title: Research cardiac magnetic resonance imaging in end stage renal disease - incidence, significance and implications of unexpected incidental findings.
abstract: OBJECTIVE
  Left ventricular mass (LVM) at cardiac magnetic resonance imaging (CMR) is a frequent end point in clinical trials in nephrology. Trial participants with end stage renal disease (ESRD) may have a greater frequency of incidental findings (IF). We retrospectively investigated prevalence of IF in previous research CMR and reviewed their subsequent impact on participants.
  
  
  METHODS
  Between 2002 and 2006, 161 ESRD patients underwent CMR in a transplant assessment study. Images were used to assess LV mass and function. In the current study a radiologist reviewed the scans for IF. Review of patient records determined the subsequent clinical significance of IF.
  
  
  RESULTS
  There were 150 IF in 95 study participants. Eighty-four (56 %) were new diagnoses. One hundred and two were non-cardiac. Fifteen were suspicious of malignancy. There was a clinically significant IF for 14.9 % of the participants. In six cases earlier identification of an IF may have improved quality of life or survival.
  
  
  CONCLUSIONS
  Without radiology support clinically important IF may be missed on CMR. Patients undergoing CMR in trials should be counselled about the frequency and implications of IF. Patients with ESRD have a higher prevalence of IF than reported in other populations. Nephrology studies require mechanisms for radiologist reporting and strategies for dealing with IF.
  
  
  CONCLUSIONS
  • Incidental findings on research cardiac magnetic resonance imaging can have significant consequences. • We considered incidental findings in historical renal cardiac resonance imaging clinical trials. • Incidental findings are common and important in the chronic kidney disease population. • Without radiology support, clinically significant incidental findings may be missed on imaging. • Study protocols, approvals and consent processes should take account of possible findings.
authors.affiliation: Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital, Dundee, DD1 9SY, UK. e.rutherford@dundee.ac.uk.
authors.forename: Elaine
authors.identifier: http://orcid.org/0000-0001-9818-8758
authors.initials: E
authors.lastname: Rutherford
authors.affiliation: Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital, Dundee, DD1 9SY, UK.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Weir-McCall
authors.affiliation: Institute of Cardiovascular and Medical Sciences, British Heart Foundation Building, Glasgow Clinical Research Centre, Glasgow, G12 8TA, UK.
authors.forename: Rajan K
authors.initials: RK
authors.lastname: Patel
authors.affiliation: Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital, Dundee, DD1 9SY, UK.
authors.forename: J Graeme
authors.initials: JG
authors.lastname: Houston
authors.affiliation: Department of Radiology, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, 84 Castle Street, Glasgow, G4 0ET, UK.
authors.forename: Giles
authors.initials: G
authors.lastname: Roditi
authors.affiliation: Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital, Dundee, DD1 9SY, UK.
authors.forename: Allan D
authors.initials: AD
authors.lastname: Struthers
authors.affiliation: Institute of Cardiovascular and Medical Sciences, British Heart Foundation Building, Glasgow Clinical Research Centre, Glasgow, G12 8TA, UK.
authors.forename: Alan G
authors.initials: AG
authors.lastname: Jardine
authors.affiliation: Institute of Cardiovascular and Medical Sciences, British Heart Foundation Building, Glasgow Clinical Research Centre, Glasgow, G12 8TA, UK.
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Mark
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006331:Heart Diseases / Q000150:complications* / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D015994:Incidence; D033162:Incidental Findings; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D015995:Prevalence; D012189:Retrospective Studies
keywords: CMR; Chronic kidney disease; Clinical trials; Incidental findings; MRI