Are Incidental Findings on Brain Magnetic Resonance Images in Children Merely Incidental?

Gupta, Smriti; Kanamalla, Uday S.; Gupta, Vikash S.

doi:10.1177/0883073810370622

Cited by 23 publications

(18 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Medical imaging over the past several decades has sought to identify an anatomic biomarker for ASD, but one has yet to be found. In the search for such a biomarker, several neuroimaging studies reported incidental asymptomatic brain findings in children with ASD [Erbetta et al, 2013;Vasa et al, 2012;Gupta, Kanamalla, & Gupta, 2010;Boddaert et al, 2009;Zeegers et al, 2006;Taber et al, 2004;Brambilla et al, 2003].…”

Section: Introductionmentioning

confidence: 99%

Incidental brain MRI findings in an autism twin study

et al. 2016

View full text Add to dashboard Cite

Brain magnetic resonance imaging (MRI) studies suggest the prevalence of asymptomatic "incidental" findings (IF) in autism spectrum disorder (ASD) is similar to that of neurotypically developing (NT) controls. However, given the causes of IF may include both genetic and environmental factors, a twin study would facilitate comparing brain IF between ASD and NT subjects. MRI scans were examined to assess the prevalence of brain IF in twin "case pairs" (at least one twin with diagnosis of ASD) and twin "control pairs" (NT). Fifty case pairs and thirty-two control pairs were analyzed. IF were found in 68% of subjects with ASD, 71% of unaffected ASD siblings, and in 58% of control subjects (P = 0.4). IF requiring clinical follow-up occurred more frequently in subjects with ASD compared to NT controls (17% vs. 5%, respectively; P = 0.02). The concordance rate of IF in twins was 83%. A mixed effects model found younger age, male sex, and "family environment" to be significantly associated with IF. There was no difference in the prevalence rate of IF between ASD subjects and NT controls. More IF required clinical follow-up in ASD subjects compared to NT controls. The prevalence rate of IF observed in this twin study was higher than rates previously reported in singleton studies. Our results suggest the shared environment of twins - perhaps in utero - increases the risk of brain IF. Brain MRI in the initial work-up of ASD may be indicated in twins, especially in males. Autism Res 2017, 10: 113-120. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

show abstract

Section: Introductionmentioning

confidence: 99%

Incidental brain MRI findings in an autism twin study

et al. 2016

View full text Add to dashboard Cite

show abstract

“…The range of normal variation includes structural anomalies that are traditionally considered as clinically, neurologically, and neuropsychologically asymptomatic. The incidence of these anomalies ranges widely, from 4% to 80%, when including samples drawn retrospectively from clinical cases with MRI whose diagnoses were ultimately deemed non-serious (Gupta and Belay 2008; Bredlau et al 2012; Famini et al 2011; S. Gupta et al 2010; Potchen et al 2013; Roth et al 2012) and, not surprisingly, was substantially higher in the elderly (Morris et al 2009).…”

Section: Introductionmentioning

confidence: 99%

Structural brain anomalies in healthy adolescents in the NCANDA cohort: relation to neuropsychological test performance, sex, and ethnicity

Sullivan

Lane

Kwon

et al. 2016

Brain Imaging and Behavior

View full text Add to dashboard Cite

Structural MRI of volunteers deemed “normal” following clinical interview provides a window into normal brain developmental morphology but also reveals unexpected dysmorphology, commonly known as “incidental findings.” Although unanticipated, these anatomical findings raise questions regarding possible treatment that could even ultimately require neurosurgical intervention, which itself carries significant risk but may not be indicated if the anomaly is nonprogressive or of no functional consequence. Neuroradiological readings of 833 structural MRI from the National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA) cohort found an 11.8% incidence of brain structural anomalies, represented proportionately across the five collection sites and ethnic groups. Anomalies included 26 mega cisterna magna, 15 subarachnoid cysts, 12 pineal cysts, 12 white matter dysmorphologies, 5 tonsillar ectopias, 5 prominent perivascular spaces, 5 gray matter heterotopias, 4 pituitary masses, 4 excessively large or asymmetrical ventricles, 4 cavum septum pellucidum, 3 developmental venous anomalies, 1 exceptionally large midsagittal vein, and single cases requiring clinical followup: cranio-cervical junction stenosis, parietal cortical mass, and Chiari I malformation. A case of possible demyelinating disorder (e.g., neuromyelitis optica or multiple sclerosis) newly emerged at the 1-year NCANDA followup, requiring clinical referral. Comparing test performance of the 98 anomalous cases with 619 anomaly-free no-to-low alcohol consuming adolescents revealed significantly lower scores on speed measures of attention and motor functions; these differences were not attributed to any one anomaly subgroup. Further, we devised an automated approach for quantifying posterior fossa CSF volumes for detection of mega cisterna magna, which represented 26.5% of clinically identified anomalies. Automated quantification fit a Gaussian distribution with a rightward skew. Using a 3SD cut-off, quantification identified 22 of the 26 clinically-identified cases, indicating that cases with percent of CSF in the posterior-inferior-middle aspect of the posterior fossa ≥3SD merit further review, and support complementing clinical readings with objective quantitative analysis. Discovery of asymptomatic brain structural anomalies, even when no clinical action is indicated, can be disconcerting to the individual and responsible family members, raising a disclosure dilemma: refrain from relating the incidental findings to avoid unnecessary alarm or anxiety; or alternatively, relate the neuroradiological findings as “normal variants” to the study volunteers and family, thereby equipping them with knowledge for the future should they have the occasion for a brain scan following an illness or accident that the incidental findings predated the later event.

show abstract

“…For example, children with developmental delay of unknown etiology, according to retrospective chart reviews, were more likely (1.8 odds ratio) to have incidental findings than healthy control subjects. 7 In a recent meta-analysis, Trzesniak et al 8 concluded that the presence of a large cavum septum pellucidum is associated with schizophrenia spectrum disorders. However, no study has examined whether a finding of cavum septum pellucidum in an epidemiologically accrued sample is associated with increased incidence of psychotic features.…”

mentioning

confidence: 99%