Ketan Nalin Naran MD, Presenter: Nothing to Disclose

William Brian Morrison MD, Abstract Co-Author: Nothing to Disclose

Adam Eugene Flanders MD, Abstract Co-Author: Investigator, Hx Technologies, Inc, Phiiladelphia, PA Consultant, Geron Corporation, Denver, CO

Adam C. Zoga MD, Abstract Co-Author: Nothing to Disclose

Angela Gessner Gopez MD, Abstract Co-Author: Nothing to Disclose

Laurence Parker PhD, Abstract Co-Author: Nothing to Disclose

(1) To show that the use of PACS facilitates visualization of a wide field of view (2)To characterize the incidental findings reported on cervical spine MRI (3) To determine the effect of PACS implementation on the reporting of incidental findings on cervical spine MRI

A total of 3000 cervical spine MRI reports were reviewed. 500 consecutive full cervical spine MRI reports were reviewed in each of 6 different years: Pre-PACS (1994 and 1996), PACS transition at our institution (1998), and Post-PACS implementation (2000, 2002, 2004). All incidental findings outside the cervical spine stated in the report were documented. The number of incidental findings, anatomic structures involved, and number of imaging follow-up studies recommended were also documented. The estimated costs of these recommended follow-up imaging studies were calculated based on Medicare reimbursement tables.

A total of 290 incidental findings in 260 patients were found out of 3000 total cases. The number of incidental findings increased from 29 and 17 in two pre-PACS years to 34 during PACS transition and to 50, 73, and 87 in the years studied after PACS implementation. Comparing Pre- to Post-PACS years, the increase in the number of incidental findings was statistically significant, rising by 204% (p=0.001). Common incidental findings included 68 thyroid, 7 esophageal, 15 pulmonary, 38 nasopharyngeal, 74 posterior fossa, and 27 neck soft tissue abnormalities. The number of recommended follow-up studies went from 6 and 6 prior to PACS to 6 during PACS transition and increased to 13, 13, and 27 after PACS implementation, which resulted in an increase by 192% (p=0.001). The cost of follow-up studies also increased by 94%.

A variety of incidental findings are reported on routine cervical spine MRI examinations. PACS Implementation appears to be associated with an increase in incidental findings reported on cervical spine MRI imaging and an increase in recommended follow-up studies.

Use of PACS appears to be associated with increased incidental findings and recommended exams, with increased societal cost but potentially improved outcomes related to discovery of occult pathology.

Naran, K, Morrison, W, Flanders, A, Zoga, A, Gopez, A, Parker, L, Effect of PACS Implementation on Incidental Findings Reported on Cervical Spine MRI.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4431122.html