Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Aug 8, 2016; 5(3): 262-272
Published online Aug 8, 2016. doi: 10.5409/wjcp.v5.i3.262
Spectrum of intracranial incidental findings on pediatric brain magnetic resonance imaging: What clinician should know?
Surya N Gupta, Vikash S Gupta, Andrew C White
Surya N Gupta, Section of Child Neurology, Children’s Hospital of Illinois, University of Illinois College of Medicine, Peoria, IL 61603, United States
Vikash S Gupta, Texila American University, Georgetown 30062, Guyana
Andrew C White, Department of General Surgery, University of Colorado Hospital, Aurora, CO 80045, United States
Author contributions: White AC searched the literature, provided suggestion, contributed in discussion, and approved the final manuscript; Gupta VS organized clinical data, wrote initial draft, prepared tables and approved the final manuscript; Gupta SN initiated, designed the study, supervised, proposed the clinical classification and a common profile for incidental findings, contributed in discussion, and approved the final version of this manuscript.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Surya N Gupta, MD, Professor (Pediatrics and Pediatric Neurology), Section of Child Neurology, Children’s Hospital of Illinois, University of Illinois College of Medicine, 420 NE Glen Oak Ave, Suite 401, Peoria, IL 61603, United States. suryangupta@rediffmail.com
Telephone: +1-309-6554242 Fax: +1-309-6552565
Received: January 29, 2016
Peer-review started: January 30, 2016
First decision: February 29, 2016
Revised: April 26, 2016
Accepted: May 17, 2016
Article in press: May 27, 2016
Published online: August 8, 2016
Processing time: 191 Days and 15.6 Hours
Abstract

Intracranial incidental findings on magnetic resonance imaging (MRI) of the brain continue to generate interest in healthy control, research, and clinical subjects. However, in clinical practice, the discovery of incidental findings acts as a “distractor”. This review is based on existing heterogeneous reports, their clinical implications, and how the results of incidental findings influence clinical management. This draws attention to the followings: (1) the prevalence of clinically significant incidental findings is low; (2) there is a lack of a systematic approach to classification; and discusses (3) how to deal with the detected incidental findings based a proposed common clinical profile. Individualized neurological care requires an active discussion regarding the need for neuroimaging. Clinical significance of incidental findings should be decided based on lesion’s neuroradiologic characteristics in the given clinical context. Available evidence suggests that the outcome of an incidentally found “serious lesion in children” is excellent. Future studies of intracranial incidental findings on pediatric brain MRI should be focused on a homogeneous population. The study should address this clinical knowledge based review powered by the statistical analyses.

Keywords: Intracranial incidental finding; Magnetic resonance imaging; Children; Common clinical profile; Seizure; Headache; Developmental delay

Core tip: The magnetic resonance imaging of the brain in children frequently reveals incidental findings. There is paucity in the literature, how to deal with such findings in clinical practice. This review based on existing heterogeneous reports reveals that the prevalence of clinically significant incidental findings is low and discusses options in the management of incidental findings in children.