Incidental Brain MRI Findings in Children: A Systematic Review and Meta-Analysis

Published on Nov 1, 2019in American Journal of Neuroradiology3.381
· DOI :10.3174/AJNR.A6281
Volodia Dangouloff-Ros9
Estimated H-index: 9
,
C.-J. Roux + 7 AuthorsO. Naggara1
Estimated H-index: 1
(Sorbonne)
Sources
Abstract
BACKGROUND: The detection of incidental findings on children9s brain MR imaging poses various practical issues because the life-long implications of such findings may be profound. PURPOSE: Our aim was to assess the prevalence and characteristics of incidental brain MR imaging findings in children. DATA SOURCES: Electronic databases (PubMed, EMBASE, and Cochrane) were searched for articles published between 1985 to July 2018, with the following search terms: “incidental,” “findings,” “brain,” “MR imaging.” STUDY SELECTION: Inclusion criteria were the following: 1) patients younger than 21 years of age, 2) healthy children without any clinical condition, 3) MR images obtained with at least a 1.5T magnet, 4) original articles, and 5) a methodologic quality score of ≥10. DATA ANALYSIS: Two observers independently extracted data and assessed data quality and validity. The number and type of incidental findings were pooled. Heterogeneity was assessed using the Cochran Q statistic and the I2 statistic. DATA SYNTHESIS: Seven studies were included, reporting 5938 children (mean age, 11.3 ± 2.8 years). Incidental findings were present in 16.4% (99% CI, 9.8–26.2; Q = 117.5, I2= 94.9%) of healthy children, intracranial cysts being the most frequent (10.2%, 99% CI, 3.1–28.5; Q = 306.4, I2 = 98.0%). Nonspecific white matter hyperintensities were reported in 1.9% (99% CI, 0.2–16.8; Q = 73.6, I2 = 94.6%), Chiari 1 malformation was found in 0.8% (99% CI, 0.5–1.3; Q = 7.6, I2 = 60.5%), and intracranial neoplasms were reported in 0.2% (99% CI, 0.1–0.6; Q = 3.4, I2 = 12.3%). In total, the prevalence of incidental findings needing follow-up was 2.6% (99% CI, 0.5–11.7; Q = 131.2, I2 = 95.4%). Incidental findings needing specific treatment were brain tumors (0.2%) and cavernomas (0.2%). LIMITATIONS: Limitations were no age stratification or ethnicity data and variation in the design of included studies. CONCLUSIONS: The prevalence of incidental findings is much more frequent in children than previously reported in adults, but clinically meaningfull incidental findings were present in
📖 Papers frequently viewed together
20167.93Radiology
19 Authors (Daniel Bos, ..., Meike W. Vernooij)
56 Citations
1 Citations
49 Citations
References30
Newest
#1Lorna Gibson (Edin.: University of Edinburgh)H-Index: 32
#2Laura Paul (Glasgow Royal Infirmary)H-Index: 1
Last. Cathie Sudlow (Edin.: University of Edinburgh)H-Index: 68
view all 8 authors...
Abstract Objectives To determine prevalence and types of potentially serious incidental findings on magnetic resonance imaging (MRI) in apparently asymptomatic adults, describe factors associated with potentially serious incidental findings, and summarise information on follow-up and final diagnoses. Design Systematic review and meta-analyses. Data sources Citation searches of relevant articles and authors’ files in Medline and Embase (from inception to 25 April 2017). Review methods Eligible st...
24 CitationsSource
#1Margaret J. Trost (Children's Hospital Los Angeles)H-Index: 4
#2Nathan RobisonH-Index: 15
Last. R. Aaron RobisonH-Index: 2
view all 5 authors...
BACKGROUND: Children with ventriculoperitoneal shunts (VPS) undergoing brain computed tomography (CT) for shunt malfunction evaluation are at risk for later malignancy due to radiation exposure. We aimed to determine if and how hospitals have adopted radiation-avoiding magnetic resonance imaging (MRI) techniques. METHODS: We performed a secondary analysis of the Pediatric Health Information System (PHIS) database. Children with VPS presenting to acute wards at 31 PHIS hospitals between January 1...
5 CitationsSource
#1Siri Sahib S Khalsa (UM: University of Michigan)H-Index: 4
#2Ndi Geh (UM: University of Michigan)H-Index: 4
Last. Cormac O. Maher (UM: University of Michigan)H-Index: 35
view all 12 authors...
OBJECTIVEChiari malformation Type I (CM-I) is typically defined on imaging by a cerebellar tonsil position ≥ 5 mm below the foramen magnum. Low cerebellar tonsil position is a frequent incidental finding on brain or cervical spine imaging, even in asymptomatic individuals. Nonspecific symptoms (e.g., headache and neck pain) are common in those with low tonsil position as well as in those with normal tonsil position, leading to uncertainty regarding appropriate management for many patients with l...
