Abstract

ObjectivesIncidental findings in neuroimaging occur in 3% of volunteers. Most data come from young subjects. Data on their occurrence in older subjects and their medical, lifestyle and financial consequences are lacking. We determined the prevalence and medical consequences of incidental findings found in community-dwelling older subjects on brain magnetic resonance imaging.DesignProspective cohort observational study.SettingSingle centre study with input from secondary care.ParticipantsLothian Birth Cohort 1936, a study of cognitive ageing.Main Outcome MeasuresIncidental findings identified by two consultant neuroradiologists on structural brain magnetic resonance imaging at age 73 years; resulting medical referrals and interventions.Primary and Secondary Outcome MeasuresPrevalence of incidental findings by individual categories: neoplasms, cysts, vascular lesions, developmental, ear, nose or throat anomalies, by intra- and extracranial location; visual rating of white matter hyperintensities and brain atrophy.ResultsThere were 281 incidental findings in 223 (32%) of 700 subjects, including 14 intra- or extracranial neoplasms (2%), 15 intracranial vascular anomalies (2%), and 137 infarcts or haemorrhages (20%). Additionally, 153 had moderate/severe deep white matter hyperintensities (22%) and 176 had cerebral atrophy at, or above, the upper limit of normal (25%) compared with a normative population template. The incidental findings were unrelated to white matter hyperintensities or atrophy; about a third of subjects had both incidental findings and moderate or severe WMH and a quarter had incidental findings and atrophy. The incidental findings resulted in one urgent and nine non-urgent referrals for further medical assessment, but ultimately in no new treatments.ConclusionsIn community-dwelling older subjects, incidental findings, including white matter hyperintensities and atrophy, were common. However, many findings were not of medical importance and, in this age group, most did not result in further assessment and none in change of treatment.

Highlights

  • In neuroimaging research, incidental findings are defined as ‘‘apparently asymptomatic intracranial abnormalities that are clinically significant because of their potential to cause symptoms or need to be treated’’ [1,2]

  • The incidental findings were unrelated to white matter hyperintensities or atrophy; about a third of subjects had both incidental findings and moderate or severe White matter hyperintensities (WMH) and a quarter had incidental findings and atrophy

  • In a meta-analysis of 16 neuroimaging studies including 19,559 volunteers with mean ages from 11 to 63 years examined with MRI, the overall prevalence of incidental findings was 3%, giving a ‘‘number needed to scan’’ of 37 to detect any incidental finding [4]

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Summary

Introduction

Incidental findings are defined as ‘‘apparently asymptomatic intracranial abnormalities that are clinically significant because of their potential to cause symptoms or need to be treated’’ [1,2]. They are unknown to the subject and unrelated to the purpose of the imaging. They may cause anxiety, and potentially have medical, lifestyle or financial consequences [3]. They are an increasing problem in imaging research, in health screening and in clinical practice. The results were of limited relevance to the ageing population, as few subjects were aged over 70 years, there existed between-study heterogeneity for some findings, and many findings were poorly described

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