Rates of Incidental Findings in Brain Magnetic Resonance Imaging in Children

Yi Li, Wesley K. Thompson, Chase Reuter, Ryan Nillo, Terry Jernigan, Anders Dale, Leo P. Sugrue, Julian Brown, Robert F. Dougherty, Andreas Rauschecker, Jeffrey Rudie, Deanna M. Barch, Vince Calhoun, Donald Hagler, Sean Hatton, Jody Tanabe, Andrew Marshall, Kenneth J. Sher, Steven Heeringa, Robert HermosilloMarie T. Banich, Lindsay Squeglia, James Bjork, Robert Zucker, Michael Neale, Megan Herting, Chandni Sheth, Rebeka Huber, Gloria Reeves, John M. Hettema, Katia Delrahim Howlett, Christine Cloak, Arielle Baskin-Sommers, Kristina Rapuano, Raul Gonzalez, Nicole Karcher, Angela Laird, Fiona Baker, Regina James, Elizabeth Sowell, Anthony Dick, Samuel Hawes, Matthew Sutherland, Kara Bagot, Jerzy Bodurka, Florence Breslin, Amanda Morris, Martin Paulus, Kevin Gray, Elizabeth Hoffman, Susan Weiss, Nishadi Rajapakse, Meyer Glantz, Bonnie Nagel, Sarah Feldstein Ewing, Aimee Goldstone, Adolf Pfefferbaum, Devin Prouty, Monica Rosenberg, Susan Bookheimer, Susan Tapert, Maria Infante, Joanna Jacobus, Jay Giedd, Paul Shilling, Natasha Wade, Kristina Uban, Frank Haist, Charles Heyser, Clare Palmer, Joshua Kuperman, John Hewitt, Linda Cottler, Amal Isaiah, Linda Chang, Sarah Edwards, Thomas Ernst, Mary Heitzeg, Leon Puttler, Chandra Sripada, William Iacono, Monica Luciana, Duncan Clark, Beatriz Luna, Claudiu Schirda, John Foxe, Edward Freedman, Michael Mason, Erin McGlade, Perry Renshaw, Deborah Yurgelun-Todd, Matthew Albaugh, Nicholas Allgaier, Bader Chaarani, Alexandra Potter, Masha Ivanova, Krista Lisdahl, Elizabeth Do, Hermine Maes, Ryan Bogdan, Andrey Anokhin, Nico Dosenbach, Paul Glaser, Andrew Heath, Betty J. Casey, Dylan Gee, Hugh P. Garavan, Gaya Dowling, Sandra Brown

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


Importance: Incidental findings (IFs) are unexpected abnormalities discovered during imaging and can range from normal anatomic variants to findings requiring urgent medical intervention. In the case of brain magnetic resonance imaging (MRI), reliable data about the prevalence and significance of IFs in the general population are limited, making it difficult to anticipate, communicate, and manage these findings. Objectives: To determine the overall prevalence of IFs in brain MRI in the nonclinical pediatric population as well as the rates of specific findings and findings for which clinical referral is recommended. Design, Setting, and Participants: This cohort study was based on the April 2019 release of baseline data from 11810 children aged 9 to 10 years who were enrolled and completed baseline neuroimaging in the Adolescent Brain Cognitive Development (ABCD) study, the largest US population-based longitudinal observational study of brain development and child health, between September 1, 2016, and November 15, 2018. Participants were enrolled at 21 sites across the US designed to mirror the demographic characteristics of the US population. Baseline structural MRIs were centrally reviewed for IFs by board-certified neuroradiologists and findings were described and categorized (category 1, no abnormal findings; 2, no referral recommended; 3; consider referral; and 4, consider immediate referral). Children were enrolled through a broad school-based recruitment process in which all children of eligible age at selected schools were invited to participate. Exclusion criteria were severe sensory, intellectual, medical, or neurologic disorders that would preclude or interfere with study participation. During the enrollment process, demographic data were monitored to ensure that the study met targets for sex, socioeconomic, ethnic, and racial diversity. Data were analyzed from March 15, 2018, to November 20, 2020. Main Outcomes and Measures: Percentage of children with IFs in each category and prevalence of specific IFs. Results: A total of 11679 children (52.1% boys, mean [SD] age, 9.9 [0.62] years) had interpretable baseline structural MRI results. Of these, 2464 participants (21.1%) had IFs, including 2013 children (17.2%) assigned to category 2, 431 (3.7%) assigned to category 3, and 20 (0.2%) assigned to category 4. Overall rates of IFs did not differ significantly between singleton and twin gestations or between monozygotic and dizygotic twins, but heritability analysis showed heritability for the presence or absence of IFs (h2= 0.260; 95% CI, 0.135-0.387). Conclusions and Relevance: Incidental findings in brain MRI and findings with potential clinical significance are both common in the general pediatric population. By assessing IFs and concurrent developmental and health measures and following these findings over the longitudinal study course, the ABCD study has the potential to determine the significance of many common IFs.

Original languageEnglish
Pages (from-to)578-587
Number of pages10
JournalJAMA Neurology
Issue number5
StatePublished - May 2021


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