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Research ArticleADULT BRAIN
Open Access

Incidental Findings from 16,400 Brain MRI Examinations of Research Volunteers

P.A. Rowley, M.J. Paukner, L.B. Eisenmenger, A.S. Field, R.J. Davidson, S.C. Johnson, S. Asthana, N.A. Chin, V. Prabhakaran, B.B. Bendlin, B.R. Postle, H.H. Goldsmith, C.M. Carlsson, M.A. Brooks, N.H. Kalin, L.E. Williams and H.A. Rowley
American Journal of Neuroradiology March 2023, DOI: https://doi.org/10.3174/ajnr.A7821
P.A. Rowley
aFrom the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
bDepartments of Radiology (P.A.R., LB.E., A.S.F., V.P., H.A.R.)
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M.J. Paukner
cStatistics (M.J.P.)
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L.B. Eisenmenger
aFrom the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
bDepartments of Radiology (P.A.R., LB.E., A.S.F., V.P., H.A.R.)
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  • ORCID record for L.B. Eisenmenger
A.S. Field
aFrom the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
bDepartments of Radiology (P.A.R., LB.E., A.S.F., V.P., H.A.R.)
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  • ORCID record for A.S. Field
R.J. Davidson
aFrom the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
dPsychology (R.J.D., B.R.P., H.H.G.)
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S.C. Johnson
aFrom the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
eWisconsin Alzheimer’s Disease Research Center (S.C.J., S.A., B.B.B., C.M.C.)
fDepartments of Medicine (S.C.J., S.A., N.A.C., B.B.B., C.M.C.)
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S. Asthana
aFrom the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
eWisconsin Alzheimer’s Disease Research Center (S.C.J., S.A., B.B.B., C.M.C.)
fDepartments of Medicine (S.C.J., S.A., N.A.C., B.B.B., C.M.C.)
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N.A. Chin
fDepartments of Medicine (S.C.J., S.A., N.A.C., B.B.B., C.M.C.)
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V. Prabhakaran
aFrom the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
bDepartments of Radiology (P.A.R., LB.E., A.S.F., V.P., H.A.R.)
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B.B. Bendlin
aFrom the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
eWisconsin Alzheimer’s Disease Research Center (S.C.J., S.A., B.B.B., C.M.C.)
fDepartments of Medicine (S.C.J., S.A., N.A.C., B.B.B., C.M.C.)
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B.R. Postle
aFrom the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
dPsychology (R.J.D., B.R.P., H.H.G.)
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H.H. Goldsmith
aFrom the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
dPsychology (R.J.D., B.R.P., H.H.G.)
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C.M. Carlsson
aFrom the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
eWisconsin Alzheimer’s Disease Research Center (S.C.J., S.A., B.B.B., C.M.C.)
fDepartments of Medicine (S.C.J., S.A., N.A.C., B.B.B., C.M.C.)
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M.A. Brooks
aFrom the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
gOrthopedics (M.A.B.)
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N.H. Kalin
aFrom the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
hPsychiatry (N.H.K., L.E.W.), University of Wisconsin–Madison, Madison, Wisconsin
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L.E. Williams
aFrom the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
hPsychiatry (N.H.K., L.E.W.), University of Wisconsin–Madison, Madison, Wisconsin
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H.A. Rowley
aFrom the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
bDepartments of Radiology (P.A.R., LB.E., A.S.F., V.P., H.A.R.)
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  • FIG 1.
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    FIG 1.

    Violin plots stratified by scan category. Boxplots within each plot have medians and interquartile ranges. The median age and interquartile range of volunteers with normal examination findings were 28 and 42 years, respectively. The median age and interquartile range of volunteers with abnormal examination findings for which follow-up was not recommended were 61 and 27 years, respectively. The median age and interquartile range of volunteers with abnormal examinations for which follow-up was recommended were 58 and 37 years, respectively.

  • FIG 2.
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    FIG 2.

    Illustrative cases of incidental findings for which clinical follow-up was recommended. Case examples of the 3 most frequently encountered abnormality categories, lesions marked by arrows, all reportedly asymptomatic at the time of scan. A, Vascular: a 38-year-old participant with trisomy 21 and normal scan findings 2 years earlier and found to have bihemispheric ischemic lesions, suspected to be cardioembolic versus Moyamoya vasculopathy (axial T2-FLAIR). B, Neoplastic: a 68-year-old participant with normal research scan findings 3 years earlier now has an infiltrative left parietal mass, later proven to be a glioblastoma (axial T2-FLAIR). C, Congenital: a 29-year-old participant with extensive left posterior Sylvian polymicrogyria (sagittal T1).

Tables

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    Table 1:

    Characteristics of study volunteers

    MaleFemaleP Value
    Sample size77828618<.001
    Age (mean) (yr)39 (SD, 24)41 (SD, 23)<.001
    No history of brain lesion (ie, typical control)61556995<.001
    Recruited due to known condition16271623<.001
    • View popup
    Table 2:

    Comparison between concerns of nonradiologists about initial imaging versus impressions of neuroradiologistsa

    Incidental Finding PresentIncidental Finding Absent
    Nonradiologist concern present52 (TP)81 (FP)PPV = 0.39
    Nonradiologist concern absent2807 (FN)13,593 (TN)NPV = 0.83
    Sensitivity = 0.02Specificity = 0.99
    • Note:—TP indicates true-positive; FP, false-positive; TN, true-negative; FN, false-negative.

    • ↵a PPV = TP/(TP + FP). NPV = TN/(FN + TN). Sensitivity = TP/(TP + FN). Specificity = TN/(TN + FP).

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P.A. Rowley, M.J. Paukner, L.B. Eisenmenger, A.S. Field, R.J. Davidson, S.C. Johnson, S. Asthana, N.A. Chin, V. Prabhakaran, B.B. Bendlin, B.R. Postle, H.H. Goldsmith, C.M. Carlsson, M.A. Brooks, N.H. Kalin, L.E. Williams, H.A. Rowley
Incidental Findings from 16,400 Brain MRI Examinations of Research Volunteers
American Journal of Neuroradiology Mar 2023, DOI: 10.3174/ajnr.A7821

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Incidental Findings from 16,400 Brain MRI Examinations of Research Volunteers
P.A. Rowley, M.J. Paukner, L.B. Eisenmenger, A.S. Field, R.J. Davidson, S.C. Johnson, S. Asthana, N.A. Chin, V. Prabhakaran, B.B. Bendlin, B.R. Postle, H.H. Goldsmith, C.M. Carlsson, M.A. Brooks, N.H. Kalin, L.E. Williams, H.A. Rowley
American Journal of Neuroradiology Mar 2023, DOI: 10.3174/ajnr.A7821
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