Fifteen-minute consultation: incidental findings on brain and spine imaging (original) (raw)
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Journal of the neurological sciences, 2008
Background and purpose: Previous studies have addressed the prevalence of incidental findings largely in healthy adult and pediatric populations. Our study aims to elucidate the prevalence of incidental findings in a pediatric neurology practice. Methods: We reviewed the charts of 1618 patients seen at a pediatric neurology practice at a tertiary care center from September 2003 to December 2005 for clinical data and incidental intracranial findings on brain magnetic resonance imaging reports. Incidental findings were divided into two categories: normal or abnormal variants. Clinical and demographic data were assessed for associations with incidental findings. Results: From 1618 charts reviewed, only 666 patients (41% of all patients) had brain MRIs ordered. One-hundred and seventy-one (171) patients (25.7% of all patients; 95% CI: 22.6, 29.0) had incidental findings. Of these, 113 (17.0%; 95% CI: 14.1, 19.8) were classified as normal-variants and 58 (8.7%; 95% CI: 6.6, 10.9) were classified as abnormal. The nature of incidental findings was not related to age group, sex or clinical diagnosis (p = 0.29, p = 0.31 and p = 0.69 respectively). Two patients (0.3%; 95% CI: ∼ 0.0, 0.7) required neurosurgical referral. Conclusions: We report a high prevalence of and a low rate of referrals for incidental findings in comparison to previous studies. The present study may help guide management decisions and discussions with patients and families. Future studies should attempt to address issues of associations between primary or secondary diagnoses and intracranial incidental findings in a controlled, prospective fashion.
Incidental brain lesions in children: to treat or not to treat?
Journal of Neuro-Oncology, 2012
Central nervous system (CNS) lesions that are discovered incidentally when imaging children for problems that were unrelated to the detected lesion pose a dilemma to physicians. Because there are few data on the outcome of such cases, we retrospectively reviewed the clinical course of a group of children followed at our institution with brain lesions found incidentally on neuroimaging. A database of all children with brain lesions followed at the University of Rochester medical center from 2000 to 2010 was reviewed. Data were obtained regarding presentation, magnetic resonance imaging (MRI) features, treatment, progression-free survival, and overall survival of children with brain lesions found incidentally. Of the 244 children with brain lesions seen over this time period, 21 (8.6%) were found to have incidentally discovered brain lesions. Of these 21 children, 12 (57%) underwent surgical resection of their brain lesions. Ten patients (48%) had symptoms considered to be unassociated with the detected lesion. Lesions were found in the cerebellum (n = 7, 33%), midline (n = 5, 24%), and cerebrum (n = 9, 43%). All lesions were B5 cm in diameter. Eight patients (38%) had surgery at presentation, one because of imaging features suspicious for a posterior fossae ependymoma, and the seven others because of location in the posterior fossae or brain stem. Of the remaining 13 patients, five had progression of disease on serial MRI scans: four underwent surgery and the fifth was monitored and remained stable after the initial progression stabilized. Nine of the ten patients (90%) with posterior fossae lesions underwent surgery, while only three of 11 with supratentorial lesions underwent surgery (27%) (P = 0.006). The progression free survival was 94% at 12 months (95% CI 65-99%) and 71% at 24 months (95% CI 39-88%). At a median follow-up of 32 months, the overall survival was 100%. Incidentally detected CNS lesions are usually small. The outcome for children with such lesions is excellent. Close monitoring of these patients with serial MRIs may be a safe alternative to immediate biopsy and/or resection for select patients.
Incidental findings on brain magnetic resonance imaging
BMJ, 2009
Objective-Incidental findings identified by MRI of the brain have been reported in up to18% of healthy adults, with clinically significant neuropathology in 0.5-2%. There are two smaller series of incidental findings on MRI of the brain in children. We describe the prevalence and range of incidental intracranial abnormalities identified by MRI of the brain in a large group of children screened for a clinical trial.
