. 2021 May 1;78(5):578-587.

doi: 10.1001/jamaneurol.2021.0306.

Rates of Incidental Findings in Brain Magnetic Resonance Imaging in Children

Yi Li¹, Wesley K Thompson², Chase Reuter², Ryan Nillo¹, Terry Jernigan³, Anders Dale³, Leo P Sugrue¹; ABCD Consortium; Julian Brown¹, Robert F Dougherty⁴, Andreas Rauschecker¹, Jeffrey Rudie¹, Deanna M Barch⁵, Vince Calhoun⁶, Donald Hagler⁷, Sean Hatton⁸, Jody Tanabe⁹, Andrew Marshall¹⁰, Kenneth J Sher¹¹, Steven Heeringa¹², Robert Hermosillo¹³, Marie T Banich¹⁴, Lindsay Squeglia¹⁵, James Bjork¹⁶, Robert Zucker¹⁷, Michael Neale¹⁶, Megan Herting¹⁸, Chandni Sheth¹⁹, Rebeka Huber¹⁹, Gloria Reeves²⁰, John M Hettema²¹, Katia Delrahim Howlett²², Christine Cloak²³, Arielle Baskin-Sommers²⁴, Kristina Rapuano²⁴, Raul Gonzalez²⁵, Nicole Karcher²⁶, Angela Laird²⁷, Fiona Baker²⁸, Regina James²⁹, Elizabeth Sowell¹⁰, Anthony Dick²⁵, Samuel Hawes²⁵, Matthew Sutherland²⁵, Kara Bagot³⁰, Jerzy Bodurka³¹, Florence Breslin³¹, Amanda Morris³¹, Martin Paulus³¹, Kevin Gray¹⁵, Elizabeth Hoffman²², Susan Weiss²², Nishadi Rajapakse³², Meyer Glantz³³, Bonnie Nagel³⁴, Sarah Feldstein Ewing³⁴, Aimee Goldstone²⁸, Adolf Pfefferbaum²⁸, Devin Prouty²⁸, Monica Rosenberg³⁵, Susan Bookheimer³⁶, Susan Tapert³⁷, Maria Infante³⁷, Joanna Jacobus³⁷, Jay Giedd³⁷, Paul Shilling³⁷, Natasha Wade³⁷, Kristina Uban³⁸, Frank Haist³⁹, Charles Heyser³, Clare Palmer³, Joshua Kuperman⁷, John Hewitt⁴⁰, Linda Cottler⁴¹, Amal Isaiah⁴², Linda Chang⁴³, Sarah Edwards²⁰, Thomas Ernst⁴⁴, Mary Heitzeg⁴⁵, Leon Puttler⁴⁵, Chandra Sripada⁴⁵, William Iacono⁴⁶, Monica Luciana⁴⁶, Duncan Clark⁴⁷, Beatriz Luna⁴⁷, Claudiu Schirda⁴⁸, John Foxe⁴⁹, Edward Freedman⁴⁹, Michael Mason⁵⁰, Erin McGlade¹⁹, Perry Renshaw¹⁹, Deborah Yurgelun-Todd¹⁹, Matthew Albaugh⁵¹, Nicholas Allgaier⁵¹, Bader Chaarani⁵¹, Alexandra Potter⁵¹, Masha Ivanova⁵¹, Krista Lisdahl⁵¹, Elizabeth Do⁵², Hermine Maes⁵³, Ryan Bogdan⁵⁴, Andrey Anokhin²⁶, Nico Dosenbach⁵⁵, Paul Glaser²⁶, Andrew Heath²⁶, Betty J Casey²⁴, Dylan Gee²⁴, Hugh P Garavan⁵¹, Gaya Dowling²², Sandra Brown⁵⁶

