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Review
. 2019 May;46(3):275-279.
doi: 10.1017/cjn.2018.397. Epub 2019 Apr 1.

Incidentaloma Discoveries in the Course of Neuroimaging Research

Emmanuel Stip  1 , Jean-Philippe Miron  1 , Marie Nolin  1 , Geneviève Letourneau  2 , Odette Bernazzani  3 , Laurie Chamelian  1 , Bernard Boileau  4 , Mona Gupta  1 , David Luck  2 , Ovidiu Lungu  5
Affiliations
Review

Incidentaloma Discoveries in the Course of Neuroimaging Research

Emmanuel Stip et al. Can J Neurol Sci. 2019 May.

Abstract
in English, French

ABSTRACTAmong healthy volunteers in psychiatric brain functional magnetic resonance imaging (fMRI) research studies, the prevalence of incidentalomas can be as high as 34%, of which 10% show clinical significance. An incidentaloma is a lesion found by coincidence without clinical symptoms or suspicion. Like lesions and other types of accidental findings, it is found in healthy individuals recruited to take part in psychiatric studies. The prevalence of these accidental findings among specific psychiatric populations remains unknown. However, a precise understanding of cerebral neuroanatomy, neuroradiological expertise, and an appropriate choice of fMRI exploration sequences will increase the sensitivity of identifying these accidental findings and enable researchers to address their clinical relevance and nature. We present recommendations on how to appropriately inform patients or participants of the accidental findings. Additionally, we propose specific suggestions pertaining to the clinical research setting aimed for investigators and psychiatrists. Unlike current articles pertaining to incidentaloma, the current report provides a distinct focus on psychiatric issues and specific recommendations for studies involving psychiatric patients.

Découvrir la présence d’incidentalomes dans le cadre de recherches en neuro-imagerie. Chez les patients en santé participant de façon volontaire à des travaux de recherche du domaine de la psychiatrie faisant appel aux techniques d’IRM fonctionnelle, la prévalence d’incidentalomes peut atteindre jusqu’à 34 %. À noter par ailleurs que 10 % de ces incidentalomes se révèlent significatifs sur le plan clinique. Un incidentalome est une lésion détectée fortuitement qui ne présente pas de symptômes cliniques et qui ne suscite aucune suspicion. À l’instar d’autres lésions et d’autres observations de nature inopinée, on retrouve l’incidentalome chez des individus en santé ayant été recrutés pour participer à des études dans le champ de la psychiatrie. La prévalence de telles observations au sein de clientèles psychiatriques spécifiques demeure inconnue. Toutefois, une compréhension fine de la neuro-anatomie cérébrale et de l’expertise neuroradiologique, de même qu’un choix approprié de séquences d’IRM fonctionnelle, pourront faire en sorte d’augmenter la sensibilité de détection de ces lésions et ainsi permettre aux chercheurs d’évaluer leur nature et leur pertinence sur le plan clinique. Nous voulons présenter ici des recommandations permettant aux praticiens de révéler de façon appropriée aux patients ou aux participants la présence d’incidentalomes. Nous entendons aussi, pour le bénéfice des chercheurs et des psychiatres, faire des suggestions relatives au domaine de la recherche clinique. Contrairement aux articles récents explorant les incidentalomes, le présent compte-rendu mettra un accent particulier sur des enjeux psychiatriques et sur des recommandations spécifiques en vue d’études incluant une clientèle psychiatrique.

Keywords: Ethics; Legal issues; Neuroethics; Neuroimaging; Neurological practice; Neurology - Education; Neuropsychiatry; Neurovascular; Psychiatry; fMRI.

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Figures

Figure 1:
Figure 1:
Sagittal T1 sections: Heterogeneous frontal mass (in hyper- and hyposignals) in the image on the left and a homogeneous hyposignal nodular lesion on the right. These images could correspond to tumor lesions – further investigation is needed.
Figure 2:
Figure 2:
Sagittal and axial T1 sections: Increased volume of the sella turcica (see arrow) occupied by fluid with pituitary tissue (arrow head) pressed against the sella turcica: cystic pituitary lesion or empty sella syndrome.
Figure 3:
Figure 3:
Polyploid tissue formation in the right maxillary sinus (arrow) with hypertrophy and of the lining of the left nasal cavity (arrowhead).
See this image and copyright information in PMC

References

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