Incidental findings on brain MR imaging in older community-dwelling subjects are common but serious medical consequences are rare: a cohort study
Open accessAbstract
OBJECTIVES: Incidental findings in neuroimaging occur in 3% of volunteers. Most data come from young subjects. Data on their occurrence in older subjects and their medical, lifestyle and financial consequences are lacking. We determined the prevalence and medical consequences of incidental findings found in community-dwelling older subjects on brain magnetic resonance imaging. DESIGN: Prospective cohort observational study. SETTING: Single centre study with input from secondary care. PARTICIPANTS: Lothian Birth Cohort 1936, a study of cognitive ageing. MAIN OUTCOME MEASURES: Incidental findings identified by two consultant neuroradiologists on structural brain magnetic resonance imaging at age 73 years; resulting medical referrals and interventions. PRIMARY AND SECONDARY OUTCOME MEASURES: PREVALENCE OF INCIDENTAL FINDINGS BY INDIVIDUAL CATEGORIES: neoplasms, cysts, vascular lesions, developmental, ear, nose or throat anomalies, by intra- and extracranial location; visual rating of white matter hyperintensities and brain atrophy. RESULTS: There were 281 incidental findings in 223 (32%) of 700 subjects, including 14 intra- or extracranial neoplasms (2%), 15 intracranial vascular anomalies (2%), and 137 infarcts or haemorrhages (20%). Additionally, 153 had moderate/severe deep white matter hyperintensities (22%) and 176 had cerebral atrophy at, or above, the upper limit of normal (25%) compared with a normative population template. The incidental findings were unrelated to white matter hyperintensities or atrophy; about a third of subjects had both incidental findings and moderate or severe WMH and a quarter had incidental findings and atrophy. The incidental findings resulted in one urgent and nine non-urgent referrals for further medical assessment, but ultimately in no new treatments. CONCLUSIONS: In community-dwelling older subjects, incidental findings, including white matter hyperintensities and atrophy, were common. However, many findings were not of medical importance and, in this age group, most did not result in further assessment and none in change of treatment.
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That no adverse events occurred is noteworthy because older adults have a higher likelihood of brain lesions, which may increase risk for TMS-related adverse events.
“Older adults have a higher likelihood of having brain lesions [50] which may increase risk for TMS-related adverse events [51]; that no adverse events (e.g. seizures) occurred is therefore noteworthy.”
From A phase I trial of accelerated intermittent theta burst rTMS for amnestic MCI (2024) · cites this paper as [50]
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Popkirov, S. (2024) · Springer eBooks · doi:10.1007/978-3-662-69215-8_3
Funktionelle kognitive Störungen erkennen und verstehen
Beckers, J., Popkirov, S., Michaelis, R., Seliger, C., & Jungilligens, J. (2026) · Zeitschrift für Neuropsychologie · doi:10.1024/1016-264x/a000443
中洲, 敏., 中洲, 庸., Nakasu, S., Notsu, A., & Nakasu, Y. (2021) · Institutional Repositories DataBase (IRDB)
- Authors
- Sandeman, E. M., Hernandez, M. D. C. V., Morris, Z., Bastin, M. E., Murray, C., Gow, A. J., Corley, J., Henderson, R., Deary, I. J., Starr, J. M., & Wardlaw, J. M.
- Affiliations
- University of Edinburgh (GB)
- Western General Hospital (GB)
- Corresponding author
- Wardlaw, Joanna M.
- ORCID
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2013-08-15
- Volume
- 8
- Issue
- 8
- Pages
- e71467
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3744549
- OpenAlex
- W2100350445
- Cited by
- 61
- References
- 29
- Citations by year
- 2026: 1 · 2024: 5 · 2023: 2 · 2022: 5 · 2021: 6 · 2020: 6 · 2019: 7 · 2018: 7 · 2017: 9 · 2016: 7 · 2015: 4 · 2014: 2
- FWCI
- 3.36
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Stirling Online Research Repository (University of Stirling) (submittedVersion, cc-by)
- Funders
- Scottish Funding Council
- Age UK
- University of Edinburgh (G0700704/84698)
- Centre for Cognitive Ageing and Cognitive Epidemiology (G0700704/84698)
- Directorate for Biological Sciences
- Medical Research Council (G0700704, MR/K026992/1)
- Engineering and Physical Sciences Research Council
- Biotechnology and Biological Sciences Research Council
- Economic and Social Research Council
- Brain Research Imaging Centre, University of Edinburgh
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiology practices and education
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced MRI Techniques and Applications
- Keywords
- incidental finding, brain MRI, older adults, community-dwelling older adults, white matter hyperintensities, brain atrophy, brain tumors, intracranial vascular anomalies, referral, Lothian Birth Cohort 1936, cognitive aging
- MeSH terms
- Aged, Aged, 80 and over, Brain, Brain Diseases, Humans, Longitudinal Studies, Magnetic Resonance Imaging, Prospective Studies, Incidence, Prevalence, Incidental Findings, Neuroimaging
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