Neuropsychiatric Disease and Treatment (Jun 2019)
Incidental intracranial pathology: a retrospective case review of structural neuroimaging results amongst young adult psychiatric patients
Abstract
David B LeBaron,1 Yasamin Mahjoub,1 Adam Abba-Aji1,21Faculty of Medicine and Dentistry, Department of Psychiatry, University of Alberta, Edmonton, Canada; 2Young Adult Assessment, Evaluation and Reintegration Alberta Hospital, Edmonton, CanadaObjective: Given that there continue to be conflicting recommendations on the inclusion of routine structural neuroimaging amongst the investigations ordered in psychiatric patients, our group aimed to add to the data on intracranial pathology amongst, specifically, the young adult psychiatric population. This is a novel study in that it includes all presentations (mania, depression, psychosis, anxiety, substance use disorders) and presents, to the authors’ knowledge, the largest cohort of imaging results amongst this group.Method: The neuroimaging (CT and MRI) reports of 224 patients admitted to the Young Adult Assessment, Evaluation and Reintegration Unit (12-A) at the Alberta Hospital Edmonton (AHE) between the years of 2012–2015 were reviewed, and all findings were classified into one of four categories (normal, abnormal/benign, abnormal and unlikely linked to symptoms, and abnormal with possible link to symptoms). This study is largely a review of CT scans, as there were only six MRI reports available in the study population.Results: In total, 86.6% of findings were classified as normal. Amongst the scans with abnormal findings, 10.7% were deemed benign and non-specific. 1.8% of abnormal findings required an outside consultation or follow-up, but were unlikely linked to symptoms; and 0.9% were deemed possibly causally related to symptoms, though follow-up imaging deemed otherwise. The most prevalent findings were cerebral atrophy (n=6), arachnoid cysts (n=5), ventricular asymmetry (n=3), and cavum septum pellucidum (n=3).Conclusions: This study represents the largest cohort of incidental findings in the young adult psychiatric population. These findings do not support the practice of ordering structural imaging tests in the young adult (17–26 years) psychiatric population. This suggestion agrees with recent recommendations on this question, and highlights the need for ongoing review in this area.Keywords: computed tomography scan, magnetic resonance imaging, incidental findings, intracranial anomalies
