Prevalence of incidental intracranial findings on magnetic resonance imaging: a systematic review and meta-analysis

BACKGROUND: As the volume and fidelity of magnetic resonance imaging (MRI) of the brain increase, observation of incidental findings may also increase. We performed a systematic review and meta-analysis to determine the prevalence of various incidental findings. METHODS: PubMed/MEDLINE, EMBASE and SCOPUS were searched from inception to May 24, 2021. We identified 6536 citations and included 35 reports of 34 studies, comprising 40,777 participants. A meta-analysis of proportions was performed, and age-stratified estimates for each finding were derived from age-adjusted non-linear models. RESULTS: Vascular abnormalities were observed in 423/35,706 participants (9.1/1000 scans, 95%CI 5.2–14.2), ranging from 2/1000 scans (95%CI 0–7) in 1-year-olds to 16/1000 scans (95%CI 1–43) in 80-year-olds. Of these, 204/34,306 were aneurysms (3.1/1000 scans, 95%CI 1–6.3), which ranged from 0/1000 scans (95%CI 0–5) at 1 year of age to 6/1000 scans (95%CI 3–9) at 60 years. Neoplastic abnormalities were observed in 456/39,040 participants (11.9/1000 scans, 95%CI 7.5–17.2), ranging from 0.2/1000 scans (95%CI 0–10) in 1-year-olds to 34/1000 scans (95%CI 12–66) in 80-year-olds. Meningiomas were the most common, in 246/38,076 participants (5.3/1000 scans, 95%CI 2.3–9.5), ranging from 0/1000 scans (95%CI 0–2) in 1-year-olds to 17/1000 scans (95%CI 4–37) in 80-year-olds. Chiari malformations were observed in 109/27,408 participants (3.7/1000 scans, 95%CI 1.8–6.3), pineal cysts in 1176/32,170 (9/1000 scans, 95%CI 1.8–21.4) and arachnoid cysts in 414/36,367 (8.5/1000 scans, 95%CI 5.8–11.8). CONCLUSION: Incidental findings are common on brain MRI and may result in substantial resource expenditure and patient anxiety but are often of little clinical significance. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00701-022-05225-7.