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From the Stanford Center for Biomedical Ethics (Drs. Illes and Raffin), Departments of Medicine (Drs. Illes and Raffin), Radiology (Drs. Illes, Huang, Goldstein, and Atlas), and Neurology and Neurological Sciences (Dr. Rosen), and the Hoover Institution (Dr. Atlas), Stanford University, Palo Alto, CA; and SRI International (Dr. Swan), Menlo Park, CA.
Address correspondence and reprint requests to Dr. Judy Illes, Stanford Center for Biomedical Ethics, 701 Welch Road, Palo Alto, CA 94304-5748; e-mail: illes{at}stanford.edu
Objective: To characterize the frequency and severity of incidental findings in brain MRIs of young and older adult research volunteers, and to provide an evaluation of the ethical challenges posed by the detection of such findings.
Methods: The authors reviewed 151 research MRI scans obtained retrospectively from subjects recruited to studies as healthy volunteers. Incidental findings were classified into four categories: no referral, routine, urgent, or immediate referral. p Values for significance were computed from 
2 tests of contingency.
Results: Of 151 studies, the authors found an overall occurrence of incidental findings having required referral of 6.6%. By age, there were more findings in the older cohort (aged >60 years) than in the younger cohort (p < 0.05) and in more men than women in the older cohort (p < 0.001). Three of four (75%) findings in the younger cohort were classified in the urgent referral category; 100% of the findings in the older cohort were classified as routine (p < 0.05).
Conclusion: The significant presence but different characteristics of incidental findings in young and older subjects presumed to be neurologically healthy suggest that standards of practice are needed to guide investigators in managing and communicating their discovery.
Received November 17, 2003. Accepted in final form January 5, 2004.
See also page 849
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