Long-Term Psychosocial Consequences of Whole-Body Magnetic Resonance Imaging and Reporting of Incidental Findings in a Population-Based Cohort Study

Abstract

Management of radiological incidental findings (IF) is of rising importance; however, psychosocial implications of IF reporting remain unclear. We compared long-term psychosocial effects between individuals who underwent whole-body magnetic resonance imaging (MRI) with and without reported IF, and individuals who did not undergo imaging. We used a longitudinal population-based cohort from Western Europe. Longitudinal analysis included three examinations (exam 1, 6 years prior to MRI; exam 2, MRI; exam 3, 4 years after MRI). Psychosocial outcomes included PHQ-9 (Patient Health Questionnaire), DEEX (Depression and Exhaustion Scale), PSS-10 (Perceived Stress Scale) and a Somatization Scale. Univariate analyses and adjusted linear mixed models were calculated. Among 855 included individuals, 25% (n = 212) underwent MRI and 6% (n = 50) had at least one reported IF. Compared to MRI participants, non-participants had a higher psychosocial burden indicated by PHQ-9 in exam 1 (3.3 ± 3.3 vs. 2.5 ± 2.3) and DEEX (8.6 ± 4.7 vs. 7.7 ± 4.4), Somatization Scale (5.9 ± 4.3 vs. 4.8 ± 3.8) and PSS-10 (14.7 ± 5.7 vs. 13.7 ± 5.3, all p < 0.05) in exam 3. MRI participation without IF reporting was significantly associated with lower values of DEEX, PHQ-9 and Somatization Scale. There were no significant differences at the three timepoints between MRI participants with and without IF. In conclusion, individuals who voluntarily participated in whole-body MRI had less psychosocial burden and imaging and IF reporting were not associated with adverse long-term psychosocial consequences. However, due to the study design we cannot conclude that the MRI exam itself represented a beneficial intervention causing improvement in mental health scores.

Keywords: incidental findings; longitudinal study; magnetic resonance imaging; mental health; whole body imaging.

Figure 1

Schematic Study Design, Sample and Endpoint Assessment. Of 3080 individuals from exam 1, only 856 participated in exam 3. Of these, 855 could be included in the main analysis. The Patient Health Questionnaire (PHQ-9), the Depression and Exhaustion Scale (DEEX) and the Somatization Scale were available at all three exams. The Short-Form-Health-Survey-12 (SF-12) was applied at exams 1 and 2, and the Perceived Stress Scale (PSS-10) at exam 3. * denotes n = 854 for Somatization Scale at exam 3.

Figure 2

Psychosocial Outcomes of the Study Population according to Participation in Whole-body MRI (MRI) and Presence of Incidental Findings (IF). For PHQ-9, DEEX, SF-12 and the Somatization Scale, arithmetic mean is shown for the four subgroups and three exams. SF-12 was merely applied in exams 1 and 2. Outcomes of PSS-10 obtained in exam 3 are presented as boxplots with arithmetic mean (dashed line) and median (continuous line). Figure 2 shows unadjusted, descriptive data.