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Background Magnetic resonance imaging (MRI) of the brain is increasingly used both in research and in clinical medicine, and scanner hardware and MRI sequences are continually being improved. These advances are likely to result in the detection of unexpected, asymptomatic brain abnormalities, such as brain tumors, aneurysms, and subclinical vascular pathologic changes. We conducted a study to determine the prevalence of such incidental brain findings in the general population.
Methods The subjects were 2000 persons (mean age, 63.3 years; range, 45.7 to 96.7) from the population-based Rotterdam Study in whom high-resolution, structural brain MRI (1.5 T) was performed according to a standardized protocol. Two trained reviewers recorded all brain abnormalities, including asymptomatic brain infarcts. The volume of white-matter lesions was quantified in milliliters with the use of automated postprocessing techniques. Two experienced neuroradiologists reviewed all incidental findings. All diagnoses were based on MRI findings, and additional histologic confirmation was not obtained.
Results Asymptomatic brain infarcts were present in 145 persons (7.2%). Among findings other than infarcts, cerebral aneurysms (1.8%) and benign primary tumors (1.6%), mainly meningiomas, were the most frequent. The prevalence of asymptomatic brain infarcts and meningiomas increased with age, as did the volume of white-matter lesions, whereas aneurysms showed no age-related increase in prevalence.
Conclusions Incidental brain findings on MRI, including subclinical vascular pathologic changes, are common in the general population. The most frequent are brain infarcts, followed by cerebral aneurysms and benign primary tumors. Information on the natural course of these lesions is needed to inform clinical management.
Source Information
From the Departments of Epidemiology and Biostatistics (M.W.V., M.A.I., A.H., M.M.B.B.), Radiology (M.W.V., H.L.T., G.P.K., W.J.N., A.L.), Neurosurgery (A.J.P.E.V.), and Medical Informatics (W.J.N.), Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Address reprint requests to Dr. van der Lugt at the Department of Radiology, Erasmus MC University Medical Center, 's-Gravendijkwal 230, Rotterdam 3015 CE, the Netherlands, or at a.vanderlugt{at}erasmusmc.nl.
Related Letters:
Incidental Findings on Brain MRI
Rocque B. G., Baskaya M. K., Kuo J. S., Lee W.-J., Chang L.-B., Lee Y.-C., Finucane T. E., Vernooij M. W., Breteler M. M.B., van der Lugt A.
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N Engl J Med 2008;
358:853-855, Feb 21, 2008.
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