Rates of Incidental Findings in Brain Magnetic Resonance Imaging in Children

Abstract

IMPORTANCE Incidental findings (IFs) are unexpected abnormalities discovered during imaging and can range from normal anatomic variants to findings requiring urgent medical intervention. In the case of brain magnetic resonance imaging (MRI), reliable data about the prevalence and significance of IFs in the general population are limited, making it difficult to anticipate, communicate, and manage these findings.OBJECTIVES To determine the overall prevalence of IFs in brain MRI in the nonclinical pediatric population as well as the rates of specific findings and findings for which clinical referral is recommended. DESIGN, SETTING, AND PARTICIPANTS This cohort study was based on the April 2019 release of baseline data from 11 810 children aged 9 to 10 years who were enrolled and completed baseline neuroimaging in the Adolescent Brain Cognitive Development (ABCD) study, the largest US population-based longitudinal observational study of brain development and child health, between September 1, 2016, and November 15, 2018. Participants were enrolled at 21 sites across the US designed to mirror the demographic characteristics of the US population.Baseline structural MRIs were centrally reviewed for IFs by board-certified neuroradiologists and findings were described and categorized (category 1, no abnormal findings; 2, no referral recommended; 3; consider referral; and 4, consider immediate referral). Children were enrolled through a broad school-based recruitment process in which all children of eligible age at selected schools were invited to participate. Exclusion criteria were severe sensory, intellectual, medical, or neurologic disorders that would preclude or interfere with study participation. During the enrollment process, demographic data were monitored to ensure that the study met targets for sex, socioeconomic, ethnic, and racial diversity. Data were analyzed from March 15, 2018, to November 20, 2020. MAIN OUTCOMES AND MEASURES Percentage of children with IFs in each category and prevalence of specific IFs.RESULTS A total of 11 679 children (52.1% boys, mean [SD] age, 9.9 [0.62] years) had interpretable baseline structural MRI results. Of these, 2464 participants (21.1%) had IFs, including 2013 children (17.2%) assigned to category 2, 431 (3.7%) assigned to category 3, and 20 (0.2%) assigned to category 4. Overall rates of IFs did not differ significantly between singleton and twin gestations or between monozygotic and dizygotic twins, but heritability analysis showed heritability for the presence or absence of IFs (h 2 = 0.260; 95% CI, 0.135-0.387). CONCLUSIONS AND RELEVANCEIncidental findings in brain MRI and findings with potential clinical significance are both common in the general pediatric population. By assessing IFs and concurrent developmental and health measures and following these findings over the longitudinal study course, the ABCD study has the potential to determine the significance of many common IFs.

Incidental Findings Among Youth Participating in Multimodal Imaging Research: Characteristics of Findings and Description of a Management Approach

“…This scoring convention was derived from an established rating scale ( 3 ). A similar 4-point rating scale has also been used with a population-based pediatric sample ( 5 ). In accordance with institutional neuroradiology practices, sinus findings were also reported when reviewing scans.…”

“…The use of imaging in youth research with healthy and clinical populations gives rise to incidental findings that require a management strategy. The prevalence of incidental findings in imaging research, particularly neuroimaging, is well documented across the lifespan (1)(2)(3)(4)(5). Whereas studies have reported on incidental findings in clinically indicated imaging of youth (6,7), little is known regarding incidental findings among youth participating in imaging research in areas other than the brain.…”

Emerging ethical issues raised by highly portable MRI research in remote and resource-limited international settings

“…Another study estimated the overall rate at 34% ( Shoemaker et al, 2011 ), with the likelihood of IFs increasing with participant age ( Morris et al, 2009 ). A recent study, analyzing an Adolescent Brain Cognitive Development (ABCD) dataset of nearly 12,000 children ages 9 to 10 years, found an IF rate of 21% ( Li et al, 2021 ). Analyses of IFs in MRI research ( Illes 2006 ) have revealed that recommended policies range from having every scan read by a radiologist ( Milstein 2008 ), to having findings reviewed by an expert only if the researcher flags a brain abnormality ( Cramer et al, 2011 ), to having no scans read by a radiologist ( Royal and Peterson 2008 ).…”

Neurologic Sequelae Associated with Hypertensive Disorders of Pregnancy

“…Disruption of neurulation and segmentation/cleavage impair neural tube closure and midline brain structures, expressed as major brain malformations such as neural tube defects and the holoprosencephaly spectrum in the susceptible fetus. These anomalies may be documented by prenatal sonography and fetal magnetic resonance neuroimaging [22], or only after birth with neonatal or childhood studies [23,24]. Sensitivity and specificity of the abnormal images obtained will be limited by the current technologies available for clinical applications.…”