Bu çalışma başka bir yerde tekrar yayınlanmamıştır veya gönderilmemiştir. Yazarlar, bu makalenin araştırılması ve/veya yazarlığı için hiçbir mali destek almamıştır. Yazarlar, bu makalenin yayınlanmasıyla ilgili hiçbir çıkar çatışması olmadığını beyan etmektedir.

Servikal vertebra manyetik rezonans görüntülemesinde ekstraspinal insidental bulgular

Öz

Kaynakça

• Wagner SC, Morrison WB, Carrino JA, Schweitzer ME, Nothnagel H. Picture archiving and communication system: effect on reporting of incidental findings. Radiology. 2002;225(2):500- 505. doi:10.1148/radiol.2252011731
• Sze G. Recent advances in spinal magnetic resonance imaging. Can Assoc Radiol J. 1991;42(3):190-198.
• Yap KK, Ramaseshan G, Sutherland T, Shafik-Eid R, Taubman K, Schlicht S. Prevalence of incidental or unexpected findings on low-dose CT performed during routine SPECT/CT nuclear medicine studies. J Med Imaging Radiat Oncol. 2015;59(1):26- 33. doi:10.1111/1754-9485.12254
• Anil G, Hegde A, Chong FH. Thyroid nodules: risk stratification for malignancy with ultrasound and guided biopsy. Cancer Imaging. 2011;11(1):209-223. Published 2011 Dec 28. doi:10.1102/1470-7330.2011.0030
• Rak KM, Newell JD 2nd, Yakes WF, Damiano MA, Luethke JM. Paranasal sinuses on MR images of the brain: significance of mucosal thickening. AJR Am J Roentgenol. 1991;156(2):381- 384. doi:10.2214/ajr.156.2.1898819
• Lupi I, Zhang J, Gutenberg A, et al. From pituitary expansion to empty sella: disease progression in a mouse model of autoimmune hypophysitis. Endocrinology. 2011;152(11):4190- 4198. doi:10.1210/en.2011-1004
• McKinney AM. Atlas of normal imaging variations of the brain, skull, and craniocervical vasculature. Springer; 2017.
• Bal M, Salturk Z, Bal EC. Et al. Mucous retention cysts in the paranasal sinuses: A retrospective study. Online Journal of Otolaryngology 2016;6(2)..
• Sekiya K, Watanabe M, Nadgir RN, et al. Nasopharyngeal cystic lesions: Tornwaldt and mucous retention cysts of the nasopharynx: findings on MR imaging. J Comput Assist Tomogr. 2014;38(1):9-13. doi:10.1097/RCT.0b013e3182a77699
• King AD, Wong LYS, Law BKH, et al. MR Imaging Criteria for the Detection of Nasopharyngeal Carcinoma: Discrimination of Early-Stage Primary Tumors from Benign Hyperplasia. AJNR Am J Neuroradiol. 2018;39(3):515-523. doi:10.3174/ajnr.A5493
• Sekula RF Jr, Jannetta PJ, Casey KF, Marchan EM, Sekula LK, McCrady CS. Dimensions of the posterior fossa in patients symptomatic for Chiari I malformation but without cerebellar tonsillar descent. Cerebrospinal Fluid Res. 2005;2:11. Published 2005 Dec 18. doi:10.1186/1743-8454-2-11
• van den Brekel MW, Stel HV, Castelijns JA, et al. Cervical lymph node metastasis: assessment of radiologic criteria. Radiology. 1990;177(2):379-384. doi:10.1148/radiology.177.2.2217772
• Lan M, Huang Y, Chen CY, et al. Prognostic Value of Cervical Nodal Necrosis in Nasopharyngeal Carcinoma: Analysis of 1800 Patients with Positive Cervical Nodal Metastasis at MR Imaging [published correction appears in Radiology. 2015 Aug;276(2):619. doi: 10.1148/radiol.15154020]. Radiology. 2015;276(2):536-544. doi:10.1148/radiol.15141251
• Steinkamp HJ, Cornehl M, Hosten N, Pegios W, Vogl T, Felix R. Cervical lymphadenopathy: ratio of long- to short-axis diameter as a predictor of malignancy. Br J Radiol. 1995;68(807):266- 270. doi:10.1259/0007-1285-68-807-266
• Karnaze MG, Sartor K, Winthrop JD, Gado MH, Hodges FJ 3rd. Suprasellar lesions: evaluation with MR imaging. Radiology. 1986;161(1):77-82. doi:10.1148/radiology.161.1.3763887
• Elster AD, Challa VR, Gilbert TH, Richardson DN, Contento JC. Meningiomas: MR and histopathologic features. Radiology. 1989;170(3 Pt 1):857-862. doi:10.1148/radiology.170.3.2916043
