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Rowley PA, Paukner MJ, Eisenmenger LB, Field AS, Davidson RJ, Johnson SC, Asthana S, Chin NA, Prabhakaran V, Bendlin BB, Postle BR, Goldsmith HH, Carlsson CM, Brooks MA, Kalin NH, Williams LE, Rowley HA. Incidental Findings from 16,400 Brain MRI Examinations of Research Volunteers. AJNR Am J Neuroradiol 2023; 44:417-423. [PMID: 36927761 PMCID: PMC10084899 DOI: 10.3174/ajnr.a7821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/20/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND AND PURPOSE Incidental findings are discovered in neuroimaging research, ranging from trivial to life-threatening. We describe the prevalence and characteristics of incidental findings from 16,400 research brain MRIs, comparing spontaneous detection by nonradiology scanning staff versus formal neuroradiologist interpretation. MATERIALS AND METHODS We prospectively collected 16,400 brain MRIs (7782 males, 8618 females; younger than 1 to 94 years of age; median age, 38 years) under an institutional review board directive intended to identify clinically relevant incidental findings. The study population included 13,150 presumed healthy volunteers and 3250 individuals with known neurologic diagnoses. Scanning staff were asked to flag concerning imaging findings seen during the scan session, and neuroradiologists produced structured reports after reviewing every scan. RESULTS Neuroradiologists reported 13,593/16,400 (83%) scans as having normal findings, 2193/16,400 (13.3%) with abnormal findings without follow-up recommended, and 614/16,400 (3.7%) with "abnormal findings with follow-up recommended." The most common abnormalities prompting follow-up were vascular (263/614, 43%), neoplastic (130/614, 21%), and congenital (92/614, 15%). Volunteers older than 65 years of age were significantly more likely to have scans with abnormal findings (P < .001); however, among all volunteers with incidental findings, those younger than 65 years of age were more likely to be recommended for follow-up. Nonradiologists flagged <1% of MRIs containing at least 1 abnormality reported by the neuroradiologists to be concerning enough to warrant further evaluation. CONCLUSIONS Four percent of individuals who undergo research brain MRIs have an incidental, potentially clinically significant finding. Routine neuroradiologist review of all scans yields a much higher rate of significant lesion detection than selective referral from nonradiologists who perform the examinations. Workflow and scan review processes need to be carefully considered when designing research protocols.
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Affiliation(s)
- P A Rowley
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Departments of Radiology (P.A.R., LB.E., A.S.F., V.P., H.A.R.)
| | | | - L B Eisenmenger
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Departments of Radiology (P.A.R., LB.E., A.S.F., V.P., H.A.R.)
| | - A S Field
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Departments of Radiology (P.A.R., LB.E., A.S.F., V.P., H.A.R.)
| | - R J Davidson
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Psychology (R.J.D., B.R.P., H.H.G.)
| | - S C Johnson
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Wisconsin Alzheimer's Disease Research Center (S.C.J., S.A., B.B.B., C.M.C.)
- Departments of Medicine (S.C.J., S.A., N.A.C., B.B.B., C.M.C.)
| | - S Asthana
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Wisconsin Alzheimer's Disease Research Center (S.C.J., S.A., B.B.B., C.M.C.)
- Departments of Medicine (S.C.J., S.A., N.A.C., B.B.B., C.M.C.)
| | - N A Chin
- Departments of Medicine (S.C.J., S.A., N.A.C., B.B.B., C.M.C.)
| | - V Prabhakaran
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Departments of Radiology (P.A.R., LB.E., A.S.F., V.P., H.A.R.)
| | - B B Bendlin
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Wisconsin Alzheimer's Disease Research Center (S.C.J., S.A., B.B.B., C.M.C.)
- Departments of Medicine (S.C.J., S.A., N.A.C., B.B.B., C.M.C.)
| | - B R Postle
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Psychology (R.J.D., B.R.P., H.H.G.)
| | - H H Goldsmith
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Psychology (R.J.D., B.R.P., H.H.G.)
| | - C M Carlsson
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Wisconsin Alzheimer's Disease Research Center (S.C.J., S.A., B.B.B., C.M.C.)
