Avoid the Abdomen: No Added Value of Abdominal MRI in Pelvic Diagnoses

From the 2018 HVPAA National Conference

Ilana Kafer (NYU Langone Health), Danny Kim (NYU Langone Health)

Background

MRI exams for the assessment of pelvic pathologies are commonly ordered with concomitant abdominal MRIs but without an indication for the additional exam.  Although serial MRI examinations do not pose radiation risks, unnecessary scanning has its own inherent risks. The value of abdominal MRI for improving diagnostic accuracy is unknown.

Objectives

The primary objective of this study was to determine the frequency by which abdominal MRI scans contribute to the ultimate diagnosis on the pelvic MRI.The secondary objective of this study was to determine the rate of incidental findings on abdominal MRI scans.

Methods

As part of a quality improvement initiative, we completed a retrospective chart review of all patients at a single institution that had an abdomen and pelvis MRI which were protocoled as “female pelvis” and “screening abdomen” scanned between between 1/1/2017 and 10/26/2017. The scans were evaluated by a radiology fellow and the clinical indication, protocol, and incidental findings were extracted from the radiology report.Incidental findings were considered positive when the abdominal finding was not related to the clinical question or the ultimate diagnosis. Frequency data were tabulated using Microsoft Excel.

Results

A total of 104 exams met the inclusion criteria. Clinical indications are described in Table 1. Preliminary results are as follows. Of the abdominal examinations ordered, 91% (95/104) did not contribute to the overall pelvic diagnosis; The 9% (9/104) that did contribute to the ultimate diagnosis were all cancer patients with known metastases. Of the 104 studies, 16% (17/104) had findings within the abdominal MRI that did not contribute to the diagnosis and were considered incidental.Of the incidental findings, 35% (6/17) were clinically relevant.

Incidental findings were as follows: 6 pancreatic cysts, 5 chest findings including pleural effusion, lymphadenopathy and patchy opacities, 3 adrenal adenomas, 1 liver lesion, 1 breast finding, and 1 patient with both chest findings and an adrenal adenoma.

Conclusion

Additional abdominal MRIs did not contribute to the ultimate diagnosis in 91% of the patients who were scanned with a pelvic MRI.However, 16% of patients had incidental findings on their abdominal MRI that did not contribute to the pelvic diagnosis. This study demonstrates that MRI abdomen is often ordered concurrently and performed regardless of clinical necessity, resulting in a moderate rate of incidental findings.

Implications for the Patient

This study demonstrates that the vast majority of abdominal MRI scans added to pelvic protocols without clinical indication do not contribute diagnostic accuracy. As part of our quality initiative, we have begun educating clinicians and radiology staff on the appropriate indications for an additional abdominal MRI scan.