Incidental Imaging Findings Research Articles

Spontaneous defects between the mastoid and posterior cranial fossa

Conclusions Spontaneous defects between the mastoid and the posterior cranial fossa are exceedingly rare. Patients with these lesions may have a lower BMI compared to those with middle cranial fossa encephaloceles, but are otherwise demographically similar. This study recommends repair via a transtemporal approach to allow for examination of the entire posterior face of the temporal bone. Objective To describe cases of spontaneous posterior cranial fossa defects. Methods This study reviewed all cases of spontaneous posterior fossa defects presenting to a tertiary referral center over the last decade and described clinical presentation, imaging, operative findings, and outcomes. We also compared these lesions to those previously reported in the literature as well as the more common spontaneous encephaloceles of the middle cranial fossa.Results This study identified five cases with a mean age of 61.4 years, female-to-male ratio of 4:1, and a mean BMI of 31. Three cases presented with spontaneous pneumocephalus, one with CSF otorrhea, and one as an incidental imaging finding. Four defects were found medial to the sigmoid sinus and one was in the lateral retrosigmoid air cells.

Incidence of Radiologically Isolated Syndrome: A Population-Based Study.

Incidental MR imaging findings resembling MS in asymptomatic individuals, fulfilling the Okuda criteria, are termed "radiologically isolated syndrome." Those with radiologically isolated syndrome are at high risk of their condition converting to MS. The epidemiology of radiologically isolated syndrome remains largely unknown, and there are no population-based studies, to our knowledge. Our aim was to study the population-based incidence of radiologically isolated syndrome in a high-incidence region for MS and to evaluate the effect on radiologically isolated syndrome incidence when revising the original radiologically isolated syndrome criteria by using the latest radiologic classification for dissemination in space. All 2272 brain MR imaging scans in 1907 persons obtained during 2013 in the Swedish county of Västmanland, with a population of 259,000 inhabitants, were blindly evaluated by a senior radiologist and a senior neuroradiologist. The Okuda criteria for radiologically isolated syndrome were applied by using both the Barkhof and Swanton classifications for dissemination in space. Assessments of clinical data were performed by a radiology resident and a senior neurologist. The cumulative incidence of radiologically isolated syndrome was 2 patients (0.1%), equaling an incidence rate of 0.8 cases per 100,000 person-years, in a region with an incidence rate of MS of 10.2 cases per 100,000 person-years. There was no difference in the radiologically isolated syndrome incidence rate when applying a modified version of the Okuda criteria by using the newer Swanton classification for dissemination in space. Radiologically isolated syndrome is uncommon in a high-incidence region for MS. Adapting the Okuda criteria to use the dissemination in space-Swanton classification may be feasible. Future studies on radiologically isolated syndrome may benefit from a collaborative approach to ensure adequate numbers of participants.

Multiplanar reconstructed CT images increased depiction of intracranial hemorrhages in pediatric head trauma.

The benefits of multiplanar reconstructed images (MPR) of unenhanced axial head computed tomography (CT) data have not been established in trauma patients younger than 3 years old, a population in which a reliable history and physical examination may be most difficult. We retrospectively evaluated unenhanced head CTs in pediatric trauma patients to investigate the various benefits of MPR in this age group. A total of 221 unenhanced head CTs performed for any case of head trauma (HT) on children younger than 3 years old were independently reviewed by two radiologists. Studies were reviewed first in the standard axial plane alone and then with the addition of MPR. Reviewers were asked to determine if the MPR affected the ability to make findings of hemorrhage, incidental findings, and artifacts. MPR improved the detection of hemorrhage in 14 cases (6.5 %, p-value < 0.01) and incidental findings in five cases (2.3 %, p-value < 0.05) as well as helped prove artifacts in five cases (2.3 %, p-value < 0.05). Routine use of MPR in HT patients younger than 3 years old has the potential to increase the detection of acute and incidental imaging findings.