Affiliations

¹ Department of Radiology and Biomedical Imaging, University of California, San Francisco.
² Department of Family Medicine and Public Health, University of California, San Diego, La Jolla.
³ Center for Human Development, University of California, San Diego, La Jolla.
⁴ Center for Cognitive and Neurobiological Imaging, Stanford University, Stanford, California.
⁵ Department of Psychological & Brain Sciences, Psychiatry, Radiology, Washington University in St Louis, St Louis, Missouri.
⁶ Tri-institutional Center for Translational Research in Neuroimaging and Data Science, Georgia State University, Georgia Tech, Emory University, Atlanta.
⁷ Department of Radiology, University of California, San Diego, La Jolla.
⁸ Department of Neurosciences, University of California, San Diego, La Jolla.
⁹ Department of Radiology, University of Colorado Anschutz Medical Center, Aurora.
¹⁰ Department of Pediatrics, Children's Hospital Los Angeles/University of Southern California, Los Angeles.
¹¹ Department of Psychological Sciences, University of Missouri, Columbia.
¹² Institute for Social Research, University of Michigan, Ann Arbor.
¹³ Department of Behavioral Neuroscience, Oregon Health Sciences University, Portland.
¹⁴ Institute of Cognitive Science, Department of Psychology and Neuroscience, University of Colorado, Boulder.
¹⁵ Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston.
¹⁶ Department of Psychiatry, Virginia Commonwealth University, Richmond.
¹⁷ Department of Psychiatry and Psychology, University of Michigan, Ann Arbor.
¹⁸ Department of Preventive Medicine, University of Southern California, Los Angeles.
¹⁹ Department of Psychiatry, University of Utah School of Medicine, Salt Lake City.
²⁰ Department of Psychiatry, University of Maryland, Baltimore.
²¹ Department of Psychiatry, Texas A&M Health Science Center, Bryan.
²² Division of Extramural Research, National Institute on Drug Abuse/National Institutes of Health, Bethesda, Maryland.
²³ Department of Radiology and Nuclear Medicine, University of Maryland, Baltimore.
²⁴ Department of Psychology, Yale University, New Haven, Connecticut.
²⁵ Department of Psychology, Florida International University, Miami.
²⁶ Department of Psychiatry, Washington University in St Louis, St Louis, Missouri.
²⁷ Department of Physics, Florida International University, Miami.
²⁸ SRI International, Menlo Park, California.
²⁹ Department of Clinical Research, 2M Research Services, Arlington, Virginia.
³⁰ Department of Psychiatry, Icahn School of Medicine at Mt Sinai, New York, New York.
³¹ Laureate Institute for Brain Research, Tulsa, Oklahoma.
³² Department of Scientific Programs, National Institute on Minority Health and Health Disparities, Bethesda, Maryland.
³³ Department of Psychology, National Institute on Drug Abuse/National Institutes of Health, Bethesda, Maryland.
³⁴ Department of Psychiatry, Oregon Health and Science University, Portland.
³⁵ Department of Psychology, University of Chicago, Chicago, Illinois.
³⁶ Department of Psychiatry and Biobehavioral Sciences, School of Medicine, University of California, Los Angeles.
³⁷ Department of Psychiatry, University of California, San Diego, La Jolla.
³⁸ Department of Public Health, University of California, Irvine.
³⁹ Department of Psychiatry and Center for Human Development, University of California, San Diego, La Jolla.
⁴⁰ Institute for Behavioral Genetics, University of Colorado, Boulder.
⁴¹ Department of Epidemiology, University of Florida, Gainesville.
⁴² Department of Otorhinolaryngology/Head and Neck Surgery and Pediatrics, University of Maryland School of Medicine, Baltimore.
⁴³ Departments of Radiology and Neurology, University of Maryland, Baltimore.
⁴⁴ Department of Radiology, University of Maryland, Baltimore.
⁴⁵ Department of Psychiatry, University of Michigan, Ann Arbor.
⁴⁶ Department of Psychology, University of Minnesota, Minneapolis.
⁴⁷ Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
⁴⁸ Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
⁴⁹ Department of Neuroscience, University of Rochester Medical Center, Rochester, New York.
⁵⁰ Center for Behavioral Health Research, University of Tennessee, Knoxville.
⁵¹ Department of Psychiatry, University of Vermont, Burlington.
⁵² Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond.
⁵³ Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond.
⁵⁴ Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, Missouri.
⁵⁵ Department of Neurology, Washington University in St Louis, St Louis, Missouri.
⁵⁶ Department of Psychiatry and Psychology, University of California, San Diego, La Jolla.

PMID: 33749724
PMCID: PMC7985817
DOI: 10.1001/jamaneurol.2021.0306

Rates of Incidental Findings in Brain Magnetic Resonance Imaging in Children

Yi Li et al. JAMA Neurol. 2021.

. 2021 May 1;78(5):578-587.

doi: 10.1001/jamaneurol.2021.0306.

