[Preventive whole-body screening encompassing modern imaging using magnetic resonance tomography]

Abstract

Background: With respect to the prognosis of the population and costs, the focus of the health-care system should lie more on preventive medicine in the future. The value of screening examinations as secondary prevention is, however, controversial, as only few investigations exist.

Patients and methods: The authors report on 1,007 consecutive patients who underwent a screening examination based on clinical examinations and whole-body magnetic resonance imaging (MRI) of the brain, arterial system, heart and abdomen in a private outpatient center. Clinical examinations consisted of physical examination, ECG, stress ECG, lung function test, ultrasound of carotid vessels and thyroid, blood and urinary tests. Besides clinical tests, all patients were studied by routine MRI of the brain, the heart (exclusive of the coronary system) and whole-body MR angiography. In the same setting, 855 of the patients (855/1,007) underwent an MR colonoscopy in dark-lumen technique, and the remaining 152 of the patients (152/1,007) an abdominal MR overview (T(1) Vibe). Patients with MR colonography obtained triple-dose gadolinium-BOPTA.

Results: Screening was performed in 1,007 patients, 71% were men and 29% women. Altogether, 895 relevant findings were reported in 1,007 patients. 24% of the findings were detected exclusively by MRI. Most of the MR-based diagnoses were cardiovascular in nature, including 29 silent myocardial infarctions (3.2%), 27 aortic aneurysms (3%), two of them being > 5 cm in diameter, eleven intracranial extraaxial tumors (1.2%), 75 colonic polyps (8.4%), four neoplastic tumors (0.44%; three renal cell carcinomas, one bronchial carcinoma), and two cerebral aneurysms (0.22%). The MRI results of two colonic polyps were false-positive.

Conclusion: Whole-body screening reveals a number of therapeutically relevant diagnoses, primarily of cardiovascular origin. MRI yields valuable additional diagnoses that have a significant impact on the further medical strategy. The value of the screening examination lies mainly in the experienced interpretation of both radiologic and clinical tests and the integration into an overall medical concept and clinical management.