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. 2010;20 Suppl 2(Suppl 2):S498-504.
doi: 10.2188/jea.je20090196. Epub 2010 Feb 23.

Incidental findings of brain magnetic resonance imaging study in a pediatric cohort in Japan and recommendation for a model management protocol

Ayumi Seki  1 , Hitoshi Uchiyama, Tamami Fukushi, Osamu Sakura, Koeda Tatsuya; Japan Children's Study Group
Affiliations

Incidental findings of brain magnetic resonance imaging study in a pediatric cohort in Japan and recommendation for a model management protocol

Ayumi Seki et al. J Epidemiol. 2010.

Abstract

Background: The increasing use of magnetic resonance imaging (MRI) in brain researches has led to growing concern over incidental findings (IFs). To establish a practical management protocol for IFs, it is useful to know the actual prevalence and problems of IF management. In the present study, we report the prevalence proportion and some handling problems of IFs in healthy Japanese children, and suggest a management protocol from ethical and practical standpoints.

Methods: Between 2006 and 2008, 120 healthy children aged 5-8 years participated in a structural MRI study conducted in a pediatric cohort in Japan. All MRI images were reviewed by a pediatric neurologist, and detected IFs were classified into 4 categories.

Results: IFs of all categories were detected in 40 of the 110 participants (36.4%) for whom T2-weighted or 3D-T1-weighted images were available. Findings of sinusitis and/or otitis media were most frequent (26.4%). Excluding these findings, the prevalence of IFs was still 10.9% (12 findings): 9 findings were categorized as "no referral" (8.2%), 2 as "routine referral" (1.8%), 1 as "urgent referral" (0.9%), and 0 as "immediate referral" (0.0%). In "routine referral" category, only one participant was referred for further examinations.

Conclusions: Although the prevalence of IFs was high, the proportion of those requiring further examination was low. This result revealed a fairly high false-positive rate and suggested that evaluating equivocal findings was the most difficult part of IF management. A management protocol needs to include a process to properly assess the clinical importance of findings.

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Figures

Figure 1.
Figure 1.. Incidental findings classified into routine referral category. a) Cystic lesion in the sphenoidal sinus, b) polyp in maxillary sinus. (A: anterior, L: left, 3D-T1W: D-T1 weighted image, T2W: T2 weighted image)
Figure 2.
Figure 2.. A incidental finding classified into routine referral category: Cervical syringomyelia. a) 3D-T1 weighted images obtained in our research, b) Spinal MRI acquired as further examination after referral. Arrows indicate the lesions. (A: anterior, L: left)
Figure 3.
Figure 3.. The recommended IF management protocol used by the Japan Children’s Study Group.
See this image and copyright information in PMC

References

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