When findings hurt: Mental health effects of cerebral MRI screening in patients with Hereditary Hemorrhagic Telangiectasia

BACKGROUND: Brain MRI is increasingly used for screening purposes, yet the psychological impact of such screening remains unclear. This study aimed to evaluate the psychological consequences of screening in patients with Hereditary Hemorrhagic Telangiectasia (HHT), specifically focusing on the association between abnormal imaging findings and depressive symptoms. METHODS: In this prospective study, 202 HHT patients were invited to complete the Short Form-36 (SF-36) and Beck Depression Inventory-II (BDI-II) at baseline and three months after MRI screening; 140 completed both assessments. MRI results were dichotomized (cerebral findings vs. no abnormal findings). A mixed-effects linear regression model evaluated the association between MRI results and BDI-II scores, adjusting for age, sex, and physical functioning. RESULTS: While the cohort as a whole showed no significant changes in quality of life or depression scores, the subgroup with abnormal MRI findings reported significantly higher BDI-II scores post-screening (β = 9.69, p = 0.003), indicating increased depressive symptoms. This effect was more pronounced in patients with poorer physical function. No significant change was observed in patients with normal MRI results. CONCLUSION: These results demonstrate that brain MRI screening in HHT is not a psychologically neutral event. While detecting treatable malformations is clinically important, the psychological burden of abnormal findings is significant. Screening protocols should therefore integrate structured pre-screening counseling and robust post-result mental health support.