title: Ethical and practical considerations in the management of incidental findings in pediatric MRI studies.
abstract: OBJECTIVE
  The authors examined the ethical and practical management issues resulting from the detection of incidental abnormal findings on magnetic resonance imaging (MRI) research studies in healthy pediatric volunteers.
  
  
  METHODS
  A retrospective examination of the findings from 60 clinical reports of research MRI scans from a cohort of healthy pediatric volunteers (ages 10-21) was conducted.
  
  
  RESULTS
  A neuroradiologist noted incidental abnormalities in 8 (13%) of 60 subjects. Of these eight children, three (5%) adolescents were found to have abnormalities (possible tumor, possible vascular malformation, and unidentified bright object in white matter, respectively) that were judged to require further diagnostic workup. In the first two cases, follow-up MRI ruled out the possibility of a tumor or vascular malformation. In the third case, a follow-up MRI 24 months later found that the white matter abnormality remained stable and was thus deemed to be of no clinical significance.
  
  
  CONCLUSIONS
  In healthy children who are participating in research MRI protocols, it is ethically difficult to determine whether films should be read clinically. Based on this retrospective analysis, there would have been no risk(s) associated with not reading the films. In contrast, considerable anxiety was generated as a consequence of having the scans clinically read by a neuroradiologist because of the reporting of incidental abnormalities that later turned out to be false positives. Also, the detection of no abnormality on a research-quality scan could imply erroneously to some subjects that no abnormality was present, which may have been falsely reassuring.
authors.affiliation: Dr Kumra is with the Department of Psychiatry, University of Minnesota; the other authors are with the Department of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System.. Electronic address: meerjakumra@hotmail.com.
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Kumra
authors.affiliation: Dr Kumra is with the Department of Psychiatry, University of Minnesota; the other authors are with the Department of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System.
authors.forename: Manzar
authors.initials: M
authors.lastname: Ashtari
authors.affiliation: Dr Kumra is with the Department of Psychiatry, University of Minnesota; the other authors are with the Department of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System.
authors.forename: Britt
authors.initials: B
authors.lastname: Anderson
authors.affiliation: Dr Kumra is with the Department of Psychiatry, University of Minnesota; the other authors are with the Department of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System.
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Cervellione
authors.affiliation: Dr Kumra is with the Department of Psychiatry, University of Minnesota; the other authors are with the Department of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System.
authors.forename: L I
authors.initials: LI
authors.lastname: Kan
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000209:etiology*; D001364:Awareness; D002648:Child; D015331:Cohort Studies; D030881:Disclosure / Q000941:ethics* / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000941:ethics*; D009369:Neoplasms / Q000453:epidemiology* / Q000523:psychology*; D012189:Retrospective Studies