Prospective analysis on brain MRI in children with neurological disease

Aims: Magnetic resonance imaging (MRI) of the brain is increasingly used in clinical practise, and scanner hardware and MRI sequences are continually being improved. These advances are likely to result in the detection of unexpected, asymptomatic brain anomalies, also called incidental findings (IFs). The clinical relevance of IFs is largely unknown and leads to uncertainness in patients and their physicians.

We conducted a prospective study to determine the prevalence of such incidental findings as well as pathologic findings in a pediatric population.

Methods: The subjects of this single center study are approximatly 450 children 0 to 18 years of age with neurological disease and subsequent first brain MRI. Exclusion criteria are preterm babies 24th to 40th week of gestational age, all patients without written consent forms and patients with follow up brain MRI. IFs as well as pathologic MRI findings are documented in association with age, gender, neurological disease, physical examination and previous investigations (CCT, EEG). Secondary outcome parameters are defined as MRI pathology and their clinical consequences (no referrral, routine referral, urgent referral, immediate referral). All MRI scans are read by two experienced blinded radiologists.

Results: Results of the first 100 study participants are presented. 60 subjects are boys, 40 girls. Age distribution is constant in all age groups. The three main reasons for brain MRI in children are epilepsy, psychiatric diseases and headache (50%). The results are as followed: normal 45%, IFs 35%, pathologic 20%. One child needed immediate surgery.

Conclusion: In our study population all MRI scans were done as routine diagnostic procedure in children with neurological disease. The major strength of our study is the prospective systemically gathered information of our study subjects during hospitalisation. To our knowledge this is the first prospective study in a general pediatric population. Information about indication for brain MRI and the prevalence of IFs in children will broaden our clinical knowledge

brain MRI - incidental findings