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Research Assessment #3

Name: Vanshika Srivastava

Date: October 20, 2017

Subject: Incidental Findings on Brain Imaging in the General Pediatric Population

MLA of APA citation: Jansen, Philip R., and Ilona A. Dekkers. Incidental Findings on Brain
Imaging in the General Pediatric Population NEJM. New England Journal of Medicine,
www.nejm.org/doi/full/10.1056/NEJMc1710724.

Analysis:

We are blessed to live in a country where the Medical industry is so advanced; it can
detect many things traditional medicine couldnt even pick up. Some of us are also blessed to
have been able to live up in life where we didnt have to worry about any financial burden that
would have been put on a child. Those that live in countries where healthcare isnt as advanced
are really at a disadvantage. They arent able to catch many diseases and disorders as easy as we
do. Many childrens parents dont also have the finances to even pay for the simplest things like
bandage and gauze for when you get a deep wound or even medicine for a dull headache. These
people tend to use things in their environment to get the job done, which isnt the best way, but
whatever works for them and doesnt cause any hardships on them is fine. I know a lot about this
because one of my cousins spent a trip in Kodaikanal where he saw many of these things in
many families. This article written by the team of Pediatric Neurologist went and did a study in
developing countries to what their brain looked like, and these were explicitly kids, not adults.

Many things in our everyday life can influence how our body grows and develops. Many
influences such as the environment and genetics affect a persons ability to build and also to
detect a disease. The team of doctors used magnetic resonance imaging (MRI) and took about
4000 childrens brain scans. They wanted to see what could they possibly find in a small town so
they can further use the information for educational purposes. The mean, which is the average, of
this population was around ten years, and the ages ranged from 8 to 12 years. I dont know if this
was intentional but, these statistics didnt include the people below 8.

The results of this were quite shocking of this experiment was quite surprising. At least
of the people in this study were found with one of the following: cyst, venous anomalies, and
partial agenesis. Under one percent of the population was found to have a brain tumor and they
needed further help from a pediatric neurologist and even oncologist. These statistics once again
show that it is a real crisis and those that dont have this access to healthcare are really at a
disadvantage and need help as soon as possible.

It is regrettable that many children have to go through with this. There is something that
doctors can do, and it is also an opportunity to get the community involved. Once we find a
problem, such as this in underdeveloped countries, we need to make sure that people are getting
the best help as possible. That is making sure that we set up clinics where they go through a
physical examination to see how healthy they are. The best way we can get the community
involved is we can educate. We can hold seminars and stress that this is a real issue. We can also
set up donations or care packages so we can do something to influence someones life positively
even if they are having a bad day.

In conclusion, little things can make someone health deteriorate fast. Some people grow
up in a society where there arent any vaccinations available. Such things can make you more
susceptible to many communicable diseases like MMR, Polio, etc. The main point that keeps
getting stressed in this is that this is a real problem that needs to get addressed quickly. The red
cross and many humanitarian associations are already on top of it, making sure that those in
developing countries are getting routine checkups and that they are healthy. If they arent, they
have doctors on standby to give them treatment. I considered doing this when after completing
residency. Going to underdeveloped countries and seeing the children and help them out as much
as I could. It would not only bring satisfaction in the children but also for me too. As the next
generation, we should try to make sure that we tackle these hardships head on.
Incidental Findings on Brain Imaging in the General Pediatric
Population

Incidentally discovered findings on brain magnetic resonance imaging (MRI) in healthy
persons pose medical and ethical considerations regarding management.1 The
prevalence of incidental findings on brain MRI has been described in adult
populations,2 but less is known about incidental findings in children. We report the
prevalence of incidental findings on brain MRI in a large, single-center neuroimaging
study involving a general pediatric population. From April 2013 through November 2015,
a total of 3966 children (mean age, 10.1 years; range, 8.6 to 11.9) in the population-
based Generation R Study3 designed to prospectively identify early environmental
and genetic influences on normal and abnormal growth, development, and health during
fetal life, childhood, and young adulthood underwent MRI scanning of the brain on a
single 3-Tesla scanner. Scans were systematically reviewed by trained researchers and
neuroradiologists for the presence of incidental findings

http://www.nejm.org/na101/home/literatum/publisher/mms/journals/content/nejm/2017/nej
m_2017.377.issue-16/nejmc1710724/20171018/images/large/nejmc1710724_t1.jpeg
(this is a link to a data table)

At least one incidental finding was present in 25.6% of the children (95% confidence
interval [CI], 24.2 to 27.0), although the prevalence of findings requiring clinical follow-
up was only 0.43% (95% CI, 0.26 to 0.70). The most common findings were cysts of the
pineal gland (in 665 children; 16.8%; 95% CI, 15.6 to 18.0), arachnoid cysts (in 86;
2.17%; 95% CI, 1.75 to 2.68), and developmental venous anomalies (in 63; 1.59%; 95%
CI, 0.12 to 2.04). Among less frequent findings were Chiari I malformations (in 25
children; 0.63%; 95% CI, 0.42 to 0.94), subependymal heterotopia (in 19; 0.48%; 95%
CI, 0.30 to 0.76), and partial agenesis of the corpus callosum (in 2; 0.05%; 95% CI, 0.01
to 0.20). A total of 17 children (0.43%) were referred to a pediatric neurologist for clinical
imaging and follow-up; 7 of these children (0.18%) had suspected primary brain tumors,
of whom 2 underwent neurosurgical treatment, with the diagnoses confirmed by
histopathological examination. The prevalence of asymptomatic brain tumors in our
population-based cohort was higher than estimates from cancer registries, which have
shown a prevalence in the United States of approximately 35 in 100,000 (0.04%) among
persons younger than 20 years of age.4 However, no reliable statistics are available to
estimate the frequency of asymptomatic brain tumors among children.5

Our results emphasize the need for careful evaluation of incidental findings on brain
scans of asymptomatic children. In addition, it may be prudent to use standardized
protocols for managing incidental findings in children, including reporting, disclosure to
parents, and subsequent follow-up when necessary.