Differentiate incidental from concerning findings on neuroimaging

Editor's note:The 2019 AAP National Conference & Exhibition will take place from Oct. 25-29 in New Orleans.

When kids are asked what they want to be when they grow up, a doctor may be among the common responses. But a neuroradiologist?

For Laura L. Hayes, M.D., FAAP, it made perfect sense.

Many of her family members had a seizure disorder, which sparked her interest in neuroscience at a young age. Coupled with that was the fact that her mom was a sonographer.

“Late night on-call trips with her to the hospital and a high school job as a radiology file clerk guided me towards a career as a pediatric neuroradiologist,” Dr. Hayes said.

Today, she is a pediatric radiologist/neuroradiologist at Nemours Children’s Health System, where she guides, interprets and explains general and advanced imaging of children. One thing she deals with every day are incidental findings on neuroimaging.

“Any time imaging is performed, there is a risk of discovering incidental findings that may cause unnecessary stress,” said Dr. Hayes, a member of the AAP Section on Radiology. 

She will help pediatricians sort out the incidental from the concerning during a session titled “The MRI Showed What? Common Findings on Neuroimaging ” (A2053) from 8:30-10 a.m. Saturday, Oct. 26 in rooms R02-R03 of the convention center. She will be joined by Brandon G. Rocque, M.D., M.S., FAAP, associate professor in the Department of Neurosurgery at University of Alabama at Birmingham and a member of the AAP Section on Neurological Surgery.

Pediatricians are ordering neuroimaging for a range of conditions, including headaches, seizures, developmental delay, back pain, concerns for tethered cord and trauma.

“It is important to only order studies that are clinically indicated and to give the radiologist a good history,” Dr. Hayes said. “Besides radiologists themselves, the ACR Appropriateness Criteria are a good resource to help determine if a study is indicated, and if so, which one.” 

Common incidental findings include pineal and pituitary cysts, arachnoid cysts, developmental venous anomalies, mild cerebellar tonsillar ectopia and arachnoid granulations, Dr. Hayes said. In older children, tiny signal abnormalities in the white matter are not uncommon.

Drs. Hayes and Rocque aim to help attendees feel more comfortable with pediatric neuroimaging and understand how to deal with incidental findings. They will present cases, give possible diagnoses or treatment options, and have attendees use a response system to choose what they think the correct option is.

“By the end of the session, attendees should feel more at ease with pediatric neuroimaging, especially by having a clear understanding of how to deal with incidental findings,” Dr. Hayes said. “(The) talk will be a fun mix of interesting cases and casual learning.”

For more coverage of the 2019 AAP National Conference & Exhibition, visit http://bit.ly/AAPNationalConference19.