Study: Unexpected MRI findings in children result in disclosure dilemmas
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Lead author Lori Jordan, MD, PhD, of Johns Hopkins Children's Center in Baltimore and colleagues explained that the most common reasons for MRI testing in children are related to seizures and headaches or as a prerequisite for enrolling in certain studies.
"Doctors need to figure out what, if anything, they want to share with patients about such findings because they seldom require urgent follow up," said Jordan.
The researchers recruited from the Children’s Center 953 predominantly African-American children between the ages of five to 14, all of whom had sickle cell disease. The children all had undergone brain MRIs prior to enrolling in a research study about their condition.
According to the study, 6.6 percent of the children presented a total of 68 abnormal brain findings. However, the researchers stressed that these discovered brain anomalies were not related to the patients' underlying condition.
The authors said no children involved in the study required emergency treatment or follow-up and only 0.6 percent of the children required urgent follow ups. The MRI findings in these six children pointed to Chiari malformation with brain tissue protrusion into the spinal canal, but the children did not have clinical symptoms suggestive of the anomalies.
Routine follow up was required in 2.6 percent and 3.4 percent of the children required no follow up at all for cavum septum pellucidum, a benign anatomical finding. While cavum septum pellucidum and Chiari malformation were the most common noted anomalies in the study cohort, other abnormalities included brain cysts and cortical dysplasia, they wrote.
Based on the study’s results, Jordan and colleagues promulgated that because most of the MRI-discovered abnormalities presented no clinical symptoms related to any underlying conditions, the findings may also apply to healthy children.
Unexpected findings can lead to more--and often unnecessary--tests and fear, noted the researchers.
“Helpful as it is, imaging technology can open a Pandora's box, sometimes showing us things we didn't expect to see and are not sure how to interpret,” stated Jordan.
In the absence of guidelines, pediatricians must be better prepared for such discussions with patients and their parents involving benign anomalies that are unlikely to cause any problems down the line, concluded the study.