Total Effective Radiation Dose Attributable to Medical Imaging in Patients With Acute Chest Pain: A Single-Center Comparison Study Between Dual-Source Coronary CT Angiography and Usual Care

Introduction: Coronary CT angiography (CCTA) can safely disposition low to intermediate risk chest pain (CP); however, there is conflicting data with respect to cumulative radiation exposure when compared with usual care over short follow-up intervals. Objectives: We report the effective radiation dose from index and downstream testing in low to intermediate risk symptomatic patients evaluated for chest pain in the ED with either CCTA or usual care to define various sources of patient radiation dose and quantify effective dose over a year and a half of follow-up. Patients and Methods: We evaluated radiation exposure from initial and downstream testing in a prospectively collected, matched cohort evaluated for CP in the emergency department (ED) with either CCTA compared with usual care over a median follow-up of 19.6 months. Effective radiation dose was calculated using published conversion factors. Results: Prospective, ECG-triggered acquisition using a 128-slice dual-source multidetector computed tomography (DSCT) scanner was performed in 92.9% of scans with a median effective dose from CCTA of 6.8 mSv (IQR 5.2, 9.1 mSv). CCTA cohort patients were more likely to undergo cardiac testing with exposure to radiation (P < 0.001); however, the median effective dose in patients exposed to radiation from cardiac testing was significantly lower in the CCTA cohort (7.1 mSv vs. 11.8 mSv, P < 0.001). Fewer patients in the CCTA cohort had additional non-cardiac thoracic imaging radiation exposure (40.8%) compared with usual care (92.8%). Total radiation exposure from any source was similar between the CCTA and usual care groups (100% vs 98.4%, P = 0.087), as was median total effective radiation dose (P = 0.105). Upfront CCTA was not associated with higher rates of incidental non-cardiac findings. Conclusions: Initial evaluation of acute chest pain in the ED with CCTA was not associated with an increase in total radiation exposure over a follow-up period of 19 months. CCTA offers a more comprehensive evaluation of multiple thoracic organ systems leading to reduced radiation exposure from non-cardiac thoracic testing and no increase in incidental imaging findings. This may represent an added benefit in this population of patients presenting acutely.

Profile of patients with gastrointestinal stromal tumors (GIST).

BackgroundThere is an improvement on the GIST treatment in last decade due to biomolecular research and adjuvant therapy with tyrosine kinases inibitors. However, both modalities of treatment rarely are available in Brazilian public hospital.AimEvaluate GIST patients profile in public oncologic hospital.MethodsA retrospective study was made on patients with GIST diagnosed and treated between 2001 and 2013.ResultsSixty-nine patients were included, mean age 59 years with slight predominance in females (51%). The main symptom was abdominal pain associated with incidental imaging finding. The occurrence of other associated neoplasm was in 28.8% of cases. The positivity of CD117 was 97.1%. The most frequent location was the stomach in 55.1% of cases. The R0 resection was possible in 63.8% and the recurrence rate was 20.3 %, with liver and peritoneum the main affected sites. Overall survival in the whole sample was 71%. Free survival rate of disease was 64%. The use of imatinib was limited to patients with residual disease (unresectable disease, R2 and R1 resection), metastatic disease or recurrence.ConclusionIn order to improve GIST treatment is necessary to add the biomolecular analysis to risk stratification. However, for this to occur, incentive in biomolecular research is required, to increase the possibility of patient survival.

Incidental imaging finding of chest wall mass

Incidental imaging finding of chest wall mass

A neuroscience perspective on incidental imaging findings and diagnostic and therapeutic silos.

