Brain MRIs offer unparalleled insight into the brain’s structure and function. These scans are often ordered to investigate specific symptoms, such as headaches, seizures, or dizziness, but they frequently reveal incidental findings—unexpected abnormalities that may or may not have clinical significance. Interpreting these findings requires not only technical skill but also specialized expertise. Many types of incidental findings are commonly seen in brain MRIs. This is why having a specialized neuroradiologist assess them in the context of a patient’s symptoms provides the best possible report and outcome for the patient.

Common Types of Incidental Findings in Brain MRIs

Incidental findings are often discovered during routine imaging and can range from benign anatomical variations to potentially significant abnormalities. Below are some of the most common types:

1. White Matter Hyperintensities (WMHs)

These bright spots on T2-weighted or FLAIR sequences are common in older adults and are often attributed to small vessel disease, aging, or migraines. While usually benign, extensive or atypical WMHs can be associated with conditions like multiple sclerosis or vasculitis.

2. Arachnoid Cysts

These fluid-filled sacs are usually benign and asymptomatic. However, their location and size can sometimes cause symptoms by exerting pressure on adjacent brain structures.

3. Chiari Malformations

This structural abnormality, where brain tissue extends into the spinal canal, is often found incidentally. While some cases are asymptomatic, others can cause headaches, dizziness, or balance issues.

4. Pineal Cysts

These are often discovered incidentally and rarely cause symptoms. However, larger cysts may lead to headaches or visual disturbances.

5. Cavernous Malformations

Small collections of abnormal blood vessels may cause no symptoms or lead to seizures, headaches, or hemorrhages.

6. Unruptured Aneurysms

While many aneurysms remain asymptomatic, their detection warrants careful assessment to evaluate the risk of rupture.

7. Tumors and Mass Lesions

Meningiomas, low-grade gliomas, or other masses can sometimes be incidental discoveries. Distinguishing these from benign findings is critical.

Why a Neuroradiologist?

While general radiologists are well-trained to interpret a wide range of imaging studies, the complexity of brain anatomy and the subtleties of neurological pathology make a neuroradiologist’s expertise indispensable when evaluating brain MRIs. Here are several reasons why a neuroradiologist is best suited to this task:

1. Specialized Training

Neuroradiologists undergo additional fellowship training focused exclusively on imaging of the brain, spine, and nervous system. This gives them a deeper understanding of neurological diseases and their imaging characteristics.

2. Recognizing Variants vs. Pathology

Many incidental findings can mimic serious pathology, and distinguishing between the two is critical. For example, differentiating an unusual vascular variant from an aneurysm requires both skill and experience.

3. Correlating Findings with Symptoms

Neuroradiologists are adept at connecting imaging findings with clinical presentations. For example, a general radiologist might note the presence of a Chiari malformation, but a neuroradiologist can better determine whether it’s likely contributing to the patient’s headaches.

4. Advanced Imaging Techniques

Neuroradiologists are familiar with advanced imaging modalities such as diffusion tensor imaging (DTI), perfusion imaging, and spectroscopy. These techniques can provide critical insights that are often beyond the purview of general radiologists.

5. Guiding Further Management

When incidental findings are detected, a neuroradiologist’s input is invaluable in guiding the next steps, whether it’s additional imaging, specialist referral, or reassurance that no further action is needed.

Getting a Second Opinion with MDView

Incidental findings on brain MRIs are common, but their significance can vary widely. Properly assessing these findings requires a nuanced understanding of brain anatomy, pathology, and clinical context—a skill set uniquely possessed by neuroradiologists. Within MDView, you have the opportunity to connect with a caring neuroradiologist who will read the information you provide about your history, condition, and concerns. Getting a second opinion by these specialists, you can be confident in the accuracy of the diagnosis and the appropriateness of the care plan. When it comes to brain health, the expertise of a neuroradiologist is not just an advantage; it’s a necessity.

From a patient’s standpoint, the discovery of an incidental finding can be anxiety-inducing. Having an expert neuroradiologist provide a second opinion on your scan ensures a thorough, expert evaluation, which can provide clarity and peace of mind. You are more likely to receive accurate diagnoses and appropriate care recommendations when your scans are reviewed by someone with the highest level of expertise in brain imaging. This is why MDView provides fast, affordable access to expert neuroradiologists from the comfort of your home. 

Get started today by visiting: https://app.mdview.com to upload your exam and get a second opinion today! Don't have your exam images? No problem! MDView can get your exam directly from the facility at no added cost! Just complete the Have MDView Get My Exam form found on the homepage of your MDView account. 

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