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Updated: Jul 30, 2026
Making MR Imaging Child's Play - Pediatric Neuroimaging Protocol, Guidelines and Procedure
Published on: July 30, 2009
Minimizing unnecessary brain magnetic resonance imaging in pediatric endocrinology: a retrospective cohort analysis
Maura Marin1, Flora Maria Murru2, Francesco Baldo2
1Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
Background:
Brain magnetic resonance imaging (MRI) is mandatory or highly recommended in many pediatric endocrinological conditions to detect causative anatomic anomalies and rule out neoplastic lesions. However, MRI can also show findings associated with the underlying clinical condition, as well as unrelated "incidentalomas". These latter findings are often abnormalities with a high incidence in the general population for which there is no clear literature regarding their management, especially in pediatric patients. The present study aimed to evaluate the number of unnecessary performed MRIs in pediatric endocrinology.
Methods:
Retrospective analysis on 584 MRI scans performed in 414 patients (254 growth hormone deficiency, 41 other causes of short stature, 116 central precocious puberty).
Results:
The MRI scans were completely normal in 67% of the individuals, and the prevalence of individuals who underwent more than one MRI was 18%, with no significant differences among the groups. The overall prevalence of incidentalomas was 17%. Among 170 repeated MRI scans, 147 (86%) were not required according to a dedicated protocol. Only five patients (four GHD, one Noonan) correctly repeated the MRI. All the repeated MRI scans did not reveal any progression in the findings. If we include the MRIs performed in cases of OCSS other than Noonan syndrome (n=32) and girls with CPP older than 6 years (n=89), an additional 121 MRIs could have been avoided, leading to a total number of unnecessary MRIs to 268 (46%).
Conclusions:
Only a few specific neuroimaging findings in endocrinologic pediatric patients warrant further investigation, while too often repeated imaging is carried out unnecessarily. We advocate the importance of guidelines to reduce costs for both the healthcare system and patients' families, as well as to alleviate physical and psychological distress for patients and caregivers.
Insights
Many pediatric brain MRIs are unnecessary, leading to increased costs and patient distress. Implementing guidelines can reduce unneeded imaging for conditions like growth hormone deficiency and precocious puberty.
Area of Science:
- Pediatric Endocrinology
- Neuroradiology
- Medical Imaging Analysis
Background:
- Brain MRI is crucial for diagnosing pediatric endocrine disorders and ruling out serious conditions.
- Incidental findings on MRI can complicate management, especially in children.
- There's a need to assess the necessity of MRI scans in pediatric endocrinology.
Purpose of the Study:
- To evaluate the rate of unnecessary MRI scans performed in pediatric endocrinology.
- To identify patterns of overuse in imaging for conditions like growth hormone deficiency and precocious puberty.
Main Methods:
- Retrospective analysis of 584 MRI scans from 414 pediatric patients.
- Patients included those with growth hormone deficiency, short stature, and central precocious puberty.
- Assessment of MRI necessity based on dedicated protocols and clinical follow-up.
Main Results:
- 67% of MRI scans were normal; 18% of patients had multiple MRIs.
- 17% of scans revealed incidentalomas.
- 86% of repeated MRIs (147 out of 170) were deemed unnecessary, with no progression noted.
Conclusions:
- A significant number of pediatric brain MRIs are performed unnecessarily.
- Adherence to established guidelines can reduce unindicated imaging.
- Reducing unnecessary MRIs can lower healthcare costs and alleviate patient/family burden.
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Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...