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Brain MRI: Should Parents Get The Full Truth?

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Do patients deserve to know the whole truth about a brain MRI? What if the patient is a child? What should parents be told?

A team led by researchers at Johns Hopkins Children’s Center in Baltimore explored those questions. Unfortunately, the researchers didn’t come up with easy answers. They did say that doctors had better decide on a plan in advance, before meeting with parents to discuss a child’s brain MRI results. (The researchers aimed their advice primarily at pediatricians, but radiologists will likely be dragged into the discussion at some point.)

Here’s the scenario: A child undergoes brain MRI. The findings reveal an unexpected but benign—or at least nonemergency—anomaly. (In the Hopkins study of 953 children ages 5 through 14, that happened with 63 of the children, or 6.6%.) What do you tell the parents?

“Doctors need to figure out what, if anything, they want to share with patients about such findings because they seldom require urgent follow-up,” said senior investigator John Strouse, MD, PhD, a hematologist at Hopkins Children’s. The report by Strouse and his team was published online last week in the journal Pediatrics.

According to the researchers, the most common reasons for brain MRI in children are seizures, headaches, and enrollment in a medical study that requires such testing as a prerequisite. The patients in the Hopkins study all had sickle cell disease; most were African-American. They were being screened for participation in a sickle cell research study.

The researchers emphasized that none of the brain anomalies were related to sickle cell disease, suggesting that the findings may apply to healthy children in general.

Of the 63 children with abnormal brain findings, none required emergency treatment. Only six needed follow-ups classified as urgent (for possible slow-growing tumors or Chiari malformation type 1, in which brain tissue extends into the spinal canal). Two of the children in the “urgent” category underwent surgery within the following six months. Twenty-five children required routine follow-up for spinal cord anomalies or a less-serious subtype of Chiari malformation. Thirty-two children required no follow-up at all for a benign anomaly called cavum septum pellucidum, in which a thin membrane separates the brain’s lateral ventricles.

Obviously, you tell parents about the “urgent” findings. But what about the benign anomalies? Should a parent know, just in case, even if there’s no clear clinical importance—and if conveying the information may lead to unnecessary tests and equally unnecessary fear?

Hopkins quoted Dr. Strouse as saying that the study highlights a need for practices to work out guidelines for such situations in advance and for physicians to prepare for such discussions with parents. Otherwise, he said, some pediatricians simply avoid discussion of the anomalies altogether and refer the patient to a neurologist or neurosurgeon—thus inevitably giving rise to additional fear and anxiety.

Lori Jordan, MD, PhD, a pediatric neurologist at Hopkins Children’s and lead investigator for the study, described the quandary this way:

Helpful as it is, imaging technology can open a Pandora’s box, sometimes showing us things we didn’t expect to see and are not sure how to interpret.

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