Imaging of common congenital anomalies of the brain and spine
Clinical Imaging, 1992
The term congenital anomalies refers to those processes that are present before or at birth. In congenital brain anomalies these defects are usually manifested as slructural abnormalities. The central nervous system (CNSJ starts forming at approximately the 17th day of intrauterine life and myelination is almost completed at about the 18th month of life when the brain reaches adult characteristics. For the purpose of this article, the major CNS abnormalities are reviewed according to the time of insult, beginning with the earlier ones. This article does not attempt to be a complete review; the emphasis is on illustrating the most important CNS anomalies utilizing ultrasound (US], computed tomography (CT), and magnetic resonance (MR) imaging.
CT Brain in Children: Evaluation of the Clinical and Radiological Findings
This study was done to the review and documentation of brain CT investigations in King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia in 2012 including CT findings for brain based on justifications for scan. The purpose of the study is to evaluate the situation of requesting CT brain versus the reporting findings. A retrospective study was carried out in the Department of Radiology , KAUH between 1 January and 31 December 2012. There were 417 children scanned by CT for brain, their data were reviewed and analyzed from radiology records to form the sample of the study. The study revealed that high percentages of radiological findings for CT brain did not confirm the clinical diagnosis. The percentages of such cases which observed in the three departments of emergency, inpatient and outpatient were 68.4%, 53.6% and 49.4% respectively. This result shows that a percentage of children were given unnecessary exposure to radiation among those who received CT brain from the radiology department in KAUH. From the study, it is concluded that most brain CT done for children were not justification as well as there were more brain CT findings not confirmed the clinical diagnosis, although the brain CT may be significant in most of the cases. Hence, there is a big concern about the increasing requests for unnecessary brain CT. Therefore, the paediatricians should be more careful in requesting of brain CT unless it is indis-pensible.
Magnetic resonance imaging of the spine in a pediatric population: incidental findings
Radiologia Brasileira
Objective: To determine the prevalence of incidental findings on magnetic resonance imaging (MRI) scans of the cervical, thoracic and lumbar spine in a paediatric population. Materials and Methods: We evaluated 190 spinal MRI examinations of patients aged ≤ 18 years of age. The study included only patients for whom complete medical records were available and who underwent complete MRI examination of the cervical, thoracic or lumbar spine, including whole-spine sagittal T2-weighted sequences. Imaging findings not related to the symptom or indication for MRI were considered incidental findings. Results: Of the 190 MRI examinations evaluated, 110 were in women and 80 were in men. The mean age of the study population was 12.46 ± 3.68 years. The main clinical indications for MRI in the sample were lumbago, scoliosis, dorsalgia and cervicalgia. Incidental findings were detected in the cervical, thoracic and lumbar spine in 40 (21.05%), 26 (13.83%) and 43 (22.63%) of the patients, respecti...
Neuroimaging in neonatal congenital anomalies and infections of brain and spine
Journal of Neonatology, 2008
Neuroimaging has an important role to play in evaluation of neonatal congenital anomalies & infections of brain & spine. Congenital anomalies can be overt but may also be occult clinically and present only on neuroimaging. With availability of plain radiographs (X-rays), Ultrasonography (USG), computerized tomography (CT) and magnetic resonance imag ing (MRI) in the neonatal period, most of the disorders can be demonstrated and classified. Use of the best modality depends on the clinical problem which is suspected & on the availability of the imaging modality. USG is useful and easily available but is operator dependant. X-Rays and CT scan are done only when absolutely necessary and avoided when possible to reduce radiation exposure to the patient. MRI is both safe & versatile but requires the neonate to be shifted to the environment of an MRI unit for some time away from the safety of the neonatal unit which may not always be feasible if the infant is not in a stable condition. However, judicious use of any of these modalities is necessary.for coming to the correct diagnosis in the shortest possible scan time.
Incidental findings on MRI of the spine
Clinical Radiology, 2009
MRI is widely used as the imaging of choice for spinal disorders and may reveal either a clinically insignificant incidental abnormality or a significant lesion, unrelated to the spine, which may explain the patient's symptoms. This article attempts to establish the importance of such findings and describes a sensible approach to the reporting of MRI examinations of the spine with special attention to the incidental findings commonly encountered. The MRI characteristics of such findings are briefly described.