- Departments of Medicine (S.C.J., S.A., N.A.C., B.B.B., C.M.C.)
| | - M A Brooks
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Orthopedics (M.A.B.)
| | - N H Kalin
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Psychiatry (N.H.K., L.E.W.), University of Wisconsin-Madison, Madison, Wisconsin
| | - L E Williams
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Psychiatry (N.H.K., L.E.W.), University of Wisconsin-Madison, Madison, Wisconsin
| | - H A Rowley
- From the University of Wisconsin School of Medicine and Public Health (P.A.R., L.B.E., A.S.F., R.J.D., S.C.J., S.A., V.P., B.B.B., B.R.P., H.H.G., C.M.C., M.A.B., N.H.K., L.E.W., H.A.R.)
- Departments of Radiology (P.A.R., LB.E., A.S.F., V.P., H.A.R.)
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Cody KA, Koscik RL, Erickson CM, Berman SE, Jonaitis EM, Williams VJ, Mueller KD, Christian BT, Chin NA, Clark LR, Betthauser TJ, Johnson SC. Associations of the Lifestyle for Brain Health index with longitudinal cognition and brain amyloid beta in clinically unimpaired older adults: Findings from the Wisconsin Registry for Alzheimer's Prevention. Alzheimers Dement (Amst) 2022; 14:e12351. [PMID: 36110432 PMCID: PMC9464997 DOI: 10.1002/dad2.12351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/13/2022] [Accepted: 07/20/2022] [Indexed: 01/25/2023]
Abstract
Introduction Modifiable health and lifestyle factors increase risk of dementia, but whether modifiable factors, when measured in late-midlife, impact the emergence or progression of Alzheimer's disease (AD) pathophysiologic or cognitive changes remains unresolved. Methods In initially cognitively unimpaired, late middle-aged participants (N = 1215; baseline age, M [standard deviation] = 59.3 [6.7] years) from the Wisconsin Registry for Alzheimer's Prevention (WRAP), we investigated the influence of the Lifestyle for Brain Health (LIBRA) index, a lifestyle-based dementia risk score, on AD-related cognitive trajectories and amyloid beta (Aβ) plaque accumulation. Results Overall, lower baseline LIBRA, denoting healthier lifestyle and lower dementia risk, was related to better overall cognitive performance, but did not moderate apolipoprotein E ε4 or Aβ-related longitudinal cognitive trajectories. LIBRA was not significantly associated with Aβ accumulation or estimated age of Aβ onset. Discussion In WRAP, late-midlife LIBRA scores were related to overall cognitive performance, but not AD-related cognitive decline or Aβ accumulation in the preclinical timeframe. Highlights The Lifestyle for Brain Health (LIBRA) index was associated with cognitive performance in late-midlife.LIBRA did not moderate apolipoprotein E ε4 or amyloid-related cognitive decline.LIBRA was not associated with the onset or accumulation of amyloid plaques.
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Affiliation(s)
- Karly A. Cody
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Rebecca L. Koscik
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Wisconsin Alzheimer's InstituteUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Claire M. Erickson
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Sara E. Berman
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Erin M. Jonaitis
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Wisconsin Alzheimer's InstituteUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Victoria J. Williams
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Kimberly D. Mueller
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Wisconsin Alzheimer's InstituteUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Department of Communication Sciences & DisordersUniversity of Wisconsin–MadisonMadisonWisconsinUSA
| | - Bradley T. Christian
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Waisman Laboratory for Brain Imaging and BehaviorUniversity of Wisconsin–MadisonMadisonWisconsinUSA,Department of Medical PhysicsUniversity of Wisconsin–MadisonMadisonWisconsinUSA
| | - Nathanial A. Chin
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Lindsay R. Clark
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Geriatric Research Education and Clinical CenterWilliam S. Middleton Veterans HospitalMadisonWisconsinUSA
| | - Tobey J. Betthauser
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Sterling C. Johnson
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Wisconsin Alzheimer's InstituteUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Geriatric Research Education and Clinical CenterWilliam S. Middleton Veterans HospitalMadisonWisconsinUSA
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