Spectrum of intracranial incidental findings on pediatric brain magnetic resonance imaging: What clinician should know?

Table 5 Summarizes incidentally found “serious lesions” on pediatric brain magnetic resonance imaging

Ref.	The context in which brain MRI was ordered	Worsening course		Outcome/comment
		Known	Potential
Yilmaz et al[5]	Children mean age 11.2 yr presented for headache evaluation	Malignant brain tumor and hydrocephalus	Chiari I malformation I; Relevant to headache	Tissue type of tumor in study was unspecified
Schwedt et al[8]	Children mean age 12.1 yr presented for headache evaluation	Tumors, moyamoya disease, and demyelinating disease	Arteriovenous malformation and intracerebral hemorrhage	Study focus was “benign” imaging abnormalities, no further information for serious lesion other than pineal tumor was available
Kalnin et al[10]	Children mean age 9.7 yr presented for the first onset seizure	None	Temporal lobe lesions	Various Epileptic abnormalities1 have been associated with pediatric brain MRI
Potchen et al[14]	Community-based children mean age 12.1 yr	Granulomas with gliosis	Empty sella and vermian atrophy	Calcified granulomas caused by neurocysticercosis or tuberculosis occurs in the endemic part of the world
Mogensen et al[19]	All girls, mean age unavailable, presented for early puberty evaluation to endocrine clinic	Pontine and pineal tumor, and hypothalamic pilocytic astrocytoma	Hydrocephalus, cortical dysplasia, and chiari II malformation	A high frequency a pathological brain findings occurred in 6-8 yr old girls with precocious puberty
2Perret et al[20]	Incidentally found mass lesions management in children mean age 7.6 yr in oncology	Low-grade glioma, craniopharyngioma, ependymoma, and CPP	Medulloblastoma and fibrillary astrocytoma	Dysembryoplastic neuroepithelial tumor and tectal glioma can be monitored conservatively
Jordan, et al[21]	Children mean age 9.2 yr with sickle cell disease in neurology research	Chiari I malformation with large spinal cord syrinx3	Possible tectal glioma, Possible tumor vs dysplasia	Amongst 6.6% incidental findings identified, 0.6% children with sickle cell disease had potentially serious or urgent finding

¹Various epileptic abnormalities includes leukomalacia/gliosis, encephalomalacia, any gray matter lesion, mass lesion, hemorrhage, vascular lesion, hippocampal abnormality, ventricular enlargement > 1.5 cm, or prominence of extra-axial fluid spaces > 1.0 cm[31];

²Of 335 newly diagnosed central nervous system tumors (CNS), 19 (5.7%) children’s CNS tumors were identified incidentally;

³Of note: Chiari I malformation with a small cervical spinal cord syrinx in asymptomatic patients is not uncommon on pediatric brain MRI. CPP: Choroid plexus papilloma; MRI: Magnetic resonance imaging.