Structural brain anomalies in healthy adolescents in the NCANDA cohort: relation to neuropsychological test performance, sex, and ethnicity

Edith V. Sullivan, Barton Lane, Dongjin Kwon, M. J. Meloy, Susan F. Tapert, Sandra A. Brown, Ian M. Colrain, Fiona C. Baker, Michael D. De Bellis, Duncan B. Clark, Bonnie Nagel, Kilian M. Pohl, Adolf Pfefferbaum

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Structural MRI of volunteers deemed “normal” following clinical interview provides a window into normal brain developmental morphology but also reveals unexpected dysmorphology, commonly known as “incidental findings.” Although unanticipated, these anatomical findings raise questions regarding possible treatment that could even ultimately require neurosurgical intervention, which itself carries significant risk but may not be indicated if the anomaly is nonprogressive or of no functional consequence. Neuroradiological readings of 833 structural MRI from the National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA) cohort found an 11.8 % incidence of brain structural anomalies, represented proportionately across the five collection sites and ethnic groups. Anomalies included 26 mega cisterna magna, 15 subarachnoid cysts, 12 pineal cysts, 12 white matter dysmorphologies, 5 tonsillar ectopias, 5 prominent perivascular spaces, 5 gray matter heterotopias, 4 pituitary masses, 4 excessively large or asymmetrical ventricles, 4 cavum septum pellucidum, 3 developmental venous anomalies, 1 exceptionally large midsagittal vein, and single cases requiring clinical followup: cranio-cervical junction stenosis, parietal cortical mass, and Chiari I malformation. A case of possible demyelinating disorder (e.g., neuromyelitis optica or multiple sclerosis) newly emerged at the 1-year NCANDA followup, requiring clinical referral. Comparing test performance of the 98 anomalous cases with 619 anomaly-free no-to-low alcohol consuming adolescents revealed significantly lower scores on speed measures of attention and motor functions; these differences were not attributed to any one anomaly subgroup. Further, we devised an automated approach for quantifying posterior fossa CSF volumes for detection of mega cisterna magna, which represented 26.5 % of clinically identified anomalies. Automated quantification fit a Gaussian distribution with a rightward skew. Using a 3SD cut-off, quantification identified 22 of the 26 clinically-identified cases, indicating that cases with percent of CSF in the posterior-inferior-middle aspect of the posterior fossa ≥3SD merit further review, and support complementing clinical readings with objective quantitative analysis. Discovery of asymptomatic brain structural anomalies, even when no clinical action is indicated, can be disconcerting to the individual and responsible family members, raising a disclosure dilemma: refrain from relating the incidental findings to avoid unnecessary alarm or anxiety; or alternatively, relate the neuroradiological findings as “normal variants” to the study volunteers and family, thereby equipping them with knowledge for the future should they have the occasion for a brain scan following an illness or accident that the incidental findings predated the later event.

Original languageEnglish (US)
Pages (from-to)1302-1315
Number of pages14
JournalBrain Imaging and Behavior
Volume11
Issue number5
DOIs
StatePublished - Oct 1 2017

Fingerprint

Neuropsychological Tests
Incidental Findings
Alcohols
Cisterna Magna
Brain
Cysts
Reading
Septum Pellucidum
Neuromyelitis Optica
Normal Distribution
Disclosure
Demyelinating Diseases
Ethnic Groups
Multiple Sclerosis
Accidents
Volunteers
Veins
Healthy Volunteers
Pathologic Constriction
Referral and Consultation

Keywords

  • Brain anomaly
  • Development, adolescence
  • Dysmorphology
  • Incidental findings

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Neurology
  • Cognitive Neuroscience
  • Clinical Neurology
  • Cellular and Molecular Neuroscience
  • Psychiatry and Mental health
  • Behavioral Neuroscience

Cite this

Structural brain anomalies in healthy adolescents in the NCANDA cohort : relation to neuropsychological test performance, sex, and ethnicity. / Sullivan, Edith V.; Lane, Barton; Kwon, Dongjin; Meloy, M. J.; Tapert, Susan F.; Brown, Sandra A.; Colrain, Ian M.; Baker, Fiona C.; De Bellis, Michael D.; Clark, Duncan B.; Nagel, Bonnie; Pohl, Kilian M.; Pfefferbaum, Adolf.

In: Brain Imaging and Behavior, Vol. 11, No. 5, 01.10.2017, p. 1302-1315.