• Geibprasert S, Pongpech S, Jiarakongmun P, Shroff MM, Armstrong DC, Krings T. Radiologic assessment of brain arteriovenous malformations: what clinicians need to know [published correction appears in Radiographics. 2011 May-Jun;31(3):904]. Radiographics. 2010;30(2):483-501. doi:10.1148/rg.302095728
• Ikushima I, Korogi Y, Makita O, et al. MRI of arachnoid granulations within the dural sinuses using a FLAIR pulse sequence. Br J Radiol. 1999;72(863):1046-1051. doi:10.1259/ bjr.72.863.10700819
• Westbrook JI, Braithwaite J, McIntosh JH. The outcomes for patients with incidental lesions: serendipitous or iatrogenic?. AJR Am J Roentgenol. 1998;171(5):1193-1196. doi:10.2214/ ajr.171.5.9798845
• Kamath S, Jain N, Goyal N, Mansour R, Mukherjee K. Incidental findings on MRI of the spine. Clin Radiol. 2009;64(4):353-361. doi:10.1016/j.crad.2008.09.010
• Ottonello C, Giuliani P, Giardino A, Lombardi L, Sardanelli F. Thyroid abnormalities as incidental findings in cervical spine MRI. European Congress of Radiology-ECR 2014. (2014, March).
• Mehanna HM, Jain A, Morton RP, Watkinson J, Shaha A. Investigating the thyroid nodule. BMJ. 2009;338:b733. Published 2009 Mar 13. doi:10.1136/bmj.b733
• Hansen AG, Helvik AS, Nordgård S, et al. Incidental findings in MRI of the paranasal sinuses in adults: a population-based study (HUNT MRI). BMC Ear Nose Throat Disord. 2014;14(1):13. Published 2014 Nov 25. doi:10.1186/1472-6815-14-13
• Foresti M, Guidali A, Susanna P. Sella vuota primitiva. Frequenza in 500 soggetti asintomatici esaminati con risonanza magnetica [Primary empty sella. Incidence in 500 asymptomatic subjects examined with magnetic resonance]. Radiol Med. 1991;81(6):803-807.
• Kollias SS, Ball WS Jr, Prenger EC. Cystic malformations of the posterior fossa: differential diagnosis clarified through embryologic analysis. Radiographics. 1993;13(6):1211-1231. doi:10.1148/radiographics.13.6.8031352
• Al-Holou WN, Terman S, Kilburg C, Garton HJ, Muraszko KM, Maher CO. Prevalence and natural history of arachnoid cysts in adults. J Neurosurg. 2013;118(2):222-231. doi:10.3171/2012.10. JNS12548
• Bal M, Berkiten G, Uyanık E. Mucous retention cysts of the paranasal sinuses. Hippokratia. 2014;18(4):379.
• Tarp B, Fiirgaard B, Christensen T, Jensen JJ, Black FT. The prevalence and significance of incidental paranasal sinus abnormalities on MRI. Rhinology. 2000;38(1):33-38.
• Dilli A, Ayaz UY, Turanlı S, et al. Incidental extraspinal findings on magnetic resonance imaging of intervertebral discs. Arch Med Sci. 2014;10(4):757-763. doi:10.5114/aoms.2014.44868
• Kızılgöz V, Kantarcı M, Aydemir H. Incidental findings of cervical magnetic resonance imaging: A retrospective reinterpretation of a large adult population. Acta Radiol Open. 2024;13(4):20584601241244785. Published 2024 Apr 4. doi:10.1177/20584601241244785
• Frager DH, Elkin CM, Kansler F, Mendelsohn SL, Leeds NE. Extraspinal abnormalities identified on lumbar spine CT. Neuroradiology. 1986;28(1):58-60. doi:10.1007/ BF00341767
• Moss WJ, Finegersh A, Narayanan A, et al. Characterizing Posterior Neck Masses: A Single-Institution Retrospective and Systematic Review. Ear Nose Throat J. 2021;100(5_suppl):766S- 770S. doi:10.1177/0145561319881845
• Guo X, Wu Y, Fang J. Incidence and Prognostic Factors of Patients with Benign Pituitary Tumors Based on the Surveillance, Epidemiology, and End Results (SEER) Database. World Neurosurg. 2022;165:e30-e42. doi:10.1016/j.wneu.2022.04.113
• Kızılgöz V, Aydın H, Sivrioğlu AK, Özcan ÜC, Menderes U, Karayol SS, Erdem A. Incidences and reporting rates of incidental findings on lumbar, thoracic, and cervical spinal magnetic resonance images and extra-neuronal findings on brain magnetic resonance imagesö. The European Research Journal. 2018; 5(3): 449-460.
• Kaya SS, Hatırlı H, Sahın MA, Genez S, Okçu M. Incidental findings detected on magnetic resonance imaging scans of the cervical, thoracic and lumbar spine of patients prediagnosed with discopathy. Marmara Medical Journal. 2023; 36(2): 210-214.