Authors

Affiliations

¹ Department of Radiology and Biomedical Imaging, University of California, San Francisco.
² Department of Family Medicine and Public Health, University of California, San Diego, La Jolla.
³ Center for Human Development, University of California, San Diego, La Jolla.
⁴ Center for Cognitive and Neurobiological Imaging, Stanford University, Stanford, California.
⁵ Department of Psychological & Brain Sciences, Psychiatry, Radiology, Washington University in St Louis, St Louis, Missouri.
⁶ Tri-institutional Center for Translational Research in Neuroimaging and Data Science, Georgia State University, Georgia Tech, Emory University, Atlanta.
⁷ Department of Radiology, University of California, San Diego, La Jolla.
⁸ Department of Neurosciences, University of California, San Diego, La Jolla.
⁹ Department of Radiology, University of Colorado Anschutz Medical Center, Aurora.
¹⁰ Department of Pediatrics, Children's Hospital Los Angeles/University of Southern California, Los Angeles.
¹¹ Department of Psychological Sciences, University of Missouri, Columbia.
¹² Institute for Social Research, University of Michigan, Ann Arbor.
¹³ Department of Behavioral Neuroscience, Oregon Health Sciences University, Portland.
¹⁴ Institute of Cognitive Science, Department of Psychology and Neuroscience, University of Colorado, Boulder.
¹⁵ Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston.
¹⁶ Department of Psychiatry, Virginia Commonwealth University, Richmond.
¹⁷ Department of Psychiatry and Psychology, University of Michigan, Ann Arbor.
¹⁸ Department of Preventive Medicine, University of Southern California, Los Angeles.
¹⁹ Department of Psychiatry, University of Utah School of Medicine, Salt Lake City.
²⁰ Department of Psychiatry, University of Maryland, Baltimore.
²¹ Department of Psychiatry, Texas A&M Health Science Center, Bryan.
²² Division of Extramural Research, National Institute on Drug Abuse/National Institutes of Health, Bethesda, Maryland.
²³ Department of Radiology and Nuclear Medicine, University of Maryland, Baltimore.
²⁴ Department of Psychology, Yale University, New Haven, Connecticut.
²⁵ Department of Psychology, Florida International University, Miami.
²⁶ Department of Psychiatry, Washington University in St Louis, St Louis, Missouri.
²⁷ Department of Physics, Florida International University, Miami.
²⁸ SRI International, Menlo Park, California.
²⁹ Department of Clinical Research, 2M Research Services, Arlington, Virginia.
³⁰ Department of Psychiatry, Icahn School of Medicine at Mt Sinai, New York, New York.
³¹ Laureate Institute for Brain Research, Tulsa, Oklahoma.
³² Department of Scientific Programs, National Institute on Minority Health and Health Disparities, Bethesda, Maryland.
³³ Department of Psychology, National Institute on Drug Abuse/National Institutes of Health, Bethesda, Maryland.
³⁴ Department of Psychiatry, Oregon Health and Science University, Portland.
³⁵ Department of Psychology, University of Chicago, Chicago, Illinois.
³⁶ Department of Psychiatry and Biobehavioral Sciences, School of Medicine, University of California, Los Angeles.
³⁷ Department of Psychiatry, University of California, San Diego, La Jolla.
³⁸ Department of Public Health, University of California, Irvine.
³⁹ Department of Psychiatry and Center for Human Development, University of California, San Diego, La Jolla.
⁴⁰ Institute for Behavioral Genetics, University of Colorado, Boulder.
⁴¹ Department of Epidemiology, University of Florida, Gainesville.
⁴² Department of Otorhinolaryngology/Head and Neck Surgery and Pediatrics, University of Maryland School of Medicine, Baltimore.
⁴³ Departments of Radiology and Neurology, University of Maryland, Baltimore.
⁴⁴ Department of Radiology, University of Maryland, Baltimore.
⁴⁵ Department of Psychiatry, University of Michigan, Ann Arbor.
⁴⁶ Department of Psychology, University of Minnesota, Minneapolis.
⁴⁷ Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
⁴⁸ Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
⁴⁹ Department of Neuroscience, University of Rochester Medical Center, Rochester, New York.
⁵⁰ Center for Behavioral Health Research, University of Tennessee, Knoxville.
⁵¹ Department of Psychiatry, University of Vermont, Burlington.
⁵² Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond.
⁵³ Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond.
⁵⁴ Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, Missouri.
⁵⁵ Department of Neurology, Washington University in St Louis, St Louis, Missouri.
⁵⁶ Department of Psychiatry and Psychology, University of California, San Diego, La Jolla.

PMID: 33749724
PMCID: PMC7985817
DOI: 10.1001/jamaneurol.2021.0306

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 (h2 = 0.260; 95% CI, 0.135-0.387).