Traditionally, psychiatry and clinical psychology have understood behavior as separate from brain function and have avoided referring neurobehavioral patients, particularly those carrying a Diagnostic Statistical Manual (DSM) diagnosis, for additional studies such as neuroimaging. Current psychiatric training programs continue to permit this dichotomous misunderstanding by neglecting neuroscience courses that elucidate the relationship between behavior and brain function. Psychiatrists and psychologists have learned to interpret and manage behavior without a clear picture of brain physiology and function (1). Moreover, with the exception of some neuropsychologists, most psychologists and psychiatrists neglect standard neurological exams and only consider behavioral symptoms. When it concerns neurobehavioral disorders, psychiatric and psychological standards of practice disregard objective imaging for assessing brain function and primarily reserve this technique for research. This omission confirms a meager understanding of brain physiology and function and their influences on behavior. Therefore, psychological and psychiatric theories have become stuck in unsubstantiated data. For example, the DSM defines disorders purely from observational data. To be fair, those diagnostic theories evolved during an era that lacked the necessary technology for objective brain evaluation, yet despite neuro-imaging and neuro-scientific advances, clinical psychology and psychiatry training programs still disregard introducing neuroscience to their students trained to be clinicians. Consequently, this omission has caused competition and isolation between clinical specialties and the development of practical and intellectual silos. Didactic programs that ignore neuroscience perspectives hinder clinical mental health students by denying them a holistic view of the patient. This incomplete picture begins the process of pseudo-specialization, a process that has little to do with developing optimal person centered therapeutics for the patient. In an ideal world, all behavioral fields would pursue a common neuroscientific language and education that permits seamless understanding of biology, behavior, sociology, and pathology.

Congenital lung disease in the adult: guide to the evaluation and management.

A high index of suspicion is required to consider the diagnosis of adult congenital lung disease because of the rarity of presentation in adulthood. The purpose of this article is to provide a framework for evaluation of these lesions and a guide to management. Adults may be asymptomatic, and the abnormality identified as an incidental imaging finding or the individual may present with symptoms of cough, hemoptysis, or recurrent pneumonia. The diagnosis may be readily apparent on computed tomography imaging because of a characteristic appearance, or the abnormality may require further evaluation for diagnosis with supplemental magnetic resonance imaging. Surgical resection provides a definitive diagnosis. The congenital lung malformation may be a solitary lesion or part of a complex group of abnormalities. A detailed review of all the components of the thorax is required to identify additional lesions. Management is typically surgical resection because of the propensity of these lesions to enlarge and to become infected as well as the potential risk for malignant transformation. Computed tomography surveillance may be appropriate for small asymptomatic lesions or lesions with either no or very low risk for developing malignancy.

Incidentalomas: managing risks.

.Incidental imaging findings such as aortic aneurysms may beclinically significant, determining interventions that may changethe natural course of the disease. However, most incidental find-ings constitute a form of overdiagnosis. Overdiagnosis is the diag-nosis of a disease that never will cause symptoms or death of thepatient, and is nowadays considered to be a public health prob-lem

Longitudinal Follow-up of a Cohort of Patients with Incidental Abnormal Magnetic Resonance Imaging Findings at Presentation and Their Risk of Developing Multiple Sclerosis.

Magnetic resonance imaging (MRI) is widely used in clinical practice, and "abnormal brain MRI" findings often prompt assessment for multiple sclerosis (MS), even when there are no symptoms suggestive of the disease. Despite several studies involving individuals with "radiologically isolated syndrome" (RIS), little is known about what factors might predict future development of MS. The objective of this study was to longitudinally evaluate clinical and MRI characteristics of people who presented to an MS clinic because of incidental abnormal MRI findings but did not have typical symptoms of MS, in order to assess risk factors for developing MS. Thirty consecutive patients presenting to an MS clinic for evaluation of abnormal MRI findings were enrolled in the study. Clinical and paraclinical data, including MRI results, were reviewed. Magnetic resonance imaging findings of T2 hyperintensities measuring more than 3 mm in diameter and fulfilling at least three out of four Barkhof criteria, with or without gadolinium-enhancing lesions, were considered to be suggestive of MS. The median follow-up time was 5.5 years. No participants without MRI findings suggestive of MS were diagnosed with MS (P = .005). Fifteen participants had MRI findings suggestive of MS. Seven of the 15 (47%) were diagnosed with MS on follow-up. Cerebrospinal fluid (CSF) testing results were available for 15 participants. Abnormal results were found in six participants, of whom five (83%) also had MRI findings suggestive of MS. Only two of the nine (22%) participants with normal CSF results (P = .04) had MRI findings suggestive of MS. In our cohort, none of the participants without MRI findings suggestive of MS developed MS. The participants with MRI findings suggestive of MS were more likely to develop symptoms and MRI changes typical of MS on follow-up.

