Incidental Brain MRI Findings in Children: A Systematic Review and Meta-Analysis.

V Dangouloff-Ros,C Lozach,O Naggara,D Grevent,N Boddaert,F Brunelle,C.-J Roux,G Boulouis,N Nicolas,R Levy

doi:10.3174/ajnr.a6281

Abstract

The detection of incidental findings on children's brain MR imaging poses various practical issues because the life-long implications of such findings may be profound. Our aim was to assess the prevalence and characteristics of incidental brain MR imaging findings in children. Electronic databases (PubMed, EMBASE, and Cochrane) were searched for articles published between 1985 to July 2018, with the following search terms: "incidental," "findings," "brain," "MR imaging." Inclusion criteria were the following: 1) patients younger than 21 years of age, 2) healthy children without any clinical condition, 3) MR images obtained with at least a 1.5T magnet, 4) original articles, and 5) a methodologic quality score of ≥10. Two observers independently extracted data and assessed data quality and validity. The number and type of incidental findings were pooled. Heterogeneity was assessed using the Cochran Q statistic and the I2 statistic. Seven studies were included, reporting 5938 children (mean age, 11.3 ± 2.8 years). Incidental findings were present in 16.4% (99% CI, 9.8-26.2; Q = 117.5, I2= 94.9%) of healthy children, intracranial cysts being the most frequent (10.2%, 99% CI, 3.1-28.5; Q = 306.4, I2 = 98.0%). Nonspecific white matter hyperintensities were reported in 1.9% (99% CI, 0.2-16.8; Q = 73.6, I2 = 94.6%), Chiari 1 malformation was found in 0.8% (99% CI, 0.5-1.3; Q = 7.6, I2 = 60.5%), and intracranial neoplasms were reported in 0.2% (99% CI, 0.1-0.6; Q = 3.4, I2 = 12.3%). In total, the prevalence of incidental findings needing follow-up was 2.6% (99% CI, 0.5-11.7; Q = 131.2, I2 = 95.4%). Incidental findings needing specific treatment were brain tumors (0.2%) and cavernomas (0.2%). Limitations were no age stratification or ethnicity data and variation in the design of included studies. The prevalence of incidental findings is much more frequent in children than previously reported in adults, but clinically meaningfull incidental findings were present in <1 in 38 children.

Highlights

The detection of incidental findings on children’s brain MR imaging poses various practical issues because the lifelong implications of such findings may be profound.PURPOSE: Our aim was to assess the prevalence and characteristics of incidental brain MR imaging findings in children.DATA SOURCES: Electronic databases (PubMed, EMBASE, and Cochrane) were searched for articles published between 1985 to July 2018, with the following search terms: “incidental,” “findings,” “brain,” “MR imaging.”STUDY SELECTION: Inclusion criteria were the following: 1) patients younger than 21 years of age, 2) healthy children without any clinical condition, 3) MR images obtained with at least a 1.5T magnet, 4) original articles, and 5) a methodologic quality score of $10.DATA ANALYSIS: Two observers independently extracted data and assessed data quality and validity
With the steadily increasing number of brain MR imaging scans obtained each year,[1] these technical advances will result in more patients and physicians being confronted with and needing to manage incidental brain findings.[2]
Estimating the probability of discovering incidental brain findings is of importance to help clinicians inform patients of these risks and to guide researchers to adequately inform either healthy volunteers in imaging research or individuals being considered for screening by brain MR imaging

Summary

Introduction

The detection of incidental findings on children’s brain MR imaging poses various practical issues because the lifelong implications of such findings may be profound.PURPOSE: Our aim was to assess the prevalence and characteristics of incidental brain MR imaging findings in children.DATA SOURCES: Electronic databases (PubMed, EMBASE, and Cochrane) were searched for articles published between 1985 to July 2018, with the following search terms: “incidental,” “findings,” “brain,” “MR imaging.”STUDY SELECTION: Inclusion criteria were the following: 1) patients younger than 21 years of age, 2) healthy children without any clinical condition, 3) MR images obtained with at least a 1.5T magnet, 4) original articles, and 5) a methodologic quality score of $10.DATA ANALYSIS: Two observers independently extracted data and assessed data quality and validity. The detection of incidental findings on children’s brain MR imaging poses various practical issues because the lifelong implications of such findings may be profound. PURPOSE: Our aim was to assess the prevalence and characteristics of incidental brain MR imaging findings in children. DATA SOURCES: Electronic databases (PubMed, EMBASE, and Cochrane) were searched for articles published between 1985 to July 2018, with the following search terms: “incidental,” “findings,” “brain,” “MR imaging.”. STUDY SELECTION: Inclusion criteria were the following: 1) patients younger than 21 years of age, 2) healthy children without any clinical condition, 3) MR images obtained with at least a 1.5T magnet, 4) original articles, and 5) a methodologic quality score of $10. The number and type of incidental findings were pooled. Heterogeneity was assessed using the Cochran Q statistic and the I2 statistic

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