Conclusions and relevance: Incidental 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.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Li reported grants from the National Institutes of Health (NIH) with provided salary support during the conduct of the study and grants from the Radiologic Society for unrelated research. Dr Jernigan reported grants from National Institutes of Health during the conduct of the study. Dr Dale reported grants from National Institutes of Health Grant # U24DA041123 during the conduct of the study; in addition, Dr Dale had a patent for US7324842 licensed to Siemens Healthineers, a patent for US8107695 licensed to General Electric, a patent for US9568580B2 licensed to General Electric, and a patent for US20120280686 licensed to General Electric; and Dr Dale is a Founder of and holds equity in CorTechs Labs, Inc, and serves on its Scientific Advisory Board. He is also a member of the Scientific Advisory Board of Human Longevity Inc and receives funding through a research agreement with General Electric Healthcare. The terms of these arrangements have been reviewed and approved by the University of California, San Diego, in accordance with its conflict of interest policies. Dr Sugrue reported receiving grant U24DA041123 for the NIH during the conduct of the study. Dr Barch reported grants from National Institute of Drug Abuse and grants from National Institute of Mental Health during the conduct of the study. Dr Hagler reported a patent for EP-2141506-B1 licensed to GE HealthCare (non-exclusive royalty-free). Dr Sher's participation in the ABCD-12 USA project is funded, in part, by a consulting agreement with Washington University, grants from the NIH, various research grants, and a training grant awarded to the home institution as principal investigator or coinvestigator. Dr Heeringa reported grants from NIDA Prime: University of California, San Diego, during the conduct of the study. Dr Bjork reported grants from NIH/NIDA during the conduct of the study. Dr Zucker reported grants from NIH/NIDA during the conduct of the study. Dr Neale reported grants from NIDA Without the grant the data would not have been collected during the conduct of the study. Dr Herting reported grants from University of Southern California during the conduct of the study. Dr Reeves reported grants from NIH during the conduct of the study. Dr Cloak reported grants from National Institutes of Health during the conduct of the study; grants from National Institute of Justice outside the submitted work. Dr Gonzalez reported grants from National Institutes of Health during the conduct of the study. Dr Karcher reported grants from National Institutes of Mental Health during the conduct of the study. Dr Paulus reported personal fees from UpToDate royalties for an article about methamphetamine outside the submitted work. Dr Gray reported other from Pfizer, Inc. Consultation outside the submitted work. Dr Weiss reported other from General Electric own stock; less than $10 000 outside the submitted work. Dr Nagel reported grants from NIH during the conduct of the study. Dr Bookheimer reported grants from UCLA during the conduct of the study. Dr Hewitt reported grants from the NIH during the conduct of the study. Dr Chang reported grants from the NIH during the conduct of the study. Dr Edwards reported grants from the NIH during the conduct of the study. Dr Iacono reported grants from the NIH during the conduct of the study. Dr Luciana reported grants from the NIH during the conduct of the study. Dr Clark reported grants from the NIDA during the conduct of the study. Dr Schirda reported grants from the NIH during the conduct of the study. Dr Lisdahl reported grants from the NIH during the conduct of the study. Dr Dosenbach reported grants from NIH NS088590, MH096773, MH124567, MH122066, MH121276 during the conduct of the study; other from NOUS Imaging outside the submitted work. No other disclosures were reported.

Comment in

Beyond the AJR: "Rates of Incidental Findings in Brain Magnetic Resonance Imaging in Children".
Kadom N, Lall N. Kadom N, et al. AJR Am J Roentgenol. 2021 Dec;217(6):1482. doi: 10.2214/AJR.21.26140. Epub 2021 May 12. AJR Am J Roentgenol. 2021. PMID: 33978463 No abstract available.

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References

1. Dangouloff-Ros V, Roux CJ, Boulouis G, et al. . Incidental brain MRI findings in children: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2019;40(11):1818-1823. doi:10.3174/ajnr.A6281 - DOI - PMC - PubMed
1. Shoemaker JM, Cole C, Petree LE, et al. . Evolution of universal review and disclosure of MRI reports to research participants. Brain Behav. 2016;6(3):e00428. doi:10.1002/brb3.428 - DOI - PMC - PubMed
1. Illes J, Chin VN. Bridging philosophical and practical implications of incidental findings in brain research. J Law Med Ethics. 2008;36(2):298-304, 212. doi:10.1111/j.1748-720X.2008.00273.x - DOI - PMC - PubMed
1. Weiner C. Anticipate and communicate: ethical management of incidental and secondary findings in the clinical, research, and direct-to-consumer contexts (December 2013 report of the Presidential Commission for the Study of Bioethical Issues). Am J Epidemiol. 2014;180(6):562-564. doi:10.1093/aje/kwu217 - DOI - PubMed
1. Volkow ND, Koob GF, Croyle RT, et al. . The conception of the ABCD study: From substance use to a broad NIH collaboration. Dev Cogn Neurosci. 2018;32:4-7. doi:10.1016/j.dcn.2017.10.002 - DOI - PMC - PubMed

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Rates of Incidental Findings in Brain Magnetic Resonance Imaging in Children

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