Spectrum of intracranial incidental findings on pediatric brain magnetic resonance imaging: What clinician should know?

Abstract

Intracranial incidental findings on magnetic resonance imaging (MRI) of the brain continue to generate interest in healthy control, research, and clinical subjects. However, in clinical practice, the discovery of incidental findings acts as a "distractor". This review is based on existing heterogeneous reports, their clinical implications, and how the results of incidental findings influence clinical management. This draws attention to the followings: (1) the prevalence of clinically significant incidental findings is low; (2) there is a lack of a systematic approach to classification; and discusses (3) how to deal with the detected incidental findings based a proposed common clinical profile. Individualized neurological care requires an active discussion regarding the need for neuroimaging. Clinical significance of incidental findings should be decided based on lesion's neuroradiologic characteristics in the given clinical context. Available evidence suggests that the outcome of an incidentally found "serious lesion in children" is excellent. Future studies of intracranial incidental findings on pediatric brain MRI should be focused on a homogeneous population. The study should address this clinical knowledge based review powered by the statistical analyses.

Management of Childhood Migraine by Headache Specialist vs Non‐Headache Specialists

“…32 In some instances, triptans were prescribed, but for reasons that were not clearly documented in the electronic record, the medication was not being used. In most instances, the reason was not documented, which then by default was categorized as "imaging performed due to parental request."…”

Incidental Findings and Normal Anatomical Variants on MRI of the Brain in Adults for Primary Headaches

“…Normal anatomical variants are also common . Definitions may differ among investigators as some may classify normal anatomical variants as incidental findings while others may not …”

“…3 Definitions may differ among investigators as some may classify normal anatomical variants as incidental findings while others may not. 4 CASE HISTORY Case 1.-This is a 32-year-old male with a history of increasingly frequent episodic migraine. MRI of the brain was normal except for a 7 mm pineal cyst.…”

Incidental Findings and Normal Anatomical Variants on Brain MRI in Children for Primary Headaches

“…7 How Common Are Incidental Findings in Pediatric Patients with Headaches?-Incidental findings are defined as image findings that are not likely the cause of the patient's headaches. Incidental findings are commonly present in children on brain MRI scans, 8 although the reported rates have varied, with 9% in a Japanese study, 9 21% in an American study, 10 and 23% in a Malawian study. 11 In a retrospective study of 241 children and adolescents who had MRI or CT imaging for headache (90% MRIs), 19.1% were found to have 50 benign abnormalities including the following: sinus disease, 13; Chiari I malformation, 11; nonspecific white matter abnormalities (WMA), 7; venous angiomas, 5; arachnoid cysts, 5; enlarged Virchow-Robin spaces (VRS), 4; pineal cysts, 2; mega cisterna magna, 1; fenestration of the proximal basilar artery, 1; and periventricular leukomalacia, 1.…”

“…Incidental findings are defined as image findings that are not likely the cause of the patient's headaches. Incidental findings are commonly present in children on brain MRI scans, although the reported rates have varied, with 9% in a Japanese study, 21% in an American study, and 23% in a Malawian study …”