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Incidental Findings on Brain Magnetic Resonance Imaging (MRI) in Pediatric Endocrine Patients
Avivit Brener1, Danil A Kozyrev2, Shelly I Shiran3
1From the Pediatric Endocrinology and Diabetes Unit, Tel-Aviv, Israel.
Insights
Brain MRI scans in children referred for endocrine issues frequently reveal incidental findings, including structural abnormalities and tumors. These common findings require careful, individualized patient management.
Area of Science:
- Pediatric Endocrinology
- Neuroradiology
- Neuro-oncology
Background:
- Brain magnetic resonance imaging (MRI) is crucial for evaluating pediatric endocrine disorders.
- Incidental findings on these scans can present diagnostic and management challenges.
Purpose of the Study:
- To investigate the prevalence and types of incidental findings on brain MRI in pediatric patients referred for endocrine evaluation.
- To analyze the clinical significance and management of these incidental findings.
Main Methods:
- Retrospective observational study of 11,011 pediatric patients undergoing 17,445 brain MRI studies.
- Inclusion criteria: patients referred for endocrine disorders, no history of malignancy, genetic syndromes, or neurologic comorbidities.
- Data linkage with neurosurgical database and retrieval of clinical information.
Main Results:
- 24.4% of 524 eligible pediatric patients had incidental findings.
- Common findings included Chiari type 1 malformation (growth disturbances), pituitary and pineal cysts, white matter lesions, and brain asymmetry.
- Twelve intracranial tumors were identified, with 5 requiring surgical intervention.
Conclusions:
- Incidental findings are common in pediatric brain MRIs for endocrine referrals, ranging from benign cysts to tumors.
- Management decisions for these findings must be individualized and patient-centered.
- Highlights the importance of multidisciplinary evaluation for these pediatric cases.
Objective:
To explore incidental findings on brain magnetic resonance imaging (MRI) studies of pediatric patients referred due to endocrine disorders.
Methods:
A retrospective, observational study conducted in a tertiary referral center. The neuroimaging database of 17,445 brain MRI studies of 11,011 pediatric patients were searched for cases with endocrine referrals and without medical history of malignancy, genetic syndromes, and/or neurologic comorbidities. This database was linked to the pediatric neurosurgical database. Clinical data were retrieved from medical files.
Results:
In total, 524 patients (50.2% males, mean age 8.5±3.5 years) were referred to brain MRI due to growth disturbances (n = 313), pubertal disorders (n = 183), prolactin hypersecretion (n = 18), central diabetes insipidus (n = 8), and obesity (n = 1). Incidental findings were found in 128 (24.4%) cases. Chiari type 1 malformation was more prevalent in patients with growth disturbances (P<.001). Small pituitary cysts were observed in 20 (3.8%) patients, and pineal cysts in 25 (4.8%) patients, mostly girls (68%, P<.001). White matter lesions were diagnosed in 30 (5.7%) patients, none with clinical evidence of neurologic disease. Brain asymmetry without clinical significance and developmental venous anomalies were observed in 14 (2.7%) and 8 (1.5%) patients, respectively. Twelve patients were diagnosed with intracranial tumors, and 5 required surgical intervention for a histopathologic diagnosis of juvenile pilocytic astrocytoma (n = 3), choroid plexus papilloma (n = 1), or inconclusive (n = 1). The rest were managed conservatively.
Conclusion:
Incidental findings on brain MRIs of pediatric patients referred by endocrinologists are common and raise dilemmas. The spectrum ranges from structural disruptions to tumors. Decision-making is individualized and patient-centered.
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