头颅磁共振平扫的脑外意外发现研究

Study of incidental extracerebral findings on brain nonenhanced magnetic resonance imaging

目的·探讨头颅磁共振(MRI)平扫脑外意外发现(IECFs)的发生率和漏诊率,评估其临床价值。方法·回顾性分析7 930例因怀疑颅内病变而行头颅MRI平扫的患者头颅MRI平扫资料,分析其IECFs。IECFs按临床意义分为3种类型:E1(无临床意义,如鼻窦黏膜增厚),E2(临床意义可能不大,如咽部对称性增厚),E3(有重要临床意义,如咽部非对称性增厚)。将结构式读片(从上至下按照器官系统逐一进行读片)的结果与初始的MRI报告结果进行比较,计算漏诊率。根据E3类IECFs患者的医疗记录,评价病变的临床意义和转归。结果·在7 930例患者中,发现53.13%的患者5 992处IECFs,其中E1类占82.2%(4 924/5 992),E2类占16.6%(995/5 992),E3类占1.2%(73/5 992)。IECFs和E1类的发现更常见于男性患者(P=0.000,P=0.024)。IECFs在不同的年龄组间比较,差异具有统计学意义(P=0.000)。IECFs总的漏诊率为56.9%(3 409/5 992);E3类IECFs的漏诊率为32.9%(24/73)。73例E3类IECFs患者中,34例(46.6%)患者在研究期间接受最终诊断和适当治疗。结论·在头颅MRI检查的患者中,IECFs普遍存在,近1/3的E3类IECFs可能会漏诊;根据临床价值对IECFs进行分级报告,有助于患者的诊治,减少漏诊。

Objective · To explore the frequency, nondetection rate, and clinical importance of incidental extracerebral findings （IECFs）on brain nonenhanced magnetic resonance imaging（MRI）. Methods · The MRI data of 7 930 cases with suspected intracerebral lesionin were retrospectively analyzed. IECFs were categorized as E1 （clinically unimportant, e.g., sinus mucosal thickening）, E2 （likely unimportant, e.g.,pharyngeal mucosal symmetrical thickening）, and E3 （potentially important, e.g., pharyngeal mucosal asymmetrical thickening）. The nondetection rate was determined by comparing the results of the structured approach with the initial MRI reports. The medical records were examined for patients with E3 IECFs to assess clinical importance and outcome of these lesions. Results · A total of 5 992 IECFs were found in 4 213 patients （53.13%, 4 213/7 930）. IECFs with E1 was 82.2% （4 924/5 992）, E2 was 16.6% （995/5 992） and E3 1.2% （73/5 992）. Overall IECFs and E1 findings were occurred more commonly in male patients （P=0.000, P=0.024）. And the statistically significant difference was also found among different age groups （P=0.000）. The nondetection rate was 56.9% （3 409/5 992） for overall IECFs and 32.9% （24/73） for E3 IECFs. Of the 73 patients with E3 IECFs, 34 （46.6%） received final diagnosis and appropriate treatment during the study period. Conclusion · IECFs are prevalent in clinical patients on brain MRI with a nondetection rate of 32.9% for potentially important （E3） findings. The reporting of IECFs according to clinical importance is helpful for patients’ management.