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Musculoskeletal Imaging

E1066. A Simple Cyst or Carcinoma? Which Incidental Body Findings on MSK MRI Matter and How to Triage Them

Leake R,  Rezvani M,  Hanrahan C,  Hansford B. University of Utah School of Medicine, Salt Lake City, UT

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Background Information: Ever-improving MRI resolution coupled with an increasing number of sequences acquired per study as well as rising use has not only resulted in increased diagnostic accuracy, but also a concomitant increase in the recognition of incidental pathology. For musculoskeletal radiologists, there are many organs within the abdomen and pelvis which are at least partially included in the field of view and may harbor significant incidental findings that can potentially drastically and immediately alter patient care.

Educational Goals/Teaching Points: Our purpose is to review the imaging features of common incidental findings seen on musculoskeletal MRI using an organ-based approach (adnexa, uterus, urinary, adrenal, renal, bowel, prostate, liver, spleen,). We discuss localizer images and the radiologist’s responsibility of viewing them for incidental pathology and offer further imaging work-up, when necessary, based on the American College of Radiology appropriateness criteria. We present the radiologist’s fiduciary responsibility to relay incidental findings with a focus on which clinical scenarios require the most time-sensitive communication.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: Steps that should be taken for each incidental finding include to localize the abnormality to an organ or anatomic space, To identify key imaging features that allow for a more focused differential diagnosis if possible, to use PACS co-registration software as well as localizer and large field of view images to maximize available diagnostic information, To compare results to prior imaging studies, including across multiple modalities, to evaluate for stability and interval change to avoid recommending additional imaging, and to triage incidental pathology with a focus on emergent communication for critical, unexpected findings.

Conclusion: A fundamental understanding of common incidental pathology on musculoskeletal MRI coupled with pathology-specific appropriate imaging recommendations and time-sensitive communication with actionable reports increases the radiologist’s value as a key consultant for the clinical team, ultimately leading to better patient outcomes.