Research cardiac magnetic resonance imaging in end stage renal disease - incidence, significance and implications of unexpected incidental findings

Elaine Rutherford (Lead / Corresponding author), Jonathan R. Weir-McCall, Rajan K. Patel, J. Graeme Houston, Giles Roditi, Allan D. Struthers, Alan G. Jardine, Patrick B. Mark

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)
155 Downloads (Pure)

Abstract

Objectives: Left ventricular mass (LVM) at cardiac magnetic resonance imaging (CMR) is a frequent end point in clinical trials in nephrology. Trial participants with end stage renal disease (ESRD) may have a greater frequency of incidental findings (IF). We retrospectively investigated prevalence of IF in previous research CMR and reviewed their subsequent impact on participants.

Methods: Between 2002 and 2006, 161 ESRD patients underwent CMR in a transplant assessment study. Images were used to assess LV mass and function. In the current study a radiologist reviewed the scans for IF. Review of patient records determined the subsequent clinical significance of IF. 

Results: There were 150 IF in 95 study participants. Eighty-four (56 %) were new diagnoses. One hundred and two were non-cardiac. Fifteen were suspicious of malignancy. There was a clinically significant IF for 14.9 % of the participants. In six cases earlier identification of an IF may have improved quality of life or survival. 

Conclusions: Without radiology support clinically important IF may be missed on CMR. Patients undergoing CMR in trials should be counselled about the frequency and implications of IF. Patients with ESRD have a higher prevalence of IF than reported in other populations. Nephrology studies require mechanisms for radiologist reporting and strategies for dealing with IF. Key Points: • Incidental findings on research cardiac magnetic resonance imaging can have significant consequences.• We considered incidental findings in historical renal cardiac resonance imaging clinical trials.• Incidental findings are common and important in the chronic kidney disease population.• Without radiology support, clinically significant incidental findings may be missed on imaging.• Study protocols, approvals and consent processes should take account of possible findings.

Original languageEnglish
Pages (from-to)315-324
Number of pages10
JournalEuropean Radiology
Volume27
Issue number1
Early online date7 Apr 2016
DOIs
Publication statusPublished - Jan 2017

Keywords

  • Chronic kidney disease
  • Clinical trials
  • CMR
  • Incidental findings
  • MRI

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