Incidental findings on cranial imaging in nonagenarians

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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 &lt; 0.0001). The mean time to death from date of MR imaging was 2.5 ± 2.3 years.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p></jats:sec>

Neuroimaging in the Oldest-Old: A Review of the Literature

“…While MRI scans typically take a longer time than CT scans, a study using satisfaction questionnaires indicated that MRI sessions of up to an hour were feasible in this age group, where the oldest-old participants (90-93 years, N = 13) tolerated the procedures as well as younger-old participants (72-80 years, N = 16) with no statistically significant differences in satisfaction surveys between the groups [18]. One study retrospectively assessed clinical MRI scans of patients between 90 and 100 years of age for incidental findings, and reported that out of 177 patients, the most common findings were acute ischemic changes or cerebrovascular accident (20%), intracranial tumors (8%), and intracranial aneurysms (3%) [19].…”

“…• Some common incidental findings found on the MRI scans of the oldest-old include ischemic changes, intracranial tumors, and intracranial aneurysms [19]. Individuals without dementia who experienced hallucinations or delusions were more often found to have calcification of the basal [13]…”

Incidental findings on cerebral MRI in twins: the Older Australian Twins Study

“…Structural magnetic resonance imaging (MRI), widely used in research studies of community based cohorts, can reveal incidental findings in asymptomatic individuals. Previous studies have demonstrated that incidental brain findings are commonly detected in healthy pediatric (Gur et al 2013), general adult (Håberg et al 2016;Vernooij et al 2007) and older community-dwelling subjects (Sandeman et al 2013;Al-Holou et al 2011). In an international systematic review of 19,559 adults who underwent a brain MRI for occupational, clinical or commercial screening, the crude prevalence of incidental findings was 2.7% (Morris et al 2009).…”

Diagnostic Role of Magnetic Resonance Imaging in Assessing Orofacial Pain and Paresthesia

“…Moreover, elderly people have a predisposition for various diseases including brain tumor and brain infarction compared with younger people, and the imaging examinations sometimes detect brain diseases incidentally. 14,15 However, only a small number of reports have so far evaluated the efficacy of these imaging tests in diagnosing patients who report orofacial pain and paresthesia. The aim of this study was to compare the efficacy of CT and MRI examinations in diagnosing orofacial pain and paresthesia.…”