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

Table 1 Summarizes the reports of intracranial incidental findings in children on brain magnetic resonance imaging[5-22]

Ref.	Country	Study objective /conclusion
Yilmaz et al[5]	Turkey	To evaluate clinical significance of MRI abnormality in children with headache/
		Despite the high rate of IFs, the yield is non-contributory to diagnosis and therapy
Bayram et al[6]	Turkey	To describe the prevalence of WML detected on MRI in children with headaches/ Non-specific WML may be seen in children with headache. In the absence of benefit, repeated MRI studies are unwarranted. It should be tailored according to clinical course
Graf et al[7]	United States	Studied the frequency and consequences of IFs on non-acute pediatric headache/
		The frequency and types of all IFs were generally comparable to previous studies
Schwedt et al[8]	United States	To study the frequency of “benign” abnormalities in children with headache, compare it with the frequency of MRI findings that dictate a change in patient management/
		About 20% children with headache have benign findings that do not result in a change in management which rarely occurred in 1.2% of children in this study
Koirala[9]	Nepal	To evaluate the yield of MRI findings in patients with seizure/
		The majority of abnormalities on MRI included hippocampal sclerosis and T2 hyperintensity
Kalnin et al[10]	United States	To characterize IFs association with seizure onset and to standardize a classification system/
		The MRI and a standardized scoring system demonstrated a higher rate of IFs than previously reported. MRI parameters need to expand the definition of significant IFs
Gupta et al[11]	United States	To test the hypothesis that children with developmental delay are more likely to have incidental findings than are the children with normal development status/
		Authors reported a higher prevalence of IFs in children with developmental delay as compared with those with normal development status
Seki et al[12]	Japan	To report prevalence of IFs in healthy children and to suggest an ethical and practical management protocol/
		The prevalence of IFs was high but those requiring further MRI was low. Evaluating equivocal findings was the most difficult part of IFs management
Gupta et al[13]	United States	To elucidate the prevalence of incidental findings in a general pediatric neurology practice/
		Authors reported a high prevalence of and a low rate of referrals in comparison to previous studies. This study may help guide management decisions and discussions
Potchen et al[14]	Malawi	To collect normative magnetic resonance imaging data for clinical and research applications/
		Incidental brain magnetic resonance abnormalities are common in Malawian children
Kim et al[15]	United States	To elucidate the prevalence of incidental findings in a healthy pediatric population/
		Frequency of important IFs was not high. But, awareness of neurologic status, the presence and variety of IFs are of vital importance for research and welfare of the child
	Incidental findings in pediatric specialty clinic other than neurology
Oh et al[16]	South Korea	To investigated the clinical characteristics of children in whom Rathke’s cleft cysts were incidentally discovered and the treatment response with endocrinopathy/
		Rathke’s cleft cysts less than 20 mm expressing cystic intensity can be treated medically
Rachmiel et al[17]	Canada	To assess IFs in children with congenital hypothyroidism compared to 38 healthy controls/
		Both groups had a similar incidence of structural abnormalities. There was no association between those findings and neurocognitive function
Whitehead et al[18]	United States	The prevalence of pineal cysts in children who have had high-resolution 3T brain MRI/
		Characteristic-appearing pineal cysts are benign findings. In lack of no referable comprehensive symptoms, no follow-up is required
Mogensen et al[19]	Denmark	To evaluate the outcome of brain MRI in girls referred with early signs of puberty/
		Girls with central precocious puberty should have a brain MRI
Perret et al[20]	Switzerland	The prevalence and management options of incidentally found mass lesions at pediatric clinic/
		A subgroup of lesions such as tectal glioma and dysembryoplastic neuroepithelial tumor can be monitored conservatively
Jordan et al[21]	United States	The prevalence of incidental findings on brain MRI in children with sickle cell disease/
		IFs were present in 6.6% patients and a potentially serious or urgent finding was 0.6%

All except four studies: Potchen et al[14], 2013, Rachmiel et al[17], 2013, Koirala[9], 2011, and Seki et al[12], 2010, were retrospective. The retrospective study by Jordan et al[21], 2010 was carried out as a clinical trial for sickle cell disease. Itoh et al[22], 1994, investigated the evolution of high-signal–intensity abnormality on T2-weighted MR images[22] which are the expected findings thus it was excluded from this review. WML: White matter lesions; IFs: Incidental findings; MRI: Magnetic resonance imaging.