title: Prevalence, Clinical Management, and Natural Course of Incidental Findings on Brain MR Images: The Population-based Rotterdam Scan Study.
abstract: Purpose To present an updated prevalence estimate for incidental findings on brain magnetic resonance (MR) images and provide information on clinical relevance, including natural course, over a period of up to 9 years. Materials and Methods This study was approved by the institutional review board and all participants gave informed consent. In a prospective population-based setting, structural brain MR imaging was performed in 5800 participants (mean age, 64.9 years; 3194 women [55.1%]). Trained reviewers recorded abnormalities, which were subsequently evaluated by neuroradiologists. The prevalence with 95% confidence interval (CI) of incidental findings was determined, and clinical management of findings that required the attention of a medical specialist was followed. Follow-up imaging in the study context provided information on the natural course of findings that were not referred. Results In 549 of 5800 participants (9.5% [95% CI: 8.7%, 10.3%]), incidental findings were found, of which meningiomas (143 of 5800; 2.5% [95% CI: 2.1%, 2.9%]) and cerebral aneurysms (134 of 5800; 2.3% [95% CI: 2.0%, 2.7%]) were most common. A total of 188 participants were referred to medical specialists for incidental findings (3.2% [95% CI: 2.8%, 3.7%]). Of these, 144 (76.6% [95% CI: 70.1%, 82.1%]) either underwent a wait-and-see policy or were discharged after the initial clinical visit. The majority of meningiomas and virtually all aneurysms not referred or referred but untreated remained stable in size during follow-up. Conclusion Incidental findings at brain MR imaging that necessitate further diagnostic evaluation occur in over 3% of the general middle-aged and elderly population, but are mostly without direct clinical consequences.©RSNA, 2016.
authors.affiliation: From the Departments of Radiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., B.F.J.V., G.P.K., M.A.I., M.W.V.), Epidemiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., Y.Y.H., B.F.J.V., V.J.A.V., J.G.J.V., A.P., A.H., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), Neurosurgery (A.J.V.), and Internal Medicine (R.A.F.), Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
authors.forename: Daniel
authors.initials: D
authors.lastname: Bos
authors.affiliation: From the Departments of Radiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., B.F.J.V., G.P.K., M.A.I., M.W.V.), Epidemiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., Y.Y.H., B.F.J.V., V.J.A.V., J.G.J.V., A.P., A.H., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), Neurosurgery (A.J.V.), and Internal Medicine (R.A.F.), Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
authors.forename: Marielle M F
authors.initials: MM
authors.lastname: Poels
authors.affiliation: From the Departments of Radiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., B.F.J.V., G.P.K., M.A.I., M.W.V.), Epidemiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., Y.Y.H., B.F.J.V., V.J.A.V., J.G.J.V., A.P., A.H., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), Neurosurgery (A.J.V.), and Internal Medicine (R.A.F.), Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
authors.forename: Hieab H H
authors.initials: HH
authors.lastname: Adams
authors.affiliation: From the Departments of Radiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., B.F.J.V., G.P.K., M.A.I., M.W.V.), Epidemiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., Y.Y.H., B.F.J.V., V.J.A.V., J.G.J.V., A.P., A.H., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), Neurosurgery (A.J.V.), and Internal Medicine (R.A.F.), Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
authors.forename: Saloua
authors.initials: S
authors.lastname: Akoudad
authors.affiliation: From the Departments of Radiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., B.F.J.V., G.P.K., M.A.I., M.W.V.), Epidemiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., Y.Y.H., B.F.J.V., V.J.A.V., J.G.J.V., A.P., A.H., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), Neurosurgery (A.J.V.), and Internal Medicine (R.A.F.), Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
authors.forename: Lotte G M
authors.initials: LG
authors.lastname: Cremers
authors.affiliation: From the Departments of Radiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., B.F.J.V., G.P.K., M.A.I., M.W.V.), Epidemiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., Y.Y.H., B.F.J.V., V.J.A.V., J.G.J.V., A.P., A.H., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), Neurosurgery (A.J.V.), and Internal Medicine (R.A.F.), Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
authors.forename: Hazel I
authors.initials: HI
authors.lastname: Zonneveld
authors.affiliation: From the Departments of Radiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., B.F.J.V., G.P.K., M.A.I., M.W.V.), Epidemiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., Y.Y.H., B.F.J.V., V.J.A.V., J.G.J.V., A.P., A.H., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), Neurosurgery (A.J.V.), and Internal Medicine (R.A.F.), Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
authors.forename: Yoo Y
authors.initials: YY
authors.lastname: Hoogendam
authors.affiliation: From the Departments of Radiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., B.F.J.V., G.P.K., M.A.I., M.W.V.), Epidemiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., Y.Y.H., B.F.J.V., V.J.A.V., J.G.J.V., A.P., A.H., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), Neurosurgery (A.J.V.), and Internal Medicine (R.A.F.), Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
