Practical approaches to incidental findings in brain imaging research

Illes, Judy; Kirschen, Matthew; Edwards, Emmeline; Bandettini, Peter A.; Cho, Moonju; Ford, Paul J.; Glover, Gary H.; Kulynych, Jennifer J.; Macklin, Ruth; Michael, D. B.; Wolf, Susan M.; Grabowski, T.; Seto, Belinda

doi:10.1212/01.wnl.0000280469.17461.94

Cited by 97 publications

(89 citation statements)

References 20 publications

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“…5 There is a current lack of neuroimaging data that can provide baseline images of "normal" brains at various ages and upon which the possible clinical significance of incidental findings can be evaluated. 10 Projects are under way to address this need. 4 There is only sparse literature on incidental CNS mass lesions in children (Table 3).…”

Section: Discussionmentioning

confidence: 99%

Incidental findings of mass lesions on neuroimages in children

Perret¹,

Boltshauser

Scheer

et al. 2011

FOC

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Increasing use of neuroimaging in children has led to more incidental findings of CNS mass lesions, the management of which is uncertain. The authors' aims in this study are to describe these mass lesions and their evolution, as well as to discuss the management options and determine the prevalence of incidental CNS mass lesions at their pediatric clinic. A retrospective study was undertaken in children with primary CNS tumors who were younger than 18 years old and were admitted to the University Children's Hospital of Zurich, Switzerland, between January 1995 and December 2010. In 19 (5.7%) of 335 patients with newly diagnosed CNS tumors, the diagnosis of a CNS mass lesion was an incidental finding. Reasons for obtaining neuroimages in these 19 patients were head trauma (in 6 patients); research protocols (in 3); nasal/orbital malformations (in 2); endocrinological and psychiatric evaluations (in 2); and vertebral bone anomaly without neurological signs, absence seizures, congenital ataxia, recurrent vomiting, developmental delay, and “check-up” at the explicit request of the parents (in 1 patient each). Seven patients underwent immediate surgery for low-grade glioma (4 patients) and craniopharyngioma, ependymoma, and choroid plexus papilloma (1 patient each); and 12 were treated conservatively or were observed. Ten of 12 conservatively treated patients remained stable (median follow-up time 1.8 years) and the other 2 underwent delayed surgery because of tumor progression (medulloblastoma in one patient and fibrillary astrocytoma in the other). Clinicians are increasingly challenged by the discovery of incidental CNS mass lesions. A subgroup of such lesions (with typical imaging patterns such as tectal glioma and dysembryoplastic neuroepithelial tumor) can be monitored conservatively, clinically, and radiographically. Future prospective studies are needed to define optimal management strategies based on larger collections of natural histories, as well as to assess the true prevalence of incidental CNS mass lesions.

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Section: Discussionmentioning

confidence: 99%

Incidental findings of mass lesions on neuroimages in children

Perret¹,

Boltshauser

Scheer

et al. 2011

FOC

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“…We also examined UK data protection law [15], European legislation [16,17], international guidelines [18][19][20] and imaging research guidelines published in medical and legal journals (e.g. Appendix A [21,22]). …”

Section: Methodsmentioning

confidence: 99%

Incidental findings found in “healthy” volunteers during imaging performed for research: current legal and ethical implications

Booth¹,

Jackson²,

Wardlaw³

et al. 2010

BJR

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ABSTRACT. Incidental findings found in ''healthy'' volunteers during research imaging are common and have important implications for study design and performance, particularly in the areas of informed consent, subjects' rights, clinical image analysis and disclosure. In this study, we aimed to determine current practice and regulations concerning information that should be given to research subjects when obtaining consent, reporting of research images, who should be informed about any incidental findings and the method of disclosure. We reviewed all UK, European and international humanitarian, legal and ethical agencies' guidance. We found that the guidance on what constitutes incidental pathology, how to recognise it and what to do about it is inconsistent between agencies, difficult to find and less complete in the UK than elsewhere. Where given, guidance states that volunteers should be informed during the consent process about how research images will be managed, whether a mechanism exists for identifying incidental findings, arrangements for their disclosure, the potential benefit or harm and therapeutic options. The effects of incidentally discovered pathology on the individual can be complex and far-reaching. Radiologist involvement in analysis of research images varies widely; many incidental findings might therefore go unrecognised. In conclusion, guidance on the management of research imaging is inconsistent, limited and does not address the interests of volunteers. Improved standards to guide management of research images and incidental findings are urgently required.

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“…12 In recent years, Judy Illes, a Stanford University neuroimaging researcher and bioethicist, is among those leading the push to define a set of guidelines for reporting incidental findings. A January 2005 workshop in Bethesda, Md, sponsored by the National Institutes of Health (NIH) and Stanford University, convened 40 distinguished scientists and scholars from the United States and Canada to address the issue of incidental findings in neuroimaging research.…”

Section: Bethesda Conferencementioning

confidence: 99%

Toward a Uniform Policy for Handling Incidental Findings in Neuroimaging Research

Brown¹,

Hasso²

2008

AJNR Am J Neuroradiol

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SUMMARY:A recent study carried out at the University of California, Irvine exemplifies a commonly overlooked ethical conundrum of neuroimaging research: incidental findings. Research study designs must address the potential of uncovering unexpected findings in subjects during the study and delineate a protocol for reporting and initiating treatment. We urge the community to petition their home institutional review board to mandate inclusion of an incidental findings protocol into all neuroimaging research applications.

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Practical approaches to incidental findings in brain imaging research

Cited by 97 publications

References 20 publications

Incidental findings of mass lesions on neuroimages in children

Incidental findings of mass lesions on neuroimages in children

Incidental findings found in “healthy” volunteers during imaging performed for research: current legal and ethical implications

Toward a Uniform Policy for Handling Incidental Findings in Neuroimaging Research

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