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Ethical and Practical Considerations in the Management of Incidental Findings in Pediatric MRI Studies

NCJ Number
215176
Journal
Journal of the American Academy of Child & Adolescent Psychiatry Volume: 45 Issue: 8 Dated: August 2006 Pages: 1000-1006
Author(s)
Sanjiv Kumra M.D.; Manzar Ashtari Ph.D.; Britt Anderson B.S.; Kelly L. Cervellione M.A.; Li Kan M.D.
Date Published
August 2006
Length
7 pages
Annotation
This study examined the ethical and practical management issues that resulted from the detection of incidental abnormal findings during magnetic resonance imaging (MRI) research studies of healthy pediatric volunteers (ages 10-21).
Abstract
A neuroradiologist identified incidental abnormalities in 8 (13 percent) of 60 of the volunteers. Of these volunteers, three had abnormalities that were determined to require further diagnostic procedures (possible tumor, possible vascular malformation, and unidentified bright object in white matter). In two of these cases, followup MRI ruled out the possibility of a tumor or vascular malformation. In the third case, a followup MRI 24 months later found that the white matter abnormally remained stable and was thus judged to be of no clinical significance. The authors note that in healthy children who are participating in research MRI protocols, it becomes an ethical issue when deciding whether films should be read clinically. As suggested by a recent National Institutes of Health workshop group, the neuroradiologist should provide information to the principal investigator about incidental findings and recommend to the principal investigator what information should be given to the participant's primary medical care provider. The clinical neuroradiologist and the investigator must provide appropriate diagnostic and followup care, respectively, that conforms to the standard of care within their communities. If there is no primary care provider for the volunteer, then appropriate care should be arranged by the principal investigator. This study involved a retrospective examination of the findings from 60 clinical reports of research MRI scans from a cohort of healthy pediatric volunteers who ranged in age from 10 to 21. 21 references