authors.forename: Benjamin F J
authors.initials: BF
authors.lastname: Verhaaren
authors.affiliation: From the Departments of Radiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., B.F.J.V., G.P.K., M.A.I., M.W.V.), Epidemiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., Y.Y.H., B.F.J.V., V.J.A.V., J.G.J.V., A.P., A.H., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), Neurosurgery (A.J.V.), and Internal Medicine (R.A.F.), Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
authors.forename: Vincent J A
authors.initials: VJ
authors.lastname: Verlinden
authors.affiliation: From the Departments of Radiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., B.F.J.V., G.P.K., M.A.I., M.W.V.), Epidemiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., Y.Y.H., B.F.J.V., V.J.A.V., J.G.J.V., A.P., A.H., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), Neurosurgery (A.J.V.), and Internal Medicine (R.A.F.), Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
authors.forename: Jasper G J
authors.initials: JG
authors.lastname: Verbruggen
authors.affiliation: From the Departments of Radiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., B.F.J.V., G.P.K., M.A.I., M.W.V.), Epidemiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., Y.Y.H., B.F.J.V., V.J.A.V., J.G.J.V., A.P., A.H., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), Neurosurgery (A.J.V.), and Internal Medicine (R.A.F.), Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
authors.forename: Abbas
authors.initials: A
authors.lastname: Peymani
authors.affiliation: From the Departments of Radiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., B.F.J.V., G.P.K., M.A.I., M.W.V.), Epidemiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., Y.Y.H., B.F.J.V., V.J.A.V., J.G.J.V., A.P., A.H., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), Neurosurgery (A.J.V.), and Internal Medicine (R.A.F.), Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.affiliation: From the Departments of Radiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., B.F.J.V., G.P.K., M.A.I., M.W.V.), Epidemiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., Y.Y.H., B.F.J.V., V.J.A.V., J.G.J.V., A.P., A.H., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), Neurosurgery (A.J.V.), and Internal Medicine (R.A.F.), Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
authors.forename: Gabriel P
authors.initials: GP
authors.lastname: Krestin
authors.affiliation: From the Departments of Radiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., B.F.J.V., G.P.K., M.A.I., M.W.V.), Epidemiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., Y.Y.H., B.F.J.V., V.J.A.V., J.G.J.V., A.P., A.H., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), Neurosurgery (A.J.V.), and Internal Medicine (R.A.F.), Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
authors.forename: Arnaud J
authors.initials: AJ
authors.lastname: Vincent
authors.affiliation: From the Departments of Radiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., B.F.J.V., G.P.K., M.A.I., M.W.V.), Epidemiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., Y.Y.H., B.F.J.V., V.J.A.V., J.G.J.V., A.P., A.H., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), Neurosurgery (A.J.V.), and Internal Medicine (R.A.F.), Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Feelders
authors.affiliation: From the Departments of Radiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., B.F.J.V., G.P.K., M.A.I., M.W.V.), Epidemiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., Y.Y.H., B.F.J.V., V.J.A.V., J.G.J.V., A.P., A.H., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), Neurosurgery (A.J.V.), and Internal Medicine (R.A.F.), Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Koudstaal
authors.affiliation: From the Departments of Radiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., B.F.J.V., G.P.K., M.A.I., M.W.V.), Epidemiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., Y.Y.H., B.F.J.V., V.J.A.V., J.G.J.V., A.P., A.H., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), Neurosurgery (A.J.V.), and Internal Medicine (R.A.F.), Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
authors.forename: Aad
authors.initials: A
authors.lastname: van der Lugt
authors.affiliation: From the Departments of Radiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., B.F.J.V., G.P.K., M.A.I., M.W.V.), Epidemiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., Y.Y.H., B.F.J.V., V.J.A.V., J.G.J.V., A.P., A.H., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), Neurosurgery (A.J.V.), and Internal Medicine (R.A.F.), Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
authors.forename: M Arfan
authors.initials: MA
authors.lastname: Ikram
authors.affiliation: From the Departments of Radiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., B.F.J.V., G.P.K., M.A.I., M.W.V.), Epidemiology (D.B., M.M.F.P., H.H.H.A., S.A., L.G.M.C., H.I.Z., Y.Y.H., B.F.J.V., V.J.A.V., J.G.J.V., A.P., A.H., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), Neurosurgery (A.J.V.), and Internal Medicine (R.A.F.), Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
authors.forename: Meike W
authors.initials: MW
authors.lastname: Vernooij
mesh_terms: D000368:Aged; D001927:Brain Diseases / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D059906:Neuroimaging / Q000379:methods*; D015995:Prevalence; D011446:Prospective Studies