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Incidental Thalamic Lesions Identified on Brain MRI in Pediatric and Young Adult Patients: Imaging Features and
Vinicius de Padua V Alves1, Marguerite M Care1,2, James L Leach3,2
1From the Department of Radiology (V.d.P.V.A., M.M.C., J.L.L.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Background And Purpose:
Nonspecific, localized thalamic signal abnormalities of uncertain significance are occasionally found on pediatric brain MR imaging. The goal of this study is to describe the MR imaging appearance and natural history of these lesions in children and young adults.
Materials And Methods:
This retrospective study evaluated clinically acquired brain MR imaging examinations obtained from February 1995 to March 2022 at a large, tertiary care pediatric hospital. Examinations with non-mass-like and nonenhancing thalamic lesions were identified based on term search of MR imaging reports. A total of 221 patients formed the initial group for imaging assessment. Additional exclusions during imaging review resulted in 171 patients. Imaging appearance and size changes were assessed at baseline and at follow-up examinations.
Results:
A total of 171 patients (102 male) at a median age of 11 years (range: 1-23 years), 568 MR imaging examinations, and 180 thalamic lesions were included. Median time from baseline to the last follow-up MR imaging was 542 days (range: 46-5730 days). No lesion enhanced at any time point. On imaging follow-up, 11% of lesions (18/161) became smaller, 10% (16/161) resolved, 73% (118/161) remained stable, and 6% (9/161) increased in size at some point during evaluation. Median time interval from baseline to enlargement was 430 days (range: 136-1074 days).
Conclusions:
Most incidental, non-mass-like thalamic signal abnormalities were stable, decreased in size, or resolved on follow-up imaging and are likely of no clinical significance. Surveillance strategies with longer follow-up intervals may be adequate in the management of such findings.
Insights
Nonspecific thalamic signal abnormalities in children are often benign. Most lesions identified on pediatric brain MRI remain stable or resolve, suggesting a favorable prognosis and potentially less intensive follow-up.
Area of Science:
- Pediatric Radiology
- Neuroimaging
- Neurology
Background:
- Nonspecific, localized thalamic signal abnormalities are occasionally detected on pediatric brain MRI.
- The clinical significance of these incidental findings is often uncertain.
Purpose of the Study:
- To characterize the MR imaging appearance of these thalamic lesions in children and young adults.
- To determine the natural history and clinical significance of these abnormalities through follow-up imaging.
Main Methods:
- Retrospective review of brain MR imaging examinations from 1995-2022 at a pediatric hospital.
- Identification of non-mass-like, non-enhancing thalamic lesions in 171 pediatric patients.
- Assessment of lesion size changes and resolution on serial MR imaging.
Main Results:
- 180 thalamic lesions were analyzed in 171 patients (median age 11 years).
- No enhancement was observed in any lesion.
- Follow-up imaging showed 11% decreased in size, 10% resolved, 73% remained stable, and 6% increased in size.
Conclusions:
- Most incidental thalamic signal abnormalities in children are stable, decrease in size, or resolve.
- These findings are likely of no clinical significance.
- Surveillance with extended follow-up intervals may be sufficient for managing these lesions.
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