Practical approaches to incidental findings in brain imaging research

Abstract

A decade of empirical work in brain imaging, genomics, and other areas of research has yielded new knowledge about the frequency of incidental findings, investigator responsibility, and risks and benefits of disclosure. Straightforward guidance for handling such findings of possible clinical significance, however, has been elusive. In early work focusing on imaging studies of the brain, we suggested that investigators and institutional review boards must anticipate and articulate plans for handling incidental findings. Here we provide a detailed analysis of different approaches to the problem and evaluate their merits in the context of the goals and setting of the research and the involvement of neurologists, radiologists, and other physicians. Protecting subject welfare and privacy, as well as ensuring scientific integrity, are the highest priorities in making choices about how to handle incidental findings. Forethought and clarity will enable these goals without overburdening research conducted within or outside the medical setting.

Figure. Series of brain abnormalities detected incidentally on research MRI scans acquired at 1.5 and 3 tesla

From left to right: Cavernous hemangioma—This finding was treated neurosurgically and followed by MRI every 6 months. No interval changes have been noted and no intervention has been needed in 3 years since discovery. Arteriovenous malformation—This finding was treated successfully by embolization and surgical resection. Meningioma—This finding was treated by surgical resection. Further information about outcome is unavailable. Glioma—This finding was detected in an undergraduate student, with poor prognosis suspected by the consulting neurologist. The student opted to pursue medical management in his home city. Further information about outcome is unavailable. Courtesy of the Richard M. Lucas MR Imaging Center, Stanford University.