Rates of Incidental Findings in Brain Magnetic Resonance Imaging in Children
Li Y,
Thompson WK,
Reuter C,
Nillo R,
Jernigan T,
Dale A,
Sugrue LP,
Brown J,
Dougherty RF,
Rauschecker A,
Rudie J,
Barch DM,
Calhoun V,
Hagler D,
Hatton S,
Tanabe J,
Marshall A,
Sher KJ,
Heeringa S,
Hermosillo R,
Banich MT,
Squeglia L,
Bjork J,
Zucker R,
Neale M,
Herting M,
Sheth C,
Huber R,
Reeves G,
Hettema JM,
Howlett KD,
Cloak C,
Baskin-Sommers A,
Rapuano K,
Gonzalez R,
Karcher N,
Laird AR,
Baker F,
James R,
Sowell E,
Dick A,
Hawes S,
Sutherland MT,
Bagot K,
Bodurka J,
Breslin F,
Morris A,
Paulus M,
Gray K,
Hoffman E,
Weiss S,
Rajapakse N,
Glantz M,
Nagel B,
Ewing SF,
Goldstone A,
Pfefferbaum A,
Prouty D,
Rosenberg M,
Bookheimer S,
Tapert S,
Infante M,
Jacobus J,
Giedd J,
Shilling P,
Wade N,
Uban K,
Haist F,
Heyser C,
Palmer C,
Kuperman J,
Hewitt J,
Cottler L,
Isaiah A,
Chang L,
Edwards S,
Ernst T,
Heitzeg M,
Puttler L,
Sripada C,
Iacono W,
Luciana M,
Clark D,
Luna B,
Schirda C,
Foxe J,
Freedman E,
Mason M,
McGlade E,
Renshaw P,
Yurgelun-Todd D,
Albaugh M,
Allgaier N,
Chaarani B,
Potter A,
Ivanova M,
Lisdahl K,
Do E,
Maes H,
Bogdan R,
Anokhin A,
Dosenbach N,
Glaser P,
Heath A,
Casey BJ,
Gee D,
Garavan HP,
Dowling G,
Brown S,
JAMA Neurol
78
(5)
:578-587
(2021).
Abstract
Importance: Incidental findings (IFs) are unexpected abnormalities discovered during imaging and
can range from normal anatomic variants to findings requiring urgent medical intervention.
In the case of brain magnetic resonance imaging (MRI), reliable data about the prevalence and
significance of IFs in the general population are limited, making it difficult to anticipate,
communicate, and manage these findings.
Objectives: To determine the overall prevalence of IFs in brain MRI in the nonclinical pediatric
population as well as the rates of specific findings and findings for which clinical referral is
recommended.
Design, Setting, and Participants: This cohort study was based on the April 2019 release of
baseline data from 11810 children aged 9 to 10 years who were enrolled and completed baseline
neuroimaging in the Adolescent Brain Cognitive Development (ABCD) study, the largest US
population-based longitudinal observational study of brain development and child health,
between September 1, 2016, and November 15, 2018.
Participants were enrolled at 21 sites across the US designed to mirror the demographic
characteristics of the US population.
Baseline structural MRIs were centrally reviewed for IFs by board-certified neuroradiologists
and findings were described and categorized (category 1, no abnormal findings; 2, no referral
recommended; 3; consider referral; and 4, consider immediate referral).
Children were enrolled through a broad school-based recruitment process in which all children of
eligible age at selected schools were invited to participate.
Exclusion criteria were severe sensory, intellectual, medical, or neurologic disorders that
would preclude or interfere with study participation.
During the enrollment process, demographic data were monitored to ensure that the study met
targets for sex, socioeconomic, ethnic, and racial diversity.
Data were analyzed from March 15, 2018, to November 20, 2020.
Main Outcomes and Measures: Percentage of children with IFs in each category and prevalence of specific IFs.
Results: A total of 11679 children (52.1% boys, mean [SD] age, 9.9 [0.62] years) had interpretable
baseline structural MRI results. Of these, 2464 participants (21.1%) had IFs, including 2013 children
(17.2%) assigned to category 2, 431 (3.7%) assigned to category 3, and 20 (0.2%) assigned to category 4.
Overall rates of IFs did not differ significantly between singleton and twin gestations or between
monozygotic and dizygotic twins, but heritability analysis showed heritability for the presence or absence
of IFs (h2 = 0.260; 95% CI, 0.135-0.387).
Conclusions and Relevance: Incidental findings in brain MRI and findings with potential clinical significance
are both common in the general pediatric population. By assessing IFs and concurrent developmental and health
measures and following these findings over the longitudinal study course, the ABCD study has the potential to
determine the significance of many common IFs.