Research output: Contribution to journalArticle

Sullivan, EV, Lane, B, Kwon, D, Meloy, MJ, Tapert, SF, Brown, SA, Colrain, IM, Baker, FC, De Bellis, MD, Clark, DB, Nagel, B, Pohl, KM & Pfefferbaum, A 2017, 'Structural brain anomalies in healthy adolescents in the NCANDA cohort: relation to neuropsychological test performance, sex, and ethnicity', Brain Imaging and Behavior, vol. 11, no. 5, pp. 1302-1315. https://doi.org/10.1007/s11682-016-9634-2
Sullivan, Edith V. ; Lane, Barton ; Kwon, Dongjin ; Meloy, M. J. ; Tapert, Susan F. ; Brown, Sandra A. ; Colrain, Ian M. ; Baker, Fiona C. ; De Bellis, Michael D. ; Clark, Duncan B. ; Nagel, Bonnie ; Pohl, Kilian M. ; Pfefferbaum, Adolf. / Structural brain anomalies in healthy adolescents in the NCANDA cohort : relation to neuropsychological test performance, sex, and ethnicity. In: Brain Imaging and Behavior. 2017 ; Vol. 11, No. 5. pp. 1302-1315.
@article{99fd6b4156004566b4714de7c3c93125,
title = "Structural brain anomalies in healthy adolescents in the NCANDA cohort: relation to neuropsychological test performance, sex, and ethnicity",
abstract = "Structural MRI of volunteers deemed “normal” following clinical interview provides a window into normal brain developmental morphology but also reveals unexpected dysmorphology, commonly known as “incidental findings.” Although unanticipated, these anatomical findings raise questions regarding possible treatment that could even ultimately require neurosurgical intervention, which itself carries significant risk but may not be indicated if the anomaly is nonprogressive or of no functional consequence. Neuroradiological readings of 833 structural MRI from the National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA) cohort found an 11.8 {\%} incidence of brain structural anomalies, represented proportionately across the five collection sites and ethnic groups. Anomalies included 26 mega cisterna magna, 15 subarachnoid cysts, 12 pineal cysts, 12 white matter dysmorphologies, 5 tonsillar ectopias, 5 prominent perivascular spaces, 5 gray matter heterotopias, 4 pituitary masses, 4 excessively large or asymmetrical ventricles, 4 cavum septum pellucidum, 3 developmental venous anomalies, 1 exceptionally large midsagittal vein, and single cases requiring clinical followup: cranio-cervical junction stenosis, parietal cortical mass, and Chiari I malformation. A case of possible demyelinating disorder (e.g., neuromyelitis optica or multiple sclerosis) newly emerged at the 1-year NCANDA followup, requiring clinical referral. Comparing test performance of the 98 anomalous cases with 619 anomaly-free no-to-low alcohol consuming adolescents revealed significantly lower scores on speed measures of attention and motor functions; these differences were not attributed to any one anomaly subgroup. Further, we devised an automated approach for quantifying posterior fossa CSF volumes for detection of mega cisterna magna, which represented 26.5 {\%} of clinically identified anomalies. Automated quantification fit a Gaussian distribution with a rightward skew. Using a 3SD cut-off, quantification identified 22 of the 26 clinically-identified cases, indicating that cases with percent of CSF in the posterior-inferior-middle aspect of the posterior fossa ≥3SD merit further review, and support complementing clinical readings with objective quantitative analysis. Discovery of asymptomatic brain structural anomalies, even when no clinical action is indicated, can be disconcerting to the individual and responsible family members, raising a disclosure dilemma: refrain from relating the incidental findings to avoid unnecessary alarm or anxiety; or alternatively, relate the neuroradiological findings as “normal variants” to the study volunteers and family, thereby equipping them with knowledge for the future should they have the occasion for a brain scan following an illness or accident that the incidental findings predated the later event.",
keywords = "Brain anomaly, Development, adolescence, Dysmorphology, Incidental findings",
author = "Sullivan, {Edith V.} and Barton Lane and Dongjin Kwon and Meloy, {M. J.} and Tapert, {Susan F.} and Brown, {Sandra A.} and Colrain, {Ian M.} and Baker, {Fiona C.} and {De Bellis}, {Michael D.} and Clark, {Duncan B.} and Bonnie Nagel and Pohl, {Kilian M.} and Adolf Pfefferbaum",
year = "2017",
month = "10",
day = "1",
doi = "10.1007/s11682-016-9634-2",
language = "English (US)",
volume = "11",
pages = "1302--1315",
journal = "Brain Imaging and Behavior",
issn = "1931-7557",
publisher = "Springer New York",
number = "5",

}

TY - JOUR

T1 - Structural brain anomalies in healthy adolescents in the NCANDA cohort

T2 - relation to neuropsychological test performance, sex, and ethnicity

AU - Sullivan, Edith V.

AU - Lane, Barton

AU - Kwon, Dongjin

AU - Meloy, M. J.

AU - Tapert, Susan F.

AU - Brown, Sandra A.

AU - Colrain, Ian M.

AU - Baker, Fiona C.

AU - De Bellis, Michael D.

AU - Clark, Duncan B.

AU - Nagel, Bonnie

AU - Pohl, Kilian M.

