Kim Brian S, Illes Judy, Kaplan Richard T, Reiss Allan, Atlas Scott W
Department of Radiology, Stanford Center for Biomedical Ethics, Stanford, CA 94304, USA.
AJNR Am J Neuroradiol. 2002 Nov-Dec;23(10):1674-7.
Previous studies have addressed the prevalence of incidental findings in symptomatic and healthy adult populations. Our study aims to elucidate the prevalence of incidental findings in a healthy pediatric population.
We retrospectively reviewed 225 conventional brain MR imaging studies obtained during structural and functional brain imaging research in a cohort of neurologically healthy children (100 boys [44%] and 125 girls [56%]) ranging in age from younger than 1 month to 18 years. All MR images were reviewed, and two board-certified neuroradiologists categorized the findings by consensus.
Incidental abnormalities were detected in 47 subjects (21%), while 79% of the images were normal. Of the 47 abnormalities detected, 17 (36%) required routine clinical referral; a single lesion (2%) required urgent referral. The occurrence of these findings in the male cohort was twice that of the female cohort; however, the percentage of subjects requiring either routine or urgent referral did not differ by sex (male subjects, 34%; female subjects, 39%).
Although the frequency of clinically important incidental abnormalities was not high in the sample of children studied, the presence and variety of findings in any pediatric group is particularly important for both the welfare of the subject and for research in which knowledge of the subject's neurologic status is vital to the interpretation of the results. Despite the limitations of the study in terms of the age and ethnic distribution, this work highlights the need for the routine involvement of trained radiologists in these studies to ensure that such incidental findings are detected and that appropriate follow-up is provided.
既往研究探讨了有症状的成人及健康成人人群中偶然发现的发生率。我们的研究旨在阐明健康儿童人群中偶然发现的发生率。
我们回顾性分析了225例常规脑磁共振成像研究，这些研究来自一组神经功能正常的儿童（100名男孩[44%]和125名女孩[56%]），年龄从小于1个月至18岁，研究内容为脑结构和功能成像。对所有磁共振图像进行了评估，两名获得委员会认证的神经放射科医生通过共识对发现进行了分类。
47名受试者（21%）检测到偶然异常，而79%的图像正常。在检测到的47项异常中，17项（36%）需要常规临床转诊；1项病变（2%）需要紧急转诊。这些发现在男性队列中的发生率是女性队列的两倍；然而，需要常规或紧急转诊的受试者百分比在性别上没有差异（男性受试者为34%；女性受试者为39%）。
尽管在所研究的儿童样本中具有临床意义的偶然异常的发生率不高，但任何儿科组中发现的存在和多样性对于受试者的福利以及对于受试者神经状态的知识对结果解释至关重要的研究而言都尤为重要。尽管该研究在年龄和种族分布方面存在局限性，但这项工作强调了训练有素的放射科医生在这些研究中常规参与的必要性，以确保检测到此类偶然发现并提供适当的随访。
