Incidental Findings in Research Imaging

Incidental Findings in Research Imaging • Incidental Finding (IF) – Finding on a research imaging study that has potential health importance – Finding discovered during the conduct of research but is beyond the aims of the research study

Wolf, et. al. J Law, Medicine & Ethics, 2008

Incidental Findings in Research Imaging • IF Prevalence – Brain MRI – Overall prevalence rates of 13% to 84% * • 9 publications , 1997 to 2006 • Range of study populations, scan protocols, IF definitions • IF prevalence classified by need for clinical referral – – – –

No referral needed, 13% to 40.4% Routine referral, 1.8% to 43% Urgent referral, 0.4% to 14% Immediate referral, 0% to 1.2%

– IF prevalence rate of 43% (2010) ** • Clinical referral /additional tests, 2.2% (5/231) (NNI=46) • Clear medical benefit, 0.9% (2/231) (NNI=116) *Wolf, et. al. J Law, Medicine & Ethics, 2008 **Lo, Arch Int Med, 2010; Orme, et.al. Arch Int Med, 2010

Incidental Findings in Research Imaging • IF Classification @ CUMC Radiology – Brain MRI – Level 1 – NO CLINICALLY SIGNIFICANT ABNORMALITY • Examples: Minimal paranasal sinus or mastoid inflammatory disease, chronic sinusitis, venous angioma (DVA), thornwaldt cyst, choroid plexus cyst, pineal cyst, small arachnoid cyst, mega cisterna magna, non-dilated ventricular asymmetry, empty sella.

– Level 2 – MINOR FINDINGS (uncertain clinical significance, discuss with personal physician)

• Examples: Acute sinusitis (with air/fluid levels) or mastoiditis, non-specific patchy white matter lesions (probably chronic ischemia in periventricular white matter, basal ganglia or pons), chronic infarct, chronic trauma, tonsillar ectopia, severe generalized atrophy , focal atrophy (e.g. isolated brain stem and/or cerebellum), small meningioma (