Incidental Intracranial Findings and Their Clinical Impact; The HUNT MRI Study in a General Population of 1006 Participants between 50-66 Years

Abstract

ObjectivesEvaluate types and prevalence of all, incidental, and clinically relevant incidental intracranial findings, i.e. those referred to primary physician or clinical specialist, in a cohort between 50 and 66 years from the Nord-Trøndelag Health (HUNT) study. Types of follow-up, outcome of repeated neuroimaging and neurosurgical treatment were assessed.Material and Methods1006 participants (530 women) underwent MRI of the head at 1.5T consisting of T1 weighted sagittal IR-FSPGR volume, axial T2 weighted, gradient echo T2* weighted and FLAIR sequences plus time of flight cerebral angiography covering the circle of Willis. The nature of a finding and if it was incidental were determined from previous radiological examinations, patient records, phone interview, and/or additional neuroimaging. Handling and outcome of the clinically relevant incidental findings were prospectively recorded. True and false positives were estimated from the repeated neuroimaging.ResultsPrevalence of any intracranial finding was 32.7%. Incidental intracranial findings were present in 27.1% and clinically relevant findings in 15.1% of the participants in the HUNT MRI cohort. 185 individuals (18.4%) were contacted by phone about their findings. 40 participants (6.2%) underwent ≥ 1 additional neuroimaging session to establish etiology. Most false positives were linked to an initial diagnosis of suspected glioma, and overall positive predictive value of initial MRI was 0.90 across different diagnoses. 90.8% of the clinically relevant incidental findings were developmental and acquired cerebrovascular pathologies, the remaining 9.2% were intracranial tumors, of which extra-axial tumors predominated. In total, 3.9% of the participants were referred to a clinical specialist, and 11.7% to their primary physician. 1.4% underwent neurosurgery/radiotherapy, and 1 (0.1%) experienced a procedure related postoperative deficit.ConclusionsIn a general population between 50 and 66 years most intracranial findings on MRI were incidental, and >15% of the cohort was referred to clinical-follow up. Hence good routines for handling of findings need to be in place to ensure timely and appropriate handling.

Magnetic Resonance Imaging-Based Screening for Asymptomatic Brain Tumors: A Review

“…As other studies have also found, meningiomas were more prevalent in women than in men (Fig. ); the gender difference is thought to be related to the estrogen and progesterone sensitivity of these tumors .…”

“…The two major studies examining the prevalence of asymptomatic brain tumors in older populations are the Rotterdam study and the HUNT MRI study . The Rotterdam study was originally designed to identify risk factors for various chronic diseases (cardiovascular, endocrine, respiratory, etc.)…”

“…In 2016, Haberg and colleagues published findings from the Nord‐Trøndelag Health (HUNT) MRI study of asymptomatic brain abnormalities, their clinical consequences, and their clinical outcomes after neurosurgery or radiotherapy in 1,006 participants (median age, 59.2 years), of whom 476 (47.3%) were male and 530 (52.7%) female, in Norway (Table ) . The investigators found intracranial abnormalities in 242 (24.1%) participants (133 women and 109 men), including 10 meningiomas (1.0%), 3 pituitary tumors (0.3%), 1 vestibular schwannoma (0.1%), and 1 glioma (0.1%), and referred all except one pituitary adenoma to a neurosurgeon.…”

Incidental Findings on Brain MRI: Insight from HUNT MRI - A General Population Study

“…This information is often difficult or impossible to obtain. The HUNT MRI study was designed to assess the true prevalence of incidental findings on brain MRI in the general middle aged population by combining an epidemiological approach coupled with access to regional hospitals' radiological and clinical patient data, and participants' medical history obtained by phone interview [6]. Types of follow up and outcomes were also recorded.…”

The relationship between multiple sclerosis and neuropsychiatric syndromes

“…Of course, the counter-argument of brain magnetic resonance imaging providing incidental findings, confusing the clinical picture, also requires consideration. 5 An earlier detection of MS in individuals could lead to more appropriate pharmacotherapeutic interventions and reduce morbidity. Consequently, a greater awareness of when psychiatric symptoms relate to an organic disorder such as MS rather than to a primary psychiatric disorder is optimal, and thus, this article by Chalah & Ayache is timely and of considerable clinical relevance.…”