Incidental Findings on Magnetic Resonance Imaging of the Spine in the Asymptomatic Pediatric Population: A Systematic Review

Study Design Systematic review. Clinical Question What is the prevalence of incidental magnetic resonance imaging (MRI) findings of the spine in asymptomatic pediatric patients? Methods Electronic databases and reference lists of key articles were searched up to December 15, 2013, to identify studies reporting the incidence or prevalence of incidental findings on MRI in asymptomatic pediatric patients. Athletes or children with a known history of trauma, infection, or congenital abnormalities were excluded. Results Seven publications, one prospective cohort, and six cross-sectional studies met the inclusion criteria. The most commonly reported findings on MRI were disc-related and included degenerative disc disease (seven studies, prevalence 19.6%), disc herniation/protrusion (four studies, 2.9%), disc height/narrowed disc space (two studies, 33.7%), and endplate changes (two studies, 5.3%). Other disc-related findings, reported by one study each, included bulging disc, abnormal nucleus shape, annular tear, high intensity zone, and nerve root compression, with prevalences ranging from 4.5 to 51.6%. Spondylolisthesis and spondylolysis were reported by one study each with a prevalence of 2.3 and 0%, respectively. Other findings reported included tumors and infections (one study, 0% for both) and Scheuermann-type changes (one study, 7.7%). Conclusions The prevalence of positive MRI findings in the asymptomatic pediatric population is higher than previously assumed, particularly in regard to disc morphology, highlighting the importance of correlating the history and physical examination to the MRI findings to avoid misdiagnosis or over-treatment in the pediatric population.

Incidental imaging findings from routine chest CT used to identify subjects at high risk of future cardiovascular events.

To investigate the contribution of incidental findings at chest computed tomography (CT) in the detection of subjects at high risk for cardiovascular disease (CVD) by deriving and validating a CT-based prediction rule. This retrospective study was approved by the ethical review board of the primary participating facility, and informed consent was waived. The derivation cohort comprised 10 410 patients who underwent diagnostic chest CT for noncardiovascular indications. During a mean follow-up of 3.7 years (maximum, 7.0 years), 1148 CVD events (cases) were identified. By using a case-cohort approach, CT scans from the cases and from an approximately 10% random sample of the baseline cohort (n = 1366) were graded visually for several cardiovascular findings. Multivariable Cox proportional hazards analysis with backward elimination technique was used to derive the best-fitting parsimonious prediction model. External validation (discrimination, calibration, and risk stratification) was performed in a separate validation cohort (n = 1653). The final model included patient age and sex, CT indication, left anterior descending coronary artery calcifications, mitral valve calcifications, descending aorta calcifications, and cardiac diameter. The model demonstrated good discriminative value, with a C statistic of 0.71 (95% confidence interval: 0.68, 0.74) and a good overall calibration, as assessed in the validation cohort. This imaging-based model allows accurate stratification of individuals into clinically relevant risk categories. Structured reporting of incidental CT findings can mediate accurate stratification of individuals into clinically relevant risk categories and subsequently allow those at higher risk of future CVD events to be distinguished.

