Incidental Abnormal Radiological Finding (IARF)

What is Incidental Abnormal Radiological Finding (IARF)

• Incidental abnormal radiological finding is an unusual mass or tissue change that is found unexpectedly during an imaging test.
• IARFs are often found in the kidneys or lungs, but they can also be found in the heart, liver, breasts, brain, gallbladder, uterus, or other organs and tissues.
• Incidental Abnormal Radiological Findings can cause symptoms or be related to an undiagnosed illness.
• Most often, however, they do not cause symptoms and are not a cause for concern.
• Incidental Abnormal Radiological Finding or Incidentalomas, incidental imaging findings serendipitously diagnosed in an asymptomatic patient or symptomatic patient undergoing imaging for an unrelated reason, are fast becoming a modern medical crisis.
• The rapid rise in demand for imaging, coupled with rapidly advancing image resolution is driving a surge in incidentalomas

What are common types of IARFs?

There are many types of Incidental Abnormal Radiological Findings.

The Common types include:

• Lesions. A lesion is a change in tissue due to infection, tissue death, or injury.
• Cysts. A cyst is a sac that is filled with fluid, crystals, or some other substance.
• Tumors. A tumor is a solid formation. Tumors can be cancerous (malignant) or non-cancerous (benign).

Your health care provider may use medical terms to describe the finding, such as “pulmonary nodule,” which means a small mass in the lung, or “renal mass,” which means a mass in the kidney.

Incidental Abnormal Radiological Finding can vary widely in nature and severity, ranging from benign and insignificant to potentially significant or concerning. Some common examples of incidental findings include:

1. Benign bone lesions: These may include bone cysts, benign tumors, or areas of bone sclerosis that are not related to the primary reason for the imaging study.
2. Pulmonary nodules: Small nodules or masses in the lungs that are incidentally detected on chest X-rays or CT scans, which may require further evaluation to determine their nature (benign or potentially malignant).
3. Renal cysts: Fluid-filled sacs in the kidneys that are commonly found incidentally during imaging studies and are usually benign.
4. Liver or adrenal lesions: Unrelated masses or lesions discovered incidentally during abdominal imaging studies, which may require further evaluation to determine their significance.

What are the goals?

• Reducing risks to patients from additional unnecessary examinations, including the risks of radiation and risks associated with interventional procedures;
• Limiting the costs of managing incidental findings to patients and the health care system;
• Achieving greater consistency in recognizing, reporting, and managing incidental findings, as a component of formal quality improvement efforts;
• Providing guidance to radiologists who are concerned about the risk for litigation for missing incidental findings that later prove to be clinically important; and
• Helping focus research efforts to lead to an evidence based approach to incidental findings.

Do I need further diagnosis?

Your health care provider may recommend that you have tests to diagnose the cause of the Incidental Abnormal Radiological Findings.

Testing is usually recommended based on:

• The size and appearance of the IARF.
• Whether you have risk factors or medical conditions that increase your risk of problems.
• Whether you have symptoms or concerns.

In many cases, testing is not needed if the Incidental Abnormal Radiological Finding is a very small mass or tissue change. Small masses or changes are not often likely to become a problem in the future.

What type of testing may be needed?

The following types of tests may be done when an Incidental Abnormal Radiological Finding is found:

• Blood tests.
• Urine tests.
• Imaging tests, such as abdominal ultrasound, CT scan, or MRI.
• Biopsy.

Tests and physical exams may be done once, or they may be done regularly for a period of time. Tests and exams that are done regularly are performed to show whether the mass or tissue change is growing and becoming a concern.

What are common treatments?

Treatment varies depending on:

• The cause of the Incidental Abnormal Radiological Findings.
• The location, size, and appearance of the IARF.
• Your age.
• Any underlying conditions or symptoms.

Treatment is not always needed. Your health care provider may recommend monitoring through watchful waiting and regular tests and exams. If treatment is needed, it may include:

• Treatments to reduce the size of the abnormality.
• Biopsy or surgical removal of the mass or tissue.
• Treatment to address any underlying conditions.

What does research says about Incidental Abnormal Radiological Finding?

Here is the abstract of a Literature review

251 potentially relevant abstracts were identified and 44 articles were finally included in the review. Overall, the mean frequency of incidental findings was 23.6% (95% confidence interval (CI) 15.8–31.3%).

The frequency of incidental findings was higher in studies involving CT technology (mean 31.1%, 95% CI 20.1–41.9%), in patients with an unspecific initial diagnosis (mean 30.5, 95% CI 0–81.6) and when the location of the incidental findings was unspecified (mean 33.9%, 95% CI 18.1–49.7).

The mean frequency of clinical follow-up was 64.5% (95% CI 52.9–76.1%) and mean frequency of clinical confirmation was 45.6% (95% CI 32.1–59.2%). Although the optimal strategy for the management of these abnormalities is still unclear, it is essential to be aware of the low clinical confirmation in findings of moderate and major importance.

Follow these instructions at home:

• Keep all follow-up visits as told by your health care provider, and schedule appointments as directed. This is important. It will allow any problems to be detected early, which can be very beneficial to you.
• Try to stay calm, and be sure to ask questions. Make sure you understand the recommendations for monitoring and understand whether there is a reason for concern.

Summary

An incidental abnormal radiological finding refers to an unexpected abnormality that is discovered on a radiological imaging study performed for another purpose, unrelated to the specific abnormality being detected. It is a finding that was not the primary reason for the imaging study but is incidentally noticed during the evaluation.

Here are a few key points about incidental abnormal radiological findings:

1. Unplanned Discovery: Incidental findings are often unexpected and not the main focus of the imaging study. They are usually unrelated to the primary reason for the imaging, which could be investigating a specific symptom or condition.
2. Range of Abnormalities: Incidental findings can vary widely and may include abnormalities in organs, bones, blood vessels, or other structures within the imaging field.
3. Clinical Significance: The clinical significance of an incidental finding can vary. Some findings may be benign or of minimal concern, while others may require further evaluation or intervention to determine their significance and potential impact on health.
4. Follow-up Evaluation: Upon discovering an incidental abnormality, the radiologist or healthcare provider may recommend additional imaging or tests to further evaluate the finding and assess its clinical significance. This may involve follow-up imaging studies, referral to a specialist, or additional diagnostic procedures.
5. Communication and Management: Proper communication and management of incidental findings are essential. The radiologist or healthcare provider responsible for reviewing the imaging study typically provides a detailed report to the ordering physician, who then discusses the finding with the patient and determines the appropriate course of action.