Incidental Findings on Brain and Spine Imaging in Children

Abstract

In recent years, the utilization of diagnostic imaging of the brain and spine in children has increased dramatically, leading to a corresponding increase in the detection of incidental findings of the central nervous system. Patients with unexpected findings on imaging are often referred for subspecialty evaluation. Even with rational use of diagnostic imaging and subspecialty consultation, the diagnostic process will always generate unexpected findings that must be explained and managed. Familiarity with the most common findings that are discovered incidentally on diagnostic imaging of the brain and spine will assist the pediatrician in providing counseling to families and in making recommendations in conjunction with a neurosurgeon, when needed, regarding additional treatments and prognosis.

Novel asymptomatic CNS findings in patients withACVR1/ALK2mutations causing fibrodysplasia ossificans progressiva

“…With the improvement of the MRI technology, the sensitivity to brain pathology has steadily increased in the last decades, and several unanticipated (and potentially clinically important) findings have emerged both on clinical and research MRI studies. These entities, called ‘incidental findings’, mostly include pineal cysts, arachnoid cysts, choroid plexus cysts, pituitary abnormalities and developmental venous anomalies, all of which are typically asymptomatic lesions not requiring further investigations 14 15. On the contrary, other incidental findings, such as benign tumours, Chiari I malformations and vascular lesions (ie, aneurysms, cavernomas and arteriovenous malformations) may necessitate neurosurgical consultation and further MRI follow-up 14 15.…”

“…These entities, called ‘incidental findings’, mostly include pineal cysts, arachnoid cysts, choroid plexus cysts, pituitary abnormalities and developmental venous anomalies, all of which are typically asymptomatic lesions not requiring further investigations 14 15. On the contrary, other incidental findings, such as benign tumours, Chiari I malformations and vascular lesions (ie, aneurysms, cavernomas and arteriovenous malformations) may necessitate neurosurgical consultation and further MRI follow-up 14 15. Interestingly, none of the trivial incidental findings found in normal individuals is similar to the asymptomatic brainstem lesions described in the present study in patients with FOP, while other entities should be considered in the differential diagnosis.…”

Incidental Findings and Normal Anatomical Variants on Brain MRI in Children for Primary Headaches

“…For further discussion on specific cysts and their incidence in children, associated imaging appearance, headache significance, and surveillance recommendations, please reference Table 1. [20][21][22][23][24][25][26][27] Developmental Venous Anomalies (DVAs).-DVAs, also known as venous angiomas, have been reported in 0.3-2.1% pf pediatric patients imaged, 5,12,28,29 which is similar rate of 2.5% reported in a large postmortem study of 4,069 serial cases. 30 DVAs are congenital anomalies of intracranial venous drainage characterized by the "caput medusae sign" of veins draining into a single larger collecting vein, which in turn drains into either a dural sinus or into a deep ependymal vein.…”

“…Pituitary enlargement is the most common incidental finding and Rathke's cleft cysts account for the least common finding among children. For further discussion on specific cysts and their incidence in children, associated imaging appearance, headache significance, and surveillance recommendations, please reference Table …”

Strategic Management of Cerebral Arachnoid Cysts in Children in the Era of Globalisation

“…[6] Even they are incidentally discovered , they must be managed. [10]. Some of them are gained through life [20]Arachnoid cysts are not the same with the false cysts formed because of cerebrospinal liquid accumulation in which there are inflammatory cells and hemosiderin , after head trauma and generating enlargement of the subarachnoid space.…”