A system for addressing incidental findings in neuroimaging research

• Published in: NeuroImage (Orlando, Fla.) Fla.), 2011-04, Vol.55 (3), p.1020-1023
• Main Authors: Cramer, Steven C., Wu, Jennifer, Hanson, Joseph A., Nouri, Sarvenaz, Karnani, Diraj, Chuang, Tony M., Le, Vu
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Algorithms; Brain; Brain research; Cerebral Ventricles - pathology; Conferences; Cysts; Cysts - pathology; Female; Humans; Image Processing, Computer-Assisted - methods; Incidental findings; Internet; Magnetic Resonance Imaging; Male; Medical imaging; Middle Aged; MRI; Nervous System - anatomy & histology; Nervous System - pathology; Nervous System Diseases - pathology; Neuroimaging; NMR; Nuclear magnetic resonance; Remote Consultation; Sinuses; Studies; Websites; Young Adult
• ISSN: 1053-8119; 1095-9572
• DOI: 10.1016/j.neuroimage.2010.11.091

When healthy subjects undergo brain imaging, incidental findings are not rare. The optimal response to such findings has been the focus of considerable discussion. The current report describes the operations and results of a system that provides a review of incidental findings by an appropriate medical professional. A web-based system was created whereby investigators performing brain MRI scans on healthy subjects could refer images with suspected concerns to a board certified radiologist who had a Certificate of Added Qualification in Neuroradiology. The specific details of this system are described. Among 27 scans suspected by an investigator of having a significant finding, all but one were referred by a researcher with a PhD. The most common concerns described by these investigators were for the possible presence of a cyst or of enlarged ventricles. The most common findings reported by the radiologist were Virchow–Robin spaces and cysts. Findings were generally of low clinical significance, with 1 major exception. Identifying the optimal response to incidental findings in neuroimaging research remains a challenge. The current report describes a system for providing expert assistance and so addresses these issues in the setting of suspected incidental findings. To our knowledge the current system is the first to provide a specific means for evaluation of incidental findings in neuroimaging research. ► Incidental findings are common in brain MRIs; optimal response is controversial. ► We describe a system that addresses core ethical issues on this topic. ► This system helps an investigator submit a scan for review by a neuroradiologist. ► Our experience is described, including cases referred for medical follow-up. ► This is the first system providing evaluation of incidental findings in research.