Incidental Findings in Patients Evaluated for Pulmonary Embolism Using Computed Tomography Angiography

Introduction: Pulmonary embolism (PE) is a common lethal disease that its clinical symptoms may be seen in many other diseases. Computed tomography pulmonary angiography (CTPA) is a valuable diagnostic modality for detection of PE. In addition, it can accurately detect the other diseases with clinical symptoms similar to PE. The aim of this study is to evaluate the frequency of PE and nonembolic disease with similar clinical symptoms including pulmonary, pleural, mediastinal, and cardiovascular diseases that have been detected by CTPA and to describe the importance of reporting these CT findings. Materials and Methods: In this cross‐sectional study, we evaluated the medical records of CTPA in 300 patients of suspected PE between March 2012 and February 2013 in Imam Reza Hospital and Ghaem Hospital in Mashhad University of Medical Sciences, Mashhad, Iran. Demographic information and the results of CTPA of these patients were re‐evaluated. One radiologist reviewed all of the CTPA and the results have been analyzed by SPSS‐16 software. Results: In this study, PE was detected in 18.7% of patients. Multiple incidental imaging findings were diagnosed as follow: pulmonary consolidation (33.2%), pleural effusion (48.7%), pulmonary nodules (10%), pulmonary masses (1.3%), pneumothorax (4.7%), mediastinal mass and lymphadenopathy (9.3%), aortic calcification (42%), coronary arteries calcification (27.3%), mitral valve calcification (2 %), cardiomegaly (30.7%), and the evidences of right ventricular dysfunction (6.7%). Conclusion: A group of disease can cause the clinical symptoms similar to that of PE. Among them, pulmonary consolidation and pleural effusion have much higher frequency than PE. In addition, CTPA can show pathologic findings in the patients that need follow‐up. It is important to detect and report these imaging findings because some of them may change the treatment and prognosis of patient who are suspected to have PE.

Congenital renal arteriovenous malformation presenting with gross hematuria after a routine jog: a case report

IntroductionCongenital renal arteriovenous malformations are abnormal communications between the intrarenal venous and arterial systems. An unusual cause of massive gross hematuria and an even rarer cause of hemodynamically significant anemia, its presentation remains variable from incidental imaging findings to severe hypertension and congestive heart failure.Case presentationWe present a case of a 44-year-old Chinese man with no personal or familial history of bleeding diasthesis that presented with gross hematuria leading to clot retention after routine physical activity.ConclusionsWe have presented this case in an effort to highlight the possibility of this entity as a cause of acute upper urinary tract hemorrhage and the need for a computed tomography angiogram to clinch the diagnosis.

Incidental parenchymal magnetic resonance imaging findings in the brains of patients with neurofibromatosis type 2

PurposeWhereas T2 hyperintensities known as NF-associated bright spots are well described in patients with neurofibromatosis type I (NF-1), there is a paucity of data on incidental findings in patients with neurofibromatosis type II (NF-2). We aim to characterize unexplained imaging findings in the brains of patients with NF-2.Materials and methodsThis study is retrospective, HIPAA-compliant and approved by the institutional review board. 34 patients with NF-2 underwent brain magnetic resonance imaging (MRI) between January 2000 and December 2012. T2 and T1-weighted imaging characteristics, diffusion weighted imaging (DWI) characteristics, and enhancement patterns were analyzed by visual inspection. Clinical information at time of imaging was available for all patients. Neuropathologic data was available for one patient.ResultsWe found unexplained T2 hyperintensities present on initial imaging in 23/34 patients (67%). Of the 23 patients with unexplained MRI findings, 15 (65%) had wedge-shaped T2 hyperintensities in the subcortical white matter extending to the cortex suggestive of a cortical dysplasia. 3 additional cases (17%) had a lesion within the cerebellum suggestive of a neuronal migration anomaly. In one patient where the MRI was suggestive of focal cortical dysplasia, histopathologic analysis revealed dysplastic glial foci without other alterations of cortical architecture or other cytologic abnormalities.ConclusionUnexplained T2 hyperintensities occur frequently in patients with NF-2. While they may not be the NF-2 equivalent of NF-associated bright spots seen in NF-1, some of these T2 hyperintensities in patients with NF-2 may represent underlying disorders of neuronal migration. Further studies are needed to validate our findings.

