Incidental Findings of Brain Magnetic Resonance Imaging Study in a Pediatric Cohort in Japan and Recommendation for a Model Management Protocol

BACKGROUND The increasing use of magnetic resonance imaging (MRI) in brain researches has led to growing concern over incidental findings (IFs). To establish a practical management protocol for IFs, it is useful to know the actual prevalence and problems of IF management. In the present study, we report the prevalence proportion and some handling problems of IFs in healthy Japanese children, and suggest a management protocol from ethical and practical standpoints. METHODS Between 2006 and 2008, 120 healthy children aged 5-8 years participated in a structural MRI study conducted in a pediatric cohort in Japan. All MRI images were reviewed by a pediatric neurologist, and detected IFs were classified into 4 categories. RESULTS IFs of all categories were detected in 40 of the 110 participants (36.4%) for whom T2-weighted or 3D-T1-weighted images were available. Findings of sinusitis and/or otitis media were most frequent (26.4%). Excluding these findings, the prevalence of IFs was still 10.9% (12 findings): 9 findings were categorized as "no referral" (8.2%), 2 as "routine referral" (1.8%), 1 as "urgent referral" (0.9%), and 0 as "immediate referral" (0.0%). In "routine referral" category, only one participant was referred for further examinations. CONCLUSIONS Although the prevalence of IFs was high, the proportion of those requiring further examination was low. This result revealed a fairly high false-positive rate and suggested that evaluating equivocal findings was the most difficult part of IF management. A management protocol needs to include a process to properly assess the clinical importance of findings.