Incidental Findings on Brain MRI in the General Population

https://www.nejm.org/doi/full/10.1056/nejmoa070972

by needlesurgeon • 7 years ago

8 2 7 years ago

I was inspired to spin-this out from a different post about full-body MRI scans.

This paper is asking the question, "If I scan the brains of 2000 people, what can I expect to find?" The findings more or less recapitulate the natural incidence of diseases. They found some brain changes related to aging, a few aneurysms, some benign brain tumors, and even a malignant brain tumor.

I'd like to focus purely on the emotional and economic implications, moving away from the case-by-case medical management side of things. Here are some of the implications of this study:

1) Congratulations -- your full body scan found a brain aneurysm. Being diagnosed with a brain aneurysm is scary and anxiety producing. Thankfully, there is pretty good literature to suggest when one should and shouldn't have their aneurysm treated by their surgeon (or neuroradiologist). After an expensive consult with a subspecialist, your surgeon would like you to have yearly checkups and repeat scans, and possibly even some invasive dye tests. Your new aneurysm may affect your ability to get insurance. It may result in you changing your lifestyle (not going on climbing trips, diving, buying more expensive disability insurance etc.). If may scare you into having the rest of your family getting screening exams for brain aneurysms. None of these outcomes are benign.

2) The kind of benign brain tumor reported from this study are meningiomas. On autopsy series, 1-2% of the population have meningiomas, and they are blissfully unaware of their presence. Finding one means an unnecessary trip to your local friendly neurosurgeon, committing to serial radiographic investigations, and also having insurance implications.

3) The study did discover a malignant brain tumor. I suppose one could make the argument that doing a full body scan is worth it to find a malignant tumor; yet brain tumors affect 1:10000 people, whereas the aforementioned (largely, but not always) benign conditions affect 1-2:100 people.

[0] https://www.nejm.org/doi/full/10.1056/nejmoa070972

phren0logy• 7 years ago

One of the things I really grew to appreciate in residency was the risk of iatrogenic harm from incidental findings on unnecessary tests.

Incidental Findings on Brain MRI in the General Population

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