ACR Members' Response to JACR White Paper on the Management of Incidental Abdominal CT Findings

In October 2010, a white paper was published in this journal that represented a consensus of the ACR Incidental Findings Committee, including guidance for characterizing, reporting, and managing incidental findings in the liver, kidneys, adrenal glands, and pancreas. A survey was conducted of the ACR membership to determine how widely this paper had been read, how the information is being used, and how management of incidental findings may be improved. A survey consisting of 14 multiple-choice and 5 free-text responses was distributed by e-mail to 14,336 ACR physician members. The survey was open during June and July 2012 using SurveyMonkey. Topics included how the paper's recommendations had affected practice and the frequency of recommendations for additional imaging, how incidental findings are reported, the content and the form of the white paper, and the possible effects of tort reform. Of the 14,336 radiologists contacted, 2,892 (20%) returned the survey; of these, 1,099 (38%) indicated that they had read the paper. Of the 1,099 radiologists who read the paper, 978 (89%) responded that the content was used in clinical practice. The white paper led 560 radiologists (51%) to recommend additional imaging less often and 33 radiologists (3%) to recommend imaging more often. Tort reform was cited by 835 radiologists (76%) as a means to decrease the likelihood of their recommending additional imaging. The 2010 JACR white paper on incidental abdominal CT findings has been read by a substantial number of radiologists, and among those who read it, the recommendations are being largely followed and are leading to a reduction in imaging recommendations. Future similar consensus-based white papers could lead to more consistent and effective management of incidental imaging findings and likely reduce the overall number of patients for whom additional imaging is recommended.

Lipoma intracraniano – Revisão da literatura

ResumoLipomas intracranianos são considerados malformações congênitas, resultantes da persistência da meninge primitiva mesenquimal e de sua posterior diferenciação em tecido adiposo. Correspondem entre 0,06% e 0,1% de todos os tumores intracranianos. Exame de neuroimagem tem sido útil no seu diagnóstico em pacientes assintomáticos. Geralmente, encontra-se associado a outras anomalias congênitas como agenesia do corpo caloso ou representa achado ocasional relacionado a outras manifestações clínicas não correlatas. Tratamento cirúrgico não é recomendado por causa da elevada taxa de complicações e pelo curso benigno dessa lesão. Este trabalho teve como delineamento uma revisão bibliográfica nas bases de dados online Cochrane, PubMed/MedLine, Lilacs e SciELO, para artigos publicados entre os anos de 1974 e 2010. Os descritores utilizados foram: “lipoma cerebral” e “lipoma intracraniano”, combinados com “tumor cerebral” e “tratamento”. Foram identificados 94 artigos, dos quais, após a leitura na íntegra e análise pelos autores, foram selecionados 75 artigos para este estudo. Os lipomas intracranianos resultam da persistência e diferenciação anômala da meninge primitiva em tecido adiposo. No exame tomográfico, apresenta-se como lesão marcadamente hipoatenuante, sem realce significativo pelo contraste endovenoso, não apresentando edema perilesional. A ressonância magnética tem sido o exame de eleição para o seu diagnóstico. Quando decorrente de achado incidental e assintomático, seu tratamento é conservador. Lipoma intracraniano é uma malformação rara resultante de alterações do desenvolvimento e encontra-se frequentemente associado a disrafismos. Geralmente é assintomático ou um achado incidental de exame de imagem. Os avanços nos métodos de diagnóstico por imagem aumentaram a probabilidade de essa malformação ser diagnosticada, mesmo que assintomática. Seu tratamento é conservador em casos assintomáticos ou de achado incidental.

