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Sluijter TE, Yakar D, Roest C, Tsoumpas C, Kwee TC. Does FDG-PET/CT for incidentally found pulmonary lesions lead to a cascade of more incidental findings? Clin Imaging 2024; 108:110116. [PMID: 38460254 DOI: 10.1016/j.clinimag.2024.110116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/13/2024] [Accepted: 02/28/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVE To determine the frequency, nature, and downstream healthcare costs of new incidental findings that are found on whole-body FDG-PET/CT in patients with a non-FDG-avid pulmonary lesion ≥10 mm that was incidentally found on previous imaging. MATERIALS AND METHODS This retrospective study included a consecutive series of patients who underwent whole-body FDG-PET/CT because of an incidentally found pulmonary lesion ≥10 mm. RESULTS Seventy patients were included, of whom 23 (32.9 %) had an incidentally found pulmonary lesion that proved to be non-FDG-avid. In 12 of these 23 cases (52.2 %) at least one new incidental finding was discovered on FDG-PET/CT. The total number of new incidental findings was 21, of which 7 turned out to be benign, 1 proved to be malignant (incurable metastasized cancer), and 13 whose nature remained unclear. One patient sustained permanent neurologic impairment of the left leg due to iatrogenic nerve damage during laparotomy for an incidental finding which turned out to be benign. The total costs of all additional investigations due to the detection of new incidental findings amounted to €9903.17, translating to an average of €141.47 per whole-body FDG-PET/CT scan performed for the evaluation of an incidentally found pulmonary lesion. CONCLUSION In many patients in whom whole-body FDG-PET/CT was performed to evaluate an incidentally found pulmonary lesion that turned out to be non-FDG-avid and therefore very likely benign, FDG-PET/CT detected new incidental findings in our preliminary study. Whether the detection of these new incidental findings is cost-effective or not, requires further research with larger sample sizes.
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Affiliation(s)
- Tim E Sluijter
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine, and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Derya Yakar
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine, and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Netherlands Cancer Institute, Amsterdam, Department of Radiology, the Netherlands
| | - Christian Roest
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine, and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Charalampos Tsoumpas
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine, and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Thomas C Kwee
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine, and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Kwee TC, Yakar D, Sluijter TE, Pennings JP, Roest C. Can we revolutionize diagnostic imaging by keeping Pandora's box closed? Br J Radiol 2023; 96:20230505. [PMID: 37906185 PMCID: PMC10646642 DOI: 10.1259/bjr.20230505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/15/2023] [Accepted: 09/09/2023] [Indexed: 11/02/2023] Open
Abstract
Incidental imaging findings are a considerable health problem, because they generally result in low-value and potentially harmful care. Healthcare professionals struggle how to deal with them, because once detected they can usually not be ignored. In this opinion article, we first reflect on current practice, and then propose and discuss a new potential strategy to pre-emptively tackle incidental findings. The core principle of this concept is to keep the proverbial Pandora's box closed, i.e. to not visualize incidental findings, which can be achieved using deep learning algorithms. This concept may have profound implications for diagnostic imaging.