18 CitationsSource
#1Tonya White (EUR: Erasmus University Rotterdam)
#1Tonya White (EUR: Erasmus University Rotterdam)H-Index: 66
Last. Henning Tiemeier (EUR: Erasmus University Rotterdam)H-Index: 119
view all 13 authors...
Paediatric population neuroimaging is an emerging field that falls at the intersection between developmental neuroscience and epidemiology. A key feature of population neuroimaging studies involves large-scale recruitment that is representative of the general population. One successful approach for population neuroimaging is to embed neuroimaging studies within large epidemiological cohorts. The Generation R Study is a large, prospective population-based birth-cohort in which nearly 10,000 pregn...
53 CitationsSource
#1Philip R. JansenH-Index: 18
#2Marjolein H.G. Dremmen (EUR: Erasmus University Rotterdam)H-Index: 7
Last. Tonya White (Erasmus University Medical Center)H-Index: 66
view all 19 authors...
Brain MRI in 3966 children from the population-based Generation R Study (mean age, 10.1 years) revealed incidental findings in 25.6%. Most findings did not require neurosurgical intervention, but 7 children (0.18%) had suspected primary brain tumors.
37 CitationsSource
#1Miro-Pekka Jussila (OUH: Oulu University Hospital)H-Index: 2
#2Päivi Olsén (OUH: Oulu University Hospital)H-Index: 10
Last. Maria Suo-Palosaari (University of Oulu)H-Index: 7
view all 4 authors...
Purpose Pineal cysts are common incidental findings in children undergoing magnetic resonance imaging (MRI). Several studies have suggested MRI follow-up if the cyst is larger than 10 mm. However, cysts do not usually change during follow-up. Prevalence, growth, and structure of the pineal cysts were analyzed to decide if follow-up MRI is necessary.
8 CitationsSource
#1Amy HardinH-Index: 4
#2Jesse M. Hackell (Pomona College)H-Index: 13
Pediatrics is a multifaceted specialty that encompasses children’s physical, psychosocial, developmental, and mental health. Pediatric care may begin periconceptionally and continues through gestation, infancy, childhood, adolescence, and young adulthood. Although adolescence and young adulthood are recognizable phases of life, an upper age limit is not easily demarcated and varies depending on the individual patient. The establishment of arbitrary age limits on pediatric care by health care pro...
111 CitationsSource
#1Julio C. Monterrey (Stanford University)H-Index: 2
#2Jennifer Philips (Stanford University)H-Index: 1
Last. Antonio Y. Hardan (Stanford University)H-Index: 58
view all 9 authors...
Brain magnetic resonance imaging (MRI) studies suggest the prevalence of asymptomatic “incidental” findings (IF) in autism spectrum disorder (ASD) is similar to that of neurotypically developing (NT) controls. However, given the causes of IF may include both genetic and environmental factors, a twin study would facilitate comparing brain IF between ASD and NT subjects. MRI scans were examined to assess the prevalence of brain IF in twin “case pairs” (at least one twin with diagnosis of ASD) and ...
9 CitationsSource
#1Daniel BosH-Index: 25
Last. Meike W. VernooijH-Index: 72
view all 19 authors...
Incidentally discovered findings on brain MR imaging that necessitate further diagnostic evaluation occur in over 3% of the middle-aged and elderly population, but are generally without substantial clinical consequences.
56 CitationsSource
#1Jody M. Shoemaker (The Mind Research Network)H-Index: 26
#2Caitlin Cole (The Mind Research Network)H-Index: 3
Last. John P. Phillips (UNM: University of New Mexico)H-Index: 30
view all 7 authors...
Background Although incidental findings (IF) are commonly encountered in neuroimaging research, there is no consensus regarding what to do with them. Whether researchers are obligated to review scans for IF, or if such findings should be disclosed to research participants at all, is controversial. Objective data are required to inform reasonable research policy; unfortunately, such data are lacking in the published literature. This manuscript summarizes the development of a radiology review and ...
12 CitationsSource
Cited By8
Newest
#1Francis X. Shen (UMN: University of Minnesota)H-Index: 16
#2Susan M. Wolf (UMN: University of Minnesota)H-Index: 38
Last. J. Thomas Vaughan (Nathan Kline Institute for Psychiatric Research)H-Index: 1
view all 19 authors...
Smaller, more affordable, and more portable MRI brain scanners offer exciting opportunities to address unmet research needs and long-standing health inequities in remote and resource-limited international settings. Field-based neuroimaging research in low- and middle-income countries (LMICs) can improve local capacity to conduct both structural and functional neuroscience studies, expand knowledge of brain injury and neuropsychiatric and neurodevelopmental disorders, and ultimately improve the t...
1 CitationsSource
#2Amandine CrombéH-Index: 10
Last. Jean-François Chateil (CNRS: Centre national de la recherche scientifique)H-Index: 24
view all 5 authors...
