Incidental brain MRI findings in intensive care unit patients: a retrospective analysis

Aims: Magnetic resonance imaging (MRI) frequently shows unexpected results unrelated to the presumed pathology. The aim of this study is to look into the frequency and type of incidental brain MRI findings in ICU patients. Methods: The Anesthesiology and Reanimation Intensive Care Unit at Erzincan Mengücek Gazi Training and Research Hospital was the setting for the retrospective observational study. A total of 5,145 ICU patients admitted between 2021 and 2023 were screened using the hospital information management system, eliminating those without a brain MRI. Incidental findings in brain MRI data were documented and divided into five categories: vascular (aneurysms, cavernomas, and other vascular structures), neoplastic (meningioma, pituitary mass, glioma, and other tumors), Chiari malformation, pineal cyst, and arachnoid cyst. Results: 1317 (25.6%) participants who received brain MRI were included in the study. Incidental MRI findings were detected in 366 patients (27.8%). The most common incidental discoveries were vascular anomalies (9.79%, primarily aneurysms and cavernomas), neoplastic lesions (8.81%, primarily meningiomas and pituitary masses), arachnoid cysts (2.89%), nonspecific plaques (2.81%), pineal cysts (2.66%), and Chiari malformations (0.84%). A large majority of these patients had clinically important findings that demanded additional clinical follow-up or evaluation; nevertheless, none required emergency surgical intervention. Patients with incidental findings had a mean age of 70.92 ± 18.42 years (range 18-98). Conclusion: In conclusion, incidental MRI results are common in critically ill patients and have significant clinical consequences. Enhanced clinician awareness and consistent management practices are critical for improving patient care, reducing unnecessary interventions, and optimizing results. Future prospective studies are required to create tailored guidelines for this population.