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Affiliation(s)
- Thomas C Kwee
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Derya Yakar
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Tim E Sluijter
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jan P Pennings
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Christian Roest
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Sluijter TE, Yakar D, Kwee TC. On-call abdominal ultrasonography: the rate of negative examinations and incidentalomas in a European tertiary care center. Abdom Radiol (NY) 2022; 47:2520-2526. [PMID: 35486165 PMCID: PMC9226090 DOI: 10.1007/s00261-022-03525-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 11/24/2022]
Abstract
Objectives To determine the proportions of abdominal US examinations during on-call hours that are negative and that contain an incidentaloma, and to explore temporal changes and determinants. Methods This study included 1615 US examinations that were done during on-call hours at a tertiary care center between 2005 and 2017. Results The total proportion of negative US examinations was 49.2% (795/1615). The total proportion of US examinations with an incidentaloma was 8.0% (130/1615). There were no significant temporal changes in either one of these proportions. The likelihood of a negative US examination was significantly higher when requested by anesthesiology [odds ratio (OR) 2.609, P = 0.011], or when the indication for US was focused on gallbladder and biliary ducts (OR 1.556, P = 0.007), transplant (OR 2.371, P = 0.005), trauma (OR 3.274, P < 0.001), or urolithiasis/postrenal obstruction (OR 3.366, P < 0.001). In contrast, US examinations were significantly less likely to be negative when requested by urology (OR 0.423, P = 0.014), or when the indication for US was acute oncology (OR 0.207, P = 0.045) or appendicitis (OR 0.260, P < 0.001). The likelihood of an incidentaloma on US was significantly higher in older patients (OR 1.020 per year of age increase, P < 0.001) or when the liver was evaluated with US (OR 3.522, P < 0.001). Discussion Nearly 50% of abdominal US examinations during on-call hours are negative, and 8% reveal an incidentaloma. Requesting specialty and indication for US affect the likelihood of a negative examination, and higher patient age and liver evaluations increase the chance of detecting an incidentaloma in this setting. These data may potentially be used to improve clinical reasoning and restrain overutilization of imaging. Supplementary Information The online version contains supplementary material available at 10.1007/s00261-022-03525-1.
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Affiliation(s)
- Tim E Sluijter
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Derya Yakar
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Thomas C Kwee
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
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Veen EJD, Koorevaar CT, Verdonschot KHM, Sluijter TE, de Groot T, van der Hoeven JH, Diercks RL, Stevens M. Compensatory Movement Patterns Are Based on Abnormal Activity of the Biceps Brachii and Posterior Deltoid Muscles in Patients with Symptomatic Rotator Cuff Tears. Clin Orthop Relat Res 2021; 479:378-388. [PMID: 33177479 PMCID: PMC7899608 DOI: 10.1097/corr.0000000000001555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/12/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Abnormal movement patterns due to compensatory mechanisms have been reported in patients with rotator cuff tears. The long head of the biceps tendon may especially be overactive and a source of pain and could induce abnormal muscle activation in these patients. It is still unknown why some patients with a rotator cuff tear develop complaints and others do not. QUESTIONS/PURPOSES (1) Which shoulder muscles show a different activation pattern on electromyography (EMG) while performing the Functional Impairment Test-Hand and Neck/Shoulder/Arm (FIT-HaNSA) in patients with a symptomatic rotator cuff tear compared with age-matched controls with an intact rotator cuff? (2) Which shoulder muscles are coactivated on EMG while performing the FIT-HaNSA? METHODS This comparative study included two groups of people aged 50 years and older: a group of patients with chronic symptomatic rotator cuff tears (confirmed by MRI or ultrasound with the exclusion of Patte stage 3 and massive rotator cuff tears) and a control group of volunteers without shoulder conditions. Starting January 2019, 12 patients with a chronic rotator cuff tear were consecutively recruited at the outpatient orthopaedic clinic. Eleven age-matched controls (randomly recruited by posters in the hospital) were included after assuring the absence of shoulder complaints and an intact rotator cuff on ultrasound imaging. The upper limb was examined using the FIT-HaNSA (score: 0 [worst] to 300 seconds [best]), shoulder-specific instruments, health-related quality of life, and EMG recordings of 10 shoulder girdle muscles while performing a tailored FIT-HaNSA. RESULTS EMG (normalized root mean square amplitudes) revealed hyperactivity of the posterior deltoid and biceps brachii muscles during the upward phase in patients with