Cranial MRI as a screening tool: findings in 1,772 military pilot applicants.

BACKGROUND: Beginning 1 January 2000, during the selection process, the German Air Force Institute of Aviation Medicine screens all applicants for flying duty using cranial MRI to rule out relevant intracranial abnormalities. Type and frequencies of abnormalities and aeromedical consequences are described.
METHODS: An intracranial MRI is done on every applicant regardless of the findings of the physical examination.
RESULTS: From 1 January 2001 to 31 December 2002 we investigated a total of 1,772 applicants with cranial MRI. All of these had normal findings in both the general medical and neurological examinations. We found that 81.7% (1,452) were normal, 9% (160) had variations of the norm, 8.4% (148) had findings of unknown significance (e.g., arachnoid cysts, white matter lesions, etc.), and only 0.7% (12) had definite abnormal findings (arteriovenous malformations, cavernomas, tumors).
CONCLUSION: Evident pathological cases are rare. However, cranial MRI screening adds substantial new information, increasing the value of the initial examination and making it possible to extend the examination according to the clinical indications. This leads to a highly individualized appraisal of the applicant, thus increasing flight safety.