Sabine Weckbach

Management of radiological incidental findings (IF) is of rising importance; however, psychosocial implications of IF reporting remain unclear. We compared long-term psychosocial effects between individuals who underwent whole-body magnetic resonance imaging (MRI) with and without reported IF, and individuals who did not undergo imaging. We used a longitudinal population-based cohort from Western Europe. Longitudinal analysis included three examinations (exam 1, 6 years prior to MRI; exam 2, MRI; exam 3, 4 years after MRI). Psychosocial outcomes included PHQ-9 (Patient Health Questionnaire), DEEX (Depression and Exhaustion Scale), PSS-10 (Perceived Stress Scale) and a Somatization Scale. Univariate analyses and adjusted linear mixed models were calculated. Among 855 included individuals, 25% (n = 212) underwent MRI and 6% (n = 50) had at least one reported IF. Compared to MRI participants, non-participants had a higher psychosocial burden indicated by PHQ-9 in exam 1 (3.3 ± 3.3 vs. 2.5 ± 2.3) and DEEX (8.6 ± 4.7 vs. 7.7 ± 4.4), Somatization Scale (5.9 ± 4.3 vs. 4.8 ± 3.8) and PSS-10 (14.7 ± 5.7 vs. 13.7 ± 5.3, all p < 0.05) in exam 3. MRI participation without IF reporting was significantly associated with lower values of DEEX, PHQ-9 and Somatization Scale. There were no significant differences at the three timepoints between MRI participants with and without IF. In conclusion, individuals who voluntarily participated in whole-body MRI had less psychosocial burden and imaging and IF reporting were not associated with adverse long-term psychosocial consequences. However, due to the study design we cannot conclude that the MRI exam itself represented a beneficial intervention causing improvement in mental health scores.

Background: To analyse the influence of whole body (wb)-MRI on patient management compared to routine diagnostic tests in patients with fever of unknown origin (FUO). Methods: Twenty-four patients with FUO, defined as illness of more than three weeks with fever greater than 38.3 °C, underwent wb-MRI at a 1.5 T MR-system. The MR-protocol consisted of the following sequences: axial T1 VIBE, coronal T2-TIRM and a coronal echoplanar diffusion weighted sequence (overall acquisition time 29:39 min:s). Furthermore, laboratory findings, chest-x-ray, abdominal ultrasound, CT-scans and/or PET-CT scans were evaluated and compared to the wb-MRI findings in regard to treatment changes. Results: Wb-MRI yielded a correct diagnosis in 70% of the patients. In 46% the inflammatory focus was exclusively detected by wb-MRI. Focus detection by wb-MRI led to a subsequent change of the clinical management in 92% of the patients. In 6 patients both a wb-MRI and a PET-CT were performed yielding the correct diagnosis in the same 4 of 6 patients for both imaging modalities. Conclusions: Wb-MRI appears to be of value in the evaluation of FUO patients, allowing for optimized treatment by increasing diagnostic certainty. Due to its lack of nephrotoxicity and ionizing radiation it may be preferred over standard imaging techniques and PET-CT in the future. However, given the low number of patients in our trial, further prospective studies have to be performed to confirm our results.

