1.To recognize ''never mind'' lesions in paediatric brain MR 2.To understand what are normal variants and incidentalomas 3. To recognize theradiological features that correspond to each normal variantand incidentaloma 4. To understand when do we findnormal variants and incidentalomas and how to deal with each of thempaediatric brain MR

''Never mind'' lesions in paediatric brain imaging usually described as. Normal variants Variants of „normal anatomy“ No clinical correlate No indication for repetition of imaging Incidental findings (Incidentalomas) „incidental“ - unexpected – not looked for Finding as such is abnormal [≠ variant] Finding does not explain symptomatology

When do we find normal variants and incidentalomas •„Routine“ – investigations (e.g. following seizure ) •Imaging following trauma •Neuroimaging in context of studies (cardiac malformations, follow-up of neonatal HIE…) •Healthy volunteers («controls» in studies) •Prenatal screening !! •Patients with a syndrome – MRI «for interest» •Check-up „ Wellness scans “ Normal variants •Temporal lobe hypoplasia–middle fossa arachnoid cyst (Fig.1) •Enlarged Virchow-Robin spaces ( Perivascular Spaces ) (Fig.2) •Pineal cyst (Fig.3) •Rathke cyst •Developmental Venous Anomaly [DVA] •Benign enlargement of subarachnoid space ( frontal / occipital...

Normal variants/ incidental findings are very prevalent Recognition is relevant Avoid unnecessary further investigations (and costs) Avoid (inappropriate) parental anxiety

Marine Grigoryan Gagik The head of radiology department ''Arabkir'' JMC, Yerevan, Armenia Associate Professor of Yerevan State Medical University radiology department, Yerevan, Armenia

Incidental findings on brain imaging in the general pediatric population , Janses RP et al, NEJM, 2017,377:1593-1595