Incidental Findings on Brain MRI in People with HIV Infection

Abstract

Background: Incidental findings are a well-known complication of imaging studies done for both diagnostic and research purposes. Little is known about the rates and types of incidental findings found on brain MRI in patients with HIV infection, who may be at risk for HIV-Associated Neurocognitive Disorders (HAND). Methods: The parent study included 108 adults with HIV infection and 125 demographically-matched uninfected controls who completed MRI and neuropsychological testing. Incidental findings were classified by the study team as vascular, neoplastic, congenital, other neurologic, or non-neurologic. Categorical measures were compared using Pearson chi-square tests; continuous measures were compared using t-tests. Results: Among participants with HIV infection, 36/108 (33%) had incidental findings compared to 33/125 (26%) controls (p = 0.248). Rates of incidental findings were significantly correlated with increasing age in both participants with HIV infection (p = 0.013) and controls (p = 0.022). We found no correlation between presence of incidental findings and sex or race/ethnicity among either cohort, and no correlation with CD4 count or HAND status for the HIV-infected cohort. Conclusions: Incidental findings were common in both participants with HIV infection and controls, at higher rates than previously reported in healthy populations. there was no significant difference in prevalence between the groups.

Prevalence of incidental intracranial findings on magnetic resonance imaging: a systematic review and meta-analysis

“…The most frequently used strengths were 1.0 T [ 57 , 70 , 77 ], 1.5 T [ 9 , 10 , 14 , 26 , 31 , 44 , 51 , 64 , 65 , 68 , 71 , 72 , 81 ], and 3.0 T [ 3 , 12 , 25 , 28 , 29 , 40 , 42 , 48 , 49 , 76 ], while some studies used more than one strength (1.5 T and 3 T) [ 15 , 41 , 43 , 52 , 62 ]. Imaging scans were read by senior radiologists and/or neuroradiologists and/or neurologists in a large number of the included studies [ 3 , 12 , 14 , 15 , 28 , 40 – 43 , 48 , 49 , 52 , 60 , 68 , 71 , 72 , 76 , 77 , 81 ]. In one study, 2 neuropsychiatrists co-assessed the MRI scans with a neuroradiologist.…”

“…Only one study [ 9 ] had no radiologist, neuroradiologist, or neurologist in the team reading the scans; their team included researchers with a doctor of medicine training in neuropsychology. T1-weighted image (T1WI) [ 25 , 28 ], T2-weighted image (T2WI) and fluid-attenuated inversion recovery (FLAIR)[ 57 ] were the most commonly used MRI sequences, either alone or combined [ 3 , 9 , 10 , 12 , 14 , 15 , 26 , 31 , 40 – 42 , 44 , 48 , 49 , 52 , 62 , 65 , 68 , 71 , 72 , 76 , 77 , 81 ]. Other sequences that were used in a smaller number of published papers were gradient recalled echo T2WI (GRE T2WI) [ 12 , 14 , 48 , 72 , 77 ], proton density weighted imaging (PDWI) [ 48 ], perfusion weighted imaging (PWI) [ 48 ], diffusion tensor imaging (DTI) [ 48 ], time-of-flight (TOF) [ 48 ] angiography and T1/T2 spine echo (SE) [ 43 ].…”

“…There was also substantial variation in patient age, with studies focusing on children [ 15 , 25 , 40 , 43 , 49 , 52 , 60 , 81 ], adults [ 3 , 14 , 28 , 29 , 31 , 41 , 62 , 68 , 77 ] or the elderly population [ 9 , 10 , 22 , 26 , 42 , 44 , 48 , 57 , 64 , 65 , 71 , 72 , 76 ]. This poses substantial analytic challenges.…”

“…Domain-level risk of bias findings is shown in Fig. 2 Study N Location Age Population Design Magnet Sequences Contrast Assessor Risk of bias Serag and Ragab, 2020 [ 68 ] 753 Egypt 49.8 ± 18.7 Healthy volunteers R-NRS 1.5 T T1W1, T2W1, FLAIR Y Radiologist High Wang et al, 2021 [ 76 ] 579 China 67.6 ± 7.6 Healthy volunteers P-NRS 3 T T1W1, T2W1, FLAIR N Radiologist Low Hanna et al, 2020 [ 28 ] 125 USA 43.9 ± 15.2 Healthy volunteers P-NRS 3 T T1W1 N Neuroradiologist High Vázquez-Justes et al, 2020 [ 71 ] 514 Spain 57 Type 2 diabetics R-NRS 1.5 T T1W1, T2W1, FLAIR Y Neuroradiologist High Keuss et al, 2019 [ 42 ] …”

An Equity and Justice-Informed Ethical Framework to Guide Incidental Findings in Brain Imaging Research

“…Individuals belonging to certain communities have historically faced barriers to access and participation in research or clinical trials [ 45 , 46 , 47 , 48 ]. Besides, significant disparities exist in access and availability of healthcare, as well as health outcomes, among vulnerable populations, including ethnic minorities, human immunodeficiency virus (HIV) patients [ 49 ] and indigenous populations, among others [ 46 , 50 , 51 , 52 ]. I argue that by integrating DEI in all aspects of the ethical framework, the implementation of distributive justice can be done inclusively and is likely to be trusted by research participants of all backgrounds.…”