AU - Pfefferbaum, Adolf

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Structural MRI of volunteers deemed “normal” following clinical interview provides a window into normal brain developmental morphology but also reveals unexpected dysmorphology, commonly known as “incidental findings.” Although unanticipated, these anatomical findings raise questions regarding possible treatment that could even ultimately require neurosurgical intervention, which itself carries significant risk but may not be indicated if the anomaly is nonprogressive or of no functional consequence. Neuroradiological readings of 833 structural MRI from the National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA) cohort found an 11.8 % incidence of brain structural anomalies, represented proportionately across the five collection sites and ethnic groups. Anomalies included 26 mega cisterna magna, 15 subarachnoid cysts, 12 pineal cysts, 12 white matter dysmorphologies, 5 tonsillar ectopias, 5 prominent perivascular spaces, 5 gray matter heterotopias, 4 pituitary masses, 4 excessively large or asymmetrical ventricles, 4 cavum septum pellucidum, 3 developmental venous anomalies, 1 exceptionally large midsagittal vein, and single cases requiring clinical followup: cranio-cervical junction stenosis, parietal cortical mass, and Chiari I malformation. A case of possible demyelinating disorder (e.g., neuromyelitis optica or multiple sclerosis) newly emerged at the 1-year NCANDA followup, requiring clinical referral. Comparing test performance of the 98 anomalous cases with 619 anomaly-free no-to-low alcohol consuming adolescents revealed significantly lower scores on speed measures of attention and motor functions; these differences were not attributed to any one anomaly subgroup. Further, we devised an automated approach for quantifying posterior fossa CSF volumes for detection of mega cisterna magna, which represented 26.5 % of clinically identified anomalies. Automated quantification fit a Gaussian distribution with a rightward skew. Using a 3SD cut-off, quantification identified 22 of the 26 clinically-identified cases, indicating that cases with percent of CSF in the posterior-inferior-middle aspect of the posterior fossa ≥3SD merit further review, and support complementing clinical readings with objective quantitative analysis. Discovery of asymptomatic brain structural anomalies, even when no clinical action is indicated, can be disconcerting to the individual and responsible family members, raising a disclosure dilemma: refrain from relating the incidental findings to avoid unnecessary alarm or anxiety; or alternatively, relate the neuroradiological findings as “normal variants” to the study volunteers and family, thereby equipping them with knowledge for the future should they have the occasion for a brain scan following an illness or accident that the incidental findings predated the later event.

AB - Structural MRI of volunteers deemed “normal” following clinical interview provides a window into normal brain developmental morphology but also reveals unexpected dysmorphology, commonly known as “incidental findings.” Although unanticipated, these anatomical findings raise questions regarding possible treatment that could even ultimately require neurosurgical intervention, which itself carries significant risk but may not be indicated if the anomaly is nonprogressive or of no functional consequence. Neuroradiological readings of 833 structural MRI from the National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA) cohort found an 11.8 % incidence of brain structural anomalies, represented proportionately across the five collection sites and ethnic groups. Anomalies included 26 mega cisterna magna, 15 subarachnoid cysts, 12 pineal cysts, 12 white matter dysmorphologies, 5 tonsillar ectopias, 5 prominent perivascular spaces, 5 gray matter heterotopias, 4 pituitary masses, 4 excessively large or asymmetrical ventricles, 4 cavum septum pellucidum, 3 developmental venous anomalies, 1 exceptionally large midsagittal vein, and single cases requiring clinical followup: cranio-cervical junction stenosis, parietal cortical mass, and Chiari I malformation. A case of possible demyelinating disorder (e.g., neuromyelitis optica or multiple sclerosis) newly emerged at the 1-year NCANDA followup, requiring clinical referral. Comparing test performance of the 98 anomalous cases with 619 anomaly-free no-to-low alcohol consuming adolescents revealed significantly lower scores on speed measures of attention and motor functions; these differences were not attributed to any one anomaly subgroup. Further, we devised an automated approach for quantifying posterior fossa CSF volumes for detection of mega cisterna magna, which represented 26.5 % of clinically identified anomalies. Automated quantification fit a Gaussian distribution with a rightward skew. Using a 3SD cut-off, quantification identified 22 of the 26 clinically-identified cases, indicating that cases with percent of CSF in the posterior-inferior-middle aspect of the posterior fossa ≥3SD merit further review, and support complementing clinical readings with objective quantitative analysis. Discovery of asymptomatic brain structural anomalies, even when no clinical action is indicated, can be disconcerting to the individual and responsible family members, raising a disclosure dilemma: refrain from relating the incidental findings to avoid unnecessary alarm or anxiety; or alternatively, relate the neuroradiological findings as “normal variants” to the study volunteers and family, thereby equipping them with knowledge for the future should they have the occasion for a brain scan following an illness or accident that the incidental findings predated the later event.

KW - Brain anomaly

KW - Development, adolescence

KW - Dysmorphology

KW - Incidental findings

UR - http://www.scopus.com/inward/record.url?scp=85042028596&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85042028596&partnerID=8YFLogxK

U2 - 10.1007/s11682-016-9634-2

DO - 10.1007/s11682-016-9634-2

M3 - Article

C2 - 27722828

AN - SCOPUS:85042028596

VL - 11

SP - 1302

EP - 1315

JO - Brain Imaging and Behavior

JF - Brain Imaging and Behavior

SN - 1931-7557

IS - 5

ER -