rotator cuff tears compared with controls (posterior deltoid: 111% ± 6% versus 102% ± 10%, mean difference -9 [95% confidence interval -17 to -1]; p = 0.03; biceps brachii: 118% ± 7% versus 111% ± 6%, mean difference -7 [95% CI -13 to 0]; p = 0.04), and there was decreased activity during the downward phase in patients with rotator cuff tears compared with controls (posterior deltoid: 89% ± 6% versus 98% ± 10%, mean difference 9 [95% CI 1 to 17]; p = 0.03; biceps brachii: 82% ± 7% versus 89% ± 6%, mean difference 7 [95% CI 0 to 14]; p = 0.03). The posterior deltoid functioned less in conjunction with the other deltoid muscles, and lower coactivation was seen in the remaining intact rotator cuff muscles in the rotator cuff tear group than in the control group. CONCLUSION Patients with a symptomatic rotator cuff tear show compensatory movement patterns based on abnormal activity of the biceps brachii and posterior deltoid muscles when compared with age-matched controls. The posterior deltoid functions less in conjunction with the other deltoid muscles, and lower coactivation was seen in the remaining intact rotator cuff muscles in the rotator cuff tear group than the control group. CLINICAL RELEVANCE This study supports the potential benefit of addressing the long head biceps tendon in the treatment of patients with a symptomatic rotator cuff tear. Moreover, clinicians might use these findings for conservative treatment; the posterior deltoid can be specifically trained to help compensate for the deficient rotator cuff.
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Affiliation(s)
- Egbert J D Veen
- E. J. D. Veen, K. H. M. Verdonschot, T. E. Sluijter, T. de Groot, R. L. Diercks, M. Stevens, Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- C. T. Koorevaar, Department of Orthopedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
- K. H. M. Verdonschot, Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- J. H. van der Hoeven, Department of Neurology and Neurophysiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Cornelis T Koorevaar
- E. J. D. Veen, K. H. M. Verdonschot, T. E. Sluijter, T. de Groot, R. L. Diercks, M. Stevens, Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- C. T. Koorevaar, Department of Orthopedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
- K. H. M. Verdonschot, Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- J. H. van der Hoeven, Department of Neurology and Neurophysiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Koen H M Verdonschot
- E. J. D. Veen, K. H. M. Verdonschot, T. E. Sluijter, T. de Groot, R. L. Diercks, M. Stevens, Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- C. T. Koorevaar, Department of Orthopedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
- K. H. M. Verdonschot, Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- J. H. van der Hoeven, Department of Neurology and Neurophysiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tim E Sluijter
- E. J. D. Veen, K. H. M. Verdonschot, T. E. Sluijter, T. de Groot, R. L. Diercks, M. Stevens, Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- C. T. Koorevaar, Department of Orthopedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
- K. H. M. Verdonschot, Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- J. H. van der Hoeven, Department of Neurology and Neurophysiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tom de Groot
- E. J. D. Veen, K. H. M. Verdonschot, T. E. Sluijter, T. de Groot, R. L. Diercks, M. Stevens, Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- C. T. Koorevaar, Department of Orthopedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
- K. H. M. Verdonschot, Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- J. H. van der Hoeven, Department of Neurology and Neurophysiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes H van der Hoeven
- E. J. D. Veen, K. H. M. Verdonschot, T. E. Sluijter, T. de Groot, R. L. Diercks, M. Stevens, Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- C. T. Koorevaar, Department of Orthopedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
- K. H. M. Verdonschot, Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- J. H. van der Hoeven, Department of Neurology and Neurophysiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ronald L Diercks
- E. J. D. Veen, K. H. M. Verdonschot, T. E. Sluijter, T. de Groot, R. L. Diercks, M. Stevens, Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- C. T. Koorevaar, Department of Orthopedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
- K. H. M. Verdonschot, Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- J. H. van der Hoeven, Department of Neurology and Neurophysiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Stevens
- E. J. D. Veen, K. H. M. Verdonschot, T. E. Sluijter, T. de Groot, R. L. Diercks, M. Stevens, Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- C. T. Koorevaar, Department of Orthopedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
- K. H. M. Verdonschot, Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- J. H. van der Hoeven, Department of Neurology and Neurophysiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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