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Clinical Question
In people without symptoms who undergo magnetic resonance imaging, what is the likelihood of finding an abnormality?
Bottom line
What do we find when we're not looking for anything? Approximately 1 in 6 asymptomatic people who undergo full-body magnetic resonance imaging (MRI), which is increasingly being offered on a pay-as-you-go basis, will have some sort of abnormality found. Of these patients, approximately 25% will have potentially serious findings. More limited screening MRI of the unsick will result in a lower likelihood of findings that require further investigation. Early detection may not be useful even in the potentially serious cases; it may cause more harm than good. 2a
Reference
Study design: Meta-analysis (other)
Funding: Foundation
Setting: Various (meta-analysis)
Synopsis
These researchers identified 32 research studies that evaluated 27,643 patients by searching MEDLINE, EMBASE, and the citations of retrieved studies. They included studies that described the prevalence and types of incidental findings of MRI testing of the brain, thorax, abdomen, or brain and body of asymptomatic individuals. One researcher selected studies for inclusion and extracted the data, and a second author checked a sample. Most (20) of the studies were performed in Europe and the rest were performed in North America, Asia, and Australia. Overall, assuming that each finding was in a separate person, 16.9% of patients who had a brain and body MRI had a positive finding; 3.9% of individuals had potentially serious findings. Abdominal-only MRI resulted in findings in 6.4% of individuals, with 1.9% having potentially serious findings. Imaging the thorax discovered something 4.3% of the time, though only 1.3% of people had potentially serious findings. Brain MRI resulted in positive results in 3.1%; 1.4% of individuals had potentially serious findings. For each type of imaging, approximately half of the potentially serious findings were suspected malignancy, which on the surface sounds like a good thing to discover until we realize that many of these suspected tumors may not be destined to cause harm or might regress without treatment.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Related to practice
We actually should never do any MRI screening
MRI Screening
I think in view of our move away from diagnostic verification in medicine as witnessed by the death of the autopsy and our over reliance on imaging and move away from clinical investigation we should move in the direction of early imaging diagnosis. George Magee