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Incidental findings on pediatric MR images of the brain
Brian S Kim1, Judy Illes, Richard T Kaplan
1Department of Radiology, Stanford Center for Biomedical Ethics, Stanford, CA 94304, USA.
Insights
Incidental findings were detected in 21% of healthy children undergoing brain MRI. While most were minor, a small percentage required clinical referral, emphasizing the need for radiologist review in pediatric research.
Area of Science:
- Pediatric Radiology
- Neuroimaging Research
- Incidental Findings
Background:
- Previous research focused on incidental findings in adult populations.
- Limited data exists on incidental findings in healthy children.
Purpose of the Study:
- To determine the prevalence of incidental findings in a healthy pediatric cohort.
- To assess the clinical significance of these findings.
Main Methods:
- Retrospective review of 225 brain MRI studies in neurologically healthy children (age <1 month to 18 years).
- Findings categorized by consensus of two board-certified neuroradiologists.
Main Results:
- Incidental abnormalities found in 21% of subjects (47/225).
- 17% of abnormalities required routine clinical referral; 2% required urgent referral.
- Males showed twice the occurrence of findings compared to females, but referral rates were similar.
Conclusions:
- Clinically significant incidental abnormalities are infrequent but present in healthy children.
- Radiologist review is crucial for detecting incidental findings and ensuring appropriate follow-up in pediatric neuroimaging research.
- Findings underscore the importance of knowing a child's neurologic status for research interpretation.
Background And Purpose:
Previous studies have addressed the prevalence of incidental findings in symptomatic and healthy adult populations. Our study aims to elucidate the prevalence of incidental findings in a healthy pediatric population.
Methods:
We retrospectively reviewed 225 conventional brain MR imaging studies obtained during structural and functional brain imaging research in a cohort of neurologically healthy children (100 boys [44%] and 125 girls [56%]) ranging in age from younger than 1 month to 18 years. All MR images were reviewed, and two board-certified neuroradiologists categorized the findings by consensus.
Results:
Incidental abnormalities were detected in 47 subjects (21%), while 79% of the images were normal. Of the 47 abnormalities detected, 17 (36%) required routine clinical referral; a single lesion (2%) required urgent referral. The occurrence of these findings in the male cohort was twice that of the female cohort; however, the percentage of subjects requiring either routine or urgent referral did not differ by sex (male subjects, 34%; female subjects, 39%).
Conclusion:
Although the frequency of clinically important incidental abnormalities was not high in the sample of children studied, the presence and variety of findings in any pediatric group is particularly important for both the welfare of the subject and for research in which knowledge of the subject's neurologic status is vital to the interpretation of the results. Despite the limitations of the study in terms of the age and ethnic distribution, this work highlights the need for the routine involvement of trained radiologists in these studies to ensure that such incidental findings are detected and that appropriate follow-up is provided.