Lumbar Spine MRI: Missed Opportunities for Abdominal Aortic Aneurysm Detection |
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| Institution: | 1. Department of Radiology, Stanford University School of Medicine, Stanford, CA;2. Division of Emergency Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA;3. Department of Radiology, Newton-Wellesley Hospital, Newton, MA;1. Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada;2. Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA;1. Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA;2. Department of Radiation Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA;1. Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA;2. Department of Pathology, Stanford University Medical center, Stanford, CA;3. Department of Radiology, Johns Hopkins University, Baltimore, MD, USA;4. Department of Pathology, University of Massachusetts Medical School, Worcester, MA, USA;5. Department of Radiology, Duke University, Durham, NC, USA;6. Department of diagnostic Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH;7. Department of Radiology, Stanford University Medical center, Stanford, CA;1. Department of Radiology, University of Florida College of Medicine, Gainesville, FL;2. Department of Radiology, The Children''s Hospital of Philadelphia, Philadelphia, PA;3. Department of Radiology, Temple University Hospital, Philadelphia, PA;4. Department of Radiology, University of Massachusetts Medical School-Baystate, Springfield, MA;5. Department of Medical Imaging, University of Toronto, Toronto, ON, Canada;6. Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA;7. Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC;8. Department of Radiology, University of Michigan School of Medicine, Ann Arbor, MI;9. Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN;10. Veteran''s Health Administration-Tennessee Valley Healthcare System Geriatric Research, Education Clinical Center, Nashville, TN;11. Department of Radiology and Biomedical Imaging, Yale University School of MedicineNew Haven, CT;12. Department of Radiology, University of Massachusetts Medical School, Worcester, MA;1. Department of Radiology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA;2. Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA |
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| Abstract: | PurposeThe US Preventive Services Task Force (USPSTF) recommends 1-time sonographic screening for abdominal aortic aneurysms (AAAs) in male smokers ages 65-75 and other selected individuals in this age group based on risk factors. Patients in this age range are frequent utilizers of lumbar spine MRI, in which the abdominal aorta is typically fully imaged. The purpose of this study was to assess the potential detection rate of AAAs on lumbar spine MRI performed in the USPSTF screening age range with systematic aortic measurement and the frequency with which AAAs are currently reported in practice.Materials and MethodsAll consecutive lumbar spine MRI exams performed without contrast at a single academic tertiary care center over a 1-year period (4/1/2016-3/31/2017) in patients ages 65-75 were retrospectively reviewed. Maximal anteroposterior, and transverse dimensions of the abdominal aorta were measured using axial T2-weighted images, supplemented with sagittal T2-weighted images if assessment was limited by field-of-view or artifact. The detection rate of AAA, defined as dilation of the aorta to a diameter of ≥3 cm, size of AAAs detected, and frequency with which AAAs were reported, were assessed. Differences in aortic diameters and aneurysm detection rates between genders were compared with the unpaired 2-sample t test.ResultsThree hundred and ninety-five lumbar spine MRIs were reviewed, 240 (60.8%) in women and 155 (39.2%) in men, with mean ± standard deviation (SD) age of 70.2 ± 3.2 years. AAAs were detected in 38/395 (9.6%) cases, most (33/38, 86.8%) of which were <4 cm. Of these, only 4 (10.5%) were reported by the interpreting radiologist; 3/4 (75%) corresponded to aneurysms ≥4 cm.ConclusionLumbar spine MRI performed in the USPSTF AAA screening age range, especially in men, facilitates frequent detection of AAA when the aorta is systematically measured. However, in typical lumbar spine assessment, AAAs are often underreported, particularly for smaller aneurysms. |
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