Kurzfassung: Die NAKO Gesundheitsstudie (NAKO) ist eine multizentrische Kohortenstudie, die die Erforschung der Ursachen für die Entstehung von Volkskrankheiten zum Ziel hat. In die Studie sollen dabei 200.000 Probanden im Alter von 20 bis 69 Jahren eingeschlossen werden. Neben diversen körperlichen Untersuchungen und dem Sammeln von Bioproben erhält eine Untergruppe von 30.000 Probanden eine Ganzkörper-Magnetresonanztomografie (GK-MRT) in einem der fünf dezidierten Studienzentren in Deutschland. Um bei diesem großen Patientenkollektiv eine hohe Reproduzierbarkeit und gleichbleibend hohe Bildqualität zu gewährleisten, erfolgt eine zentrale Qualitätssicherung durch einen sogenannten „MR imaging core”, welcher aus vier Untereinheiten besteht: einem Zentrum für Datenverarbeitung (Bremen), für Studienkoordination und Training (München), einem Zentrum für Qualitätskontrolle (Greifswald) und einem Zentrum für das Management der Zufallsergebnisse (Incidental Findings, IF) (Heidelberg). Je nach Studiendesign zeigen ca. 10% der Probanden relevante IF in GK-MRT-Untersuchungen. Hier stellt sich das grundsätzliche Problem zu entscheiden, welche dieser Ergebnisse den Teilnehmern mitgeteilt werden sollen. Um bei der großen Anzahl der beteiligten Radiologen einen einheitlichen Umgang mit IFs zu gewährleisten, wurde ein komplexes System zur Erfassung und Mitteilung von Zufallsergebnissen entwickelt: Die Studienradiologen wählen, nachdem sie ein mehrstufiges Training durchlaufen haben, in einem eigens entwickelten, web-basierten Betrachtungsprogramm aus einer vorgegebenen Liste von relevanten Zufallsergebnissen das betreffende IF aus und markieren es, so dass dann je nach Dringlichkeit eine telefonische oder postalische Ergebnisübermittlung an die Probanden erfolgt. Lernziele: Unser Poster wird eine ausführlichere Übersicht über das Management von Zufallsbefunden in der NAKO geben und anhand von Bildbeispielen verschiedene Kategorieren von Zufallsbefunden illustrieren.

Objective (1) To examine how many patients have clinically and/or radiologically active chronic recurrent multifocal osteomyelitis (CRMO) ≥ 10 years after first onset of symptoms, and (2) to compare clinical and whole-body magnetic resonance imaging (WB-MRI) findings. Methods Seventeen patients (82% women) who were diagnosed with childhood-onset CRMO at least 10 years (average 12) before reexamination were reevaluated. Patients completed a standardized questionnaire, and underwent clinical and laboratory investigation and WB-MRI. Clinical features were compared with imaging findings. Results Five patients were found to be in clinical and radiological remission. One of these patients demonstrated 1 radiologically inactive lesion on WB-MRI. Four patients showed radiologically active lesions despite full clinical remission, 2 of them in 3 vertebral bodies. Spinal involvement in 6 patients (35%) caused vertebral compression fractures, vertebra plana, or vertebral hemifusion. Eight patients presented with ongoing clinical disease activity. When applying a CRMO activity score based on clinical and imaging findings, 2 patients were identified as having pain amplification. Overall, 22/55 known CRMO lesions were identified; 11 of them were radiologically active lesions. Additionally, 14 so far unknown clinically silent lesions were detected: 8 radiologically active lesions and 6 radiologically inactive lesions. Conclusion CRMO activity on longterm followup might have been underestimated. Our study demonstrates that clinical remission does not necessarily mean radiological remission. We therefore propose that all patients with CRMO, including patients in clinical remission, require longterm clinical followup and should undergo evaluation with WB-MRI on a regular basis until radiological remission or a steady state of disease is achieved.

Whole-body MRI (WBMRI) is an excellent tool for the imaging of rheumatologic diseases with a multifocal and systemic character. These include the different forms of spondyloarthritis, chronic recurrent multifocal osteomyelitis (CRMO), and inflammatory muscle diseases along with diseases such as systemic lupus and systemic sclerosis that show organ involvement. Although it is not recommended as a first-line investigation in every patient, it may add important information in difficult cases. Currently WBMRI for inflammatory arthritis is mainly used in imaging the seronegative spondyloarthropathies. The technique visualizes most of the involved joints and soft tissue structures with both (early) active and chronic inflammatory changes in one examination. Different patterns of joint involvement can be recognized, with both the acute features of the disease and the longer term sequelae being shown. The technique also allows therapeutic response to be assessed. In CRMO, WBMRI is able to detect asymptomatic and radiographically occult multifocal lesions that typically show a symmetrical distribution predominating in the lower extremity. In inflammatory muscle diseases, WBMRI is able to provide important information for biochemical and genetic differential diagnosis because there is growing knowledge of the correlation between typical patterns of disease and defined clinical entities. In addition, it helps in biopsy localization and is very well suited for assessing disease activity. WBMRI is particularly useful for studying internal organ involvement, especially the brain, heart, and lungs in connective tissue diseases such as systemic lupus erythematosus in one whole-body exam.