Incidental findings on brain magnetic resonance imaging of children with sickle cell disease.
OBJECTIVE
We describe the prevalence and range of incidental intracranial abnormalities identified through MRI of the brain in a large group of children screened for a clinical trial.


METHODS
We included 953 children between 5 and 14 years of age who were screened with MRI of the brain for the Silent Infarct Transfusion Trial. All had sickle cell anemia or sickle beta-null thalassemia. MRI scans were interpreted by 3 neuroradiologists. MRI scans reported to have any abnormality were reviewed by 2 study neuroradiologists. Incidental findings were classified into 4 categories, that is, no, routine, urgent, or immediate referral recommended. Cerebral infarctions and vascular lesions were not considered incidental and were excluded.


RESULTS
We identified 63 children (6.6% [95% confidence interval: 5.1%-8.4%]) with 68 incidental intracranial MRI findings. Findings were classified as urgent in 6 cases (0.6%), routine in 25 cases (2.6%), and no referral required in 32 cases (3.4%). No children required immediate referral. Two children with urgent findings underwent surgery in the subsequent 6 months.


CONCLUSIONS
In this large cohort of children, incidental intracranial findings were identified for 6.6%, with potentially serious or urgent findings for 0.6%.
Jordan
Lori C
LC
Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
McKinstry
Robert C
RC
Kraut
Michael A
MA
Ball
William S
WS
Vendt
Bruce A
BA
Casella
James F
JF
DeBaun
Michael R
MR
Strouse
John J
JJ
D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D001921:Brain / Q000473:pathology*; D001927:Brain Diseases / Q000175:diagnosis* / Q000209:etiology; D002544:Cerebral Infarction / Q000175:diagnosis / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033162:Incidental Findings; D008279:Magnetic Resonance Imaging; D008297:Male; D008403:Mass Screening / Q000379:methods; D018579:Patient Selection; D015995:Prevalence; D011336:Probability; D018570:Risk Assessment