Abstract
BACKGROUND
The detection of incidental findings on children’s brain MR imaging poses various practical issues because the life-long implications of such findings may be profound.
PURPOSE
Our aim was to assess the prevalence and characteristics of incidental brain MR imaging findings in children.
DATA SOURCES
Electronic databases (PubMed, EMBASE, and Cochrane) were searched for articles published between 1985 to July 2018, with the following search terms: “incidental,” “findings,” “brain,” “MR imaging.”
STUDY SELECTION
Inclusion criteria were the following: 1) patients younger than 21 years of age, 2) healthy children without any clinical condition, 3) MR images obtained with at least a 1.5T magnet, 4) original articles, and 5) a methodologic quality score of ≥10.
DATA ANALYSIS
Two observers independently extracted data and assessed data quality and validity. The number and type of incidental findings were pooled. Heterogeneity was assessed using the Cochran Q statistic and the I2 statistic.
DATA SYNTHESIS
Seven studies were included, reporting 5938 children (mean age, 11.3 ± 2.8 years). Incidental findings were present in 16.4% (99% CI, 9.8–26.2; Q = 117.5, I2= 94.9%) of healthy children, intracranial cysts being the most frequent (10.2%, 99% CI, 3.1–28.5; Q = 306.4, I2= 98.0%). Nonspecific white matter hyperintensities were reported in 1.9% (99% CI, 0.2–16.8; Q = 73.6, I2 = 94.6%), Chiari 1 malformation was found in 0.8% (99% CI, 0.5–1.3; Q = 7.6, I2 = 60.5%), and intracranial neoplasms were reported in 0.2% (99% CI, 0.1–0.6; Q = 3.4, I2 = 12.3%). In total, the prevalence of incidental findings needing follow-up was 2.6% (99% CI, 0.5–11.7; Q = 131.2, I2 = 95.4%). Incidental findings needing specific treatment were brain tumors (0.2%) and cavernomas (0.2%).
LIMITATIONS
Limitations were no age stratification or ethnicity data and variation in the design of included studies.
CONCLUSIONS
The prevalence of incidental findings is much more frequent in children than previously reported in adults, but clinically meaningfull incidental findings were present in <1 in 38 children.
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Fellows’ Journal Club
Seven studies were included, reporting 5938 children (mean age, 11.3 ± 2.8 years). Incidental findings were present in 16.4% of healthy children, intracranial cysts being the most frequent (10.2%). Nonspecific white matter hyperintensities were reported in 1.9%, Chiari I malformation was found in 0.8%, and intracranial neoplasms were reported in 0.2%. In total, the prevalence of incidental findings needing follow-up was 2.6%. The prevalence of incidental findings is much more frequent in children than previously reported in adults, but clinically significant incidental findings were present in <1 in 38 children.