BACKGROUND Quantitative magnetic resonance imaging (MRI) could improve the estimation of fetal brain maturation and the interpretation of white matter signal intensity in pathological conditions. OBJECTIVE To investigate T2-based and diffusion-weighted imaging (DWI) measurements for the evaluation of fetal brain maturation during the last trimester of pregnancy. MATERIALS AND METHODS One hundred sixty-eight fetal brain MRIs were retrospectively analyzed (age range: 28-37 weeks of gestation) afte...
Source
#1Aicha Soumare (University of Bordeaux)H-Index: 17
#2Naka Beguedou (University of Bordeaux)H-Index: 1
Last. Stéphanie Debette (University of Bordeaux)H-Index: 61
view all 17 authors...
Background and Objectives: Young adults represent an increasingly large proportion of healthy volunteers in brain imaging research, but descriptions of incidental findings (IFs) in this age group are scarce. We aimed to assess the prevalence and severity of IFs on brain MRIs of healthy young research participants aged 18-35 years, and to describe the protocol implemented to handle them. Methods: The study population comprised 1,867 participants aged 22.1±2.3 years (72% women) from MRi-Share, the...
Source
#1Miro-Pekka Jussila (OUH: Oulu University Hospital)H-Index: 2
#2Juho Nissilä (OUH: Oulu University Hospital)
Last. Maria Suo-Palosaari (OUH: Oulu University Hospital)H-Index: 7
view all 9 authors...
Background The purpose of our study was to research the parameters of magnetic resonance imaging (MRI) that would predict the outcome of surgery in patients with Chiari 1 malformation (CM1) and to evaluate changes in MRI parameters after surgery. Methods Fifty-one patients (19 children, 13 adolescents, and 19 adults) operated on due to CM1 in Oulu University Hospital between 2004 and 2018 were evaluated. Seventeen parameters were measured from the preoperative MRI and 11 from the postoperative M...
Source
#1Yi Li (UCSF: University of California, San Francisco)H-Index: 94
#2Wesley K. Thompson (UCSD: University of California, San Diego)H-Index: 68
Last. Sandra A. Brown (UCSD: University of California, San Diego)H-Index: 124
view all 109 authors...
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...
Source
Abstract Introduction and objective Arachnoid cysts (ACs) are relatively frequent lesions related to different neurological symptoms, being mostly incidentally diagnosed. This study aims to clarify whether AC surgery in epileptic patients is useful in their treatment. Material and methods The patients registered in the database of the Neuropediatrics Section from May 1990 to August 2019 are analyzed retrospectively. Patients in whom the diagnosis of ACs and epilepsy coincide are studied. The loc...
Source
#1Rudaina BanihaniH-Index: 3
#2Judy Seesahai (Sunnybrook Health Sciences Centre)
Last. Paige ChurchH-Index: 16
view all 4 authors...
Advances in neuroimaging of the preterm infant have enhanced the ability to detect brain injury. This added information has been a blessing and a curse. Neuroimaging, particularly with magnetic resonance imaging, has provided greater insight into the patterns of injury and specific vulnerabilities. It has also provided a better understanding of the microscopic and functional impacts of subtle and significant injuries. While the ability to detect injury is important and irresistible, the evidence...
Source
#1Miro Pekka Jussila (OUH: Oulu University Hospital)
#2Päivi Olsén (OUH: Oulu University Hospital)H-Index: 10
Last. Maria Suo-Palosaari (OUH: Oulu University Hospital)H-Index: 7
view all 4 authors...
Aim The purpose of our study was to suggest an imaging strategy and guidelines for the selection of the children with mild intellectual disability (ID) for magnetic resonance imaging (MRI), to avoid unnecessary imaging. Methods The brain MRIs and patient reports of 471 children were reviewed for the imaging findings and ID severity. The correlation between the clinical and brain MRI findings was analyzed in the 305 children with mild ID. Results Thirty-eight (12.5%) of the children with mild ID ...
Source
We examined the potential benefits of neuroimaging measurements across the first 5 years of life in detecting early comorbid or etiological signs of autism spectrum disorder (ASD). In particular, we analyzed the prevalence of neuroradiologic findings in routine magnetic resonance imaging (MRI) scans of a group of 117 ASD children younger than 5 years old. These data were compared to those reported in typically developing (TD) children. MRI findings in children with ASD were analyzed in relation ...
Source
#1S. CalvezH-Index: 1
#2R. LevyH-Index: 2
Last. Volodia Dangouloff-RosH-Index: 9
view all 15 authors...
BACKGROUND AND PURPOSE Focal areas of high signal intensity are T2WI/T2-FLAIR hyperintensities frequently found on MR imaging of children diagnosed with neurofibromatosis type 1, often thought to regress spontaneously during adolescence or puberty. Due to the risk of tumor in this population, some focal areas of high signal intensity may pose diagnostic problems. The objective of this study was to assess the characteristics and temporal evolution of focal areas of high signal intensity in childr...
2 CitationsSource