Clinical, Ethical and Financial Implications of Incidental Imaging Findings: Experience from a Phase I Trial in Healthy Elderly Volunteers

BackgroundThe detection of incidental findings (IF) in magnetic resonance imaging (MRI) studies is common and increases as a function of age. Responsible handling of IF is required, with implications for the conduct of research and the provision of good clinical care.AimTo investigate the prevalence and clinical significance of IF in a prospective cohort of healthy elderly volunteers who underwent MRI of the torso as a baseline investigation for a phase I trial. We assessed the follow-up pathway with consequent cost implications and impact on trial outcomes.MethodsA total of 29 elderly healthy volunteers (mean age 67, range 61–77, 59% female) were eligible at screening and underwent MRI for assessment of visceral and subcutaneous fat.ResultsIF were detected in 19 subjects (66%). Suspected IF of high and low clinical significance were found in 14% and 52% of participants, respectively. Follow up of IF was conducted in 18 individuals, confirming abnormalities in 13 subjects, 3 of whom were recommended for deferred clinical re-evaluation. The remaining 5 subjects had false positive IF based on second line imaging tests. Costs of follow-up medical care were considerable.ConclusionMRI abnormalities are common in elderly individuals, as a result of age and non-diagnostic quality of research scans. In the presence of IF in the context of clinical trials, immediate referrals and follow up assessments may be required to rule out suspected pathology prior to exposing trial participants to investigational medicine products (IMP). Unanticipated costs, ethical implication and the possible impact of IF on trial outcomes need to be taken into account when designing and conducting trials with an IMP.

Radiologically isolated syndrome – incidental magnetic resonance imaging findings suggestive of multiple sclerosis, a systematic review

With increasing availability of magnetic resonance imaging (MRI), there is also an increase in incidental abnormal findings. MRI findings suggestive of multiple sclerosis in persons without typical multiple sclerosis symptoms and with normal neurological findings are defined as radiologically isolated syndrome (RIS). Half of the persons with RIS have their initial MRI because of headache, and some have a subclinical cognitive impairment similar to that seen in multiple sclerosis. Radiological measurements also show a similarity between RIS and multiple sclerosis. Approximately two-thirds of persons with RIS show radiological progression and one-third develop neurological symptoms during mean follow-up times of up to five years. Cervical cord lesions are important predictors of clinical conversion. Management has to be individualised, but initiation of disease modifying therapy is controversial and not recommended outside of clinical trials since its effects have not been studied in RIS. Future studies should try to establish the prevalence and long-term prognosis of RIS, its impact on quality of life, and define the role of disease modifying therapy in RIS.

Incidental findings on cranial imaging in nonagenarians

The aim of this article was to report on the nature and prevalence of incidental imaging findings in a consecutive series of patients older than 90 years of age who underwent intracranial imaging for any reason. The authors retrospectively reviewed the electronic medical and imaging records of consecutive patients who underwent brain MR imaging at a single institution over a 153-month interval and were at least 90 but less than 100 years of age at the time of the imaging study. The prevalence of lesions by type in this consecutive series of MR imaging evaluations was calculated for all patients. The authors reviewed the medical record to evaluate whether a change in management was recommended based on MR imaging findings. They evaluated patient age at the time of death and the time interval between MR imaging and death. The authors identified 177 patients who met the study criteria. The group included 119 women (67%) and 58 (33%) men. Their mean age was 92.3 ± 1.8 years. Evidence of acute ischemic changes or cerebrovascular accident (CVA) was found in 36 patients (20%). Fifteen patients (8%) had an intracranial tumor. Intracranial aneurysms were incidentally identified in 6 patients (3%). Chronic subdural hematomas were found in 3 patients (2%). Overall, 25 patients (14%) had some change in medical management as a result of the MR imaging findings. The most common MR imaging finding that resulted in a change in medical management was an acute CVA (p < 0.0001). The mean time to death from date of MR imaging was 2.5 ± 2.3 years. Intracranial imaging is rarely performed in patients older than 90 years. In cases of suspected stroke, MR imaging findings may influence treatment decisions. Brain MR imaging studies ordered for other indications in this age group rarely influence treatment decisions. Incidentally discovered lesions in this age group are generally not treated.