title: Incidental findings on brain MR imaging in older community-dwelling subjects are common but serious medical consequences are rare: a cohort study.
abstract: OBJECTIVE
  Incidental findings in neuroimaging occur in 3% of volunteers. Most data come from young subjects. Data on their occurrence in older subjects and their medical, lifestyle and financial consequences are lacking. We determined the prevalence and medical consequences of incidental findings found in community-dwelling older subjects on brain magnetic resonance imaging.
  
  
  METHODS
  Prospective cohort observational study.
  
  
  METHODS
  Single centre study with input from secondary care.
  
  
  METHODS
  Lothian Birth Cohort 1936, a study of cognitive ageing.
  
  
  METHODS
  Incidental findings identified by two consultant neuroradiologists on structural brain magnetic resonance imaging at age 73 years; resulting medical referrals and interventions.
  
  
  METHODS
  PREVALENCE OF INCIDENTAL FINDINGS BY INDIVIDUAL CATEGORIES: neoplasms, cysts, vascular lesions, developmental, ear, nose or throat anomalies, by intra- and extracranial location; visual rating of white matter hyperintensities and brain atrophy.
  
  
  RESULTS
  There were 281 incidental findings in 223 (32%) of 700 subjects, including 14 intra- or extracranial neoplasms (2%), 15 intracranial vascular anomalies (2%), and 137 infarcts or haemorrhages (20%). Additionally, 153 had moderate/severe deep white matter hyperintensities (22%) and 176 had cerebral atrophy at, or above, the upper limit of normal (25%) compared with a normative population template. The incidental findings were unrelated to white matter hyperintensities or atrophy; about a third of subjects had both incidental findings and moderate or severe WMH and a quarter had incidental findings and atrophy. The incidental findings resulted in one urgent and nine non-urgent referrals for further medical assessment, but ultimately in no new treatments.
  
  
  CONCLUSIONS
  In community-dwelling older subjects, incidental findings, including white matter hyperintensities and atrophy, were common. However, many findings were not of medical importance and, in this age group, most did not result in further assessment and none in change of treatment.
authors: Brain Research Imaging Centre, Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, United Kingdom.
authors: Elaine M
authors: EM
authors: Sandeman
authors: Maria Del Carmen Valdes
authors: Mdel C
authors: Hernandez
authors: Zoe
authors: Z
authors: Morris
authors: Mark E
authors: ME
authors: Bastin
authors: Catherine
authors: C
authors: Murray
authors: Alan J
authors: AJ
authors: Gow
authors: Janie
authors: J
authors: Corley
authors: Ross
authors: R
authors: Henderson
authors: Ian J
authors: IJ
authors: Deary
authors: John M
authors: JM
authors: Starr
authors: Joanna M
authors: JM
authors: Wardlaw
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D001927:Brain Diseases / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D015994:Incidence; D033162:Incidental Findings; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D059906:Neuroimaging; D015995:Prevalence; D011446:Prospective Studies
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