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Ethical consideration of incidental findings on adult brain MRI in research
1Stanford Center for Biomedical Ethics, Department of Medicine, Stanford University, Palo Alto, CA, USA. illes@stanford.edu
Objective:
To characterize the frequency and severity of incidental findings in brain MRIs of young and older adult research volunteers, and to provide an evaluation of the ethical challenges posed by the detection of such findings.
Methods:
The authors reviewed 151 research MRI scans obtained retrospectively from subjects recruited to studies as healthy volunteers. Incidental findings were classified into four categories: no referral, routine, urgent, or immediate referral. p Values for significance were computed from chi(2) tests of contingency.
Results:
Of 151 studies, the authors found an overall occurrence of incidental findings having required referral of 6.6%. By age, there were more findings in the older cohort (aged >60 years) than in the younger cohort (p < 0.05) and in more men than women in the older cohort (p < 0.001). Three of four (75%) findings in the younger cohort were classified in the urgent referral category; 100% of the findings in the older cohort were classified as routine (p < 0.05).
Conclusion:
The significant presence but different characteristics of incidental findings in young and older subjects presumed to be neurologically healthy suggest that standards of practice are needed to guide investigators in managing and communicating their discovery.
Insights
Incidental findings in brain MRIs are common in healthy volunteers, particularly older adults. Clear guidelines are needed for managing these unexpected discoveries in research settings.
Area of Science:
- Neuroimaging
- Radiology
- Medical Ethics
Background:
- Incidental findings in brain Magnetic Resonance Imaging (MRI) scans of research volunteers present unique challenges.
- Understanding the frequency and nature of these findings in healthy populations is crucial for ethical research conduct.
Purpose of the Study:
- To determine the incidence and severity of incidental findings in brain MRIs of young and older adult research volunteers.
- To evaluate the ethical considerations associated with detecting incidental findings in this cohort.
Main Methods:
- Retrospective review of 151 research brain MRI scans from healthy volunteers.
- Classification of incidental findings into referral categories: no referral, routine, urgent, or immediate.
- Statistical analysis using chi-squared tests to assess significance.
Main Results:
- 6.6% of scans revealed incidental findings requiring referral.
- Older adults (>60 years) showed a higher incidence of findings compared to younger adults (p < 0.05).
- In the older cohort, findings were more prevalent in men (p < 0.001) and predominantly routine referrals (100%), while younger adults had more urgent referrals (75%).
Conclusions:
- Incidental findings occur with significant frequency in neurologically healthy individuals undergoing brain MRI.
- The characteristics of these findings differ between young and older adults.
- Standardized practices are essential for researchers to manage and communicate incidental discoveries effectively.
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