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Expected anomalies on MRI lead to disclosure dilemmas for physicians
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Pediatricians need to figure out what, if anything, they want to share with patients about unexpected-but-benign brain anomalies found on magnetic resonance imaging, according to results of a study published online.
The researchers from Johns Hopkins Children’s Center studied 953 children with sickle cell disease (SCD) between the ages of 5 and 14 years between February 2005 and September 2008. The children were screened with MRI for the Silent Infarct Transfusion Trial (SIT), and the results were interpreted by three neuroradiologists.
John Strouse, MD, PhD, senior investigator and hematologist at Johns Hopkins Children’s Center, and colleagues noted 63 children (6.6%) had 68 incidental intracranial MRI findings. The findings varied in urgency. Six of the children needed an urgent referral, 25 had routine referrals and 32 children did not require a referral.
“Helpful as it is, imaging technology can open a Pandora’s box, sometimes showing us things that we didn’t expect to see and are not sure how to interpret,” said Lori Jordan, MD, PhD, also of Hopkins.
Chiari malformation type I was the most common malformations seen, followed by cavum abnormalities, cortical dysplasia, gray matter heterotopias and various types of cysts.
The researchers said their study findings were limited because the population study population was restricted to children with SCD from an ethnically restricted environment.
The researchers said that their findings can assist neurologists and hematologists interpret the incidental MRI findings for children with SCD and may even be applicable to children in general. The researchers recommended routine referral to a pediatric neurologist when MRI findings are asymptomatic and are of uncertain significance.
Jordan LC. Pediatrics. 2010;doi:10.1542/peds.2008-2009.