Incidental Brain MRI Findings in Children: A Systematic Review and Meta-Analysis

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Fig 1.
Flow chart of included studies.
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Fig 2.
Funnel plot of incidental findings in brain MR imaging of healthy children. Each dot represents a study; the y-axis represents the size of the study (ie, number of subjects) and the x-axis shows the result of the study (ie, prevalence of incidental findings). Aysmmetric funnel plot suggests no relationship between IF prevalence and study size.

Table 1:

Characteristics of included studies

Study	Country	Total Sample Size	Mean Age (Range) (yr)	% Male	MR Imaging Magnet	<2 mm³ Resolution	T2 or FLAIR WI	3D
Kim et al, 2002³	US	225	NA (1–18)	44	1.5	No	Yes	No
Kumra et al, 2006⁴	US	60	NA (10–21)	NA	1.5	No	Yes	Yes
Seki et al, 2010⁵	Japan	110	NA (5–8)	54	1.5	No	Yes	Yes
Gur et al, 2013⁶	US	1400	14.8 (8–21)	48	3	Yes	No	Yes
Kaiser et al, 2015⁷	US	114	8.3 (0.2–18)	41	3	Yes	Yes	Yes
Monterrey et al, 2017⁸	US	65	10.1 (NA)	71	3	Yes	No	Yes
Jansen et al, 2017⁹	Netherlands	3966	10.1 (8.6–11.9)	49	3	Yes	Yes	Yes

Table 2:

Population characteristics and incidental findings in pooled studies^{^a,3–9}

	No. Available (Studies)	Rate (%) (No.) or Mean Value ± SD	99% CI	P (Het)	I²/Q Value
Patients	5938 (7)
Sex (female)	5878 (6)	50.2 (2990)	45.0–55.4	.001	76.0/20.9
Age (mean) (SD) (yr)	5543 (4)	11.3 ± 2.8
Incidental findings
No IF	5938 (7)	79.9 (4648)	66.1–89.0	<.001	96.7/183.3
≥1 IF	5938 (7)	16.4 (1189)	9.8–26.2	<.001	94.9/117.6
≥1 IF, high resolution	5543 (4)	18.9 (1128)	9.4–34.6	<.001	97.1/104.6
≥1 IF, standard resolution	395 (3)	13.2 (61)	5.8–27.2	.016	75.7/8.2
≥1 IF, boys	816 (3)	17.6 (133)	14.1–21.7	<.001	97.5/81.0
≥1 IF, girls	874 (3)	16.3 (100)	9.2–19.9	.002	83.4/12.0
IF to follow	5938 (7)	2.6 (67)	0.5–11.7	<.001	95.4/131.2

Note:—Het indicates heterogeneity.
↵a Values are expressed as absolute number of patients (studies) or a percentage, unless otherwise specified.

Table 3:

Detailed incidental findings in pooled studies^3–9

	No. Available (Studies)	Rate % (No.)	99% CI	P (Heterogeneity)	I²/Q Value
Normal variations
Mega cisterna magna	4428 (5)	2.5 (116)	0.8–7.4	<.001	78.0/22.7
Cavum septum pellucidum	5653 (5)	2.2 (105)	1.1–4.6	.007	71.4/14.0
Empty sella	3966 (1)	0.2 (7)	0.1–0.5	1	0/0
Cysts	5938 (7)	10.2 (1096)	3.1–28.5	<.001	98.0/306.4
Pineal	5878 (6)	2.3 (704)	0.4–12.4	<.001	97.1/175.4
Arachnoid	4256 (3)	2.2 (89)	1.7–2.9	.10	52.8/6.4
Choroid plexus	4031 (2)	0.4 (8)	0.1–6.4	.04	75.6/4.1
Porencephalic	4143 (3)	0.2 (4)	0.1–0.6	.05	69.7/5.8
Ventricular dilation	5656 (4)	1.1 (46)	0.1–12.4	<.001	95.5/65.9
Enlarged perivascular spaces	175 (2)	7.4 (24)	0.1–93.9	<.001	93.6/15.5
Vascular anomalies
Developmental venous anomaly	4256 (3)	1.6 (66)	1.1–2.1	.72	0/0.66
Cavernoma	3966 (1)	0.2 (7)	0.1–0.5	1	0/0
Capillary telangiectasia	3966 (1)	0.1 (2)	0–0.3	1	0/0
Developmental disorders
Gray matter heterotopia	4031 (2)	0.5 (19)	0.3–0.9	.75	0/0.1
Gray matter dysplasia	3966 (1)	0.1 (2)	0–0.3	1	0/0
Corpus callosum anomaly	4143 (3)	0.7 (7)	0.1–15.1	<.001	90.3/20.5
Chiari I malformation	4263 (4)	0.8 (32)	0.5–1.3	.06	60.5/7.6
White matter hyperintensities	4428 (5)	1.9 (27)	0.2–16.8	<.001	94.6/73.6
Neoplasm	4368 (4)	0.2 (9)	0.1–0.6	.33	12.3/3.4