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Mehan WA, González RG, Buchbinder BR, Chen JW, Copen WA, Gupta R, Hirsch JA, Hunter GJ, Hunter S, Johnson JM, Kelly HR, Larvie M, Lev MH, Pomerantz SR, Rapalino O, Rincon S, Romero JM, Schaefer PW, Shah V. Optimal brain MRI protocol for new neurological complaint. PLoS One 2014; 9:e110803. [PMID: 25343371 PMCID: PMC4208779 DOI: 10.1371/journal.pone.0110803] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 09/08/2014] [Indexed: 11/18/2022] Open
Abstract
Background/Purpose Patients with neurologic complaints are imaged with MRI protocols that may include many pulse sequences. It has not been documented which sequences are essential. We assessed the diagnostic accuracy of a limited number of sequences in patients with new neurologic complaints. Methods 996 consecutive brain MRI studies from patients with new neurological complaints were divided into 2 groups. In group 1, reviewers used a 3-sequence set that included sagittal T1-weighted, axial T2-weighted fluid-attenuated inversion recovery, and axial diffusion-weighted images. Subsequently, another group of studies were reviewed using axial susceptibility-weighted images in addition to the 3 sequences. The reference standard was the study's official report. Discrepancies between the limited sequence review and the reference standard including Level I findings (that may require immediate change in patient management) were identified. Results There were 84 major findings in 497 studies in group 1 with 21 not identified in the limited sequence evaluations: 12 enhancing lesions and 3 vascular abnormalities identified on MR angiography. The 3-sequence set did not reveal microhemorrhagic foci in 15 of 19 studies. There were 117 major findings in 499 studies in group 2 with 19 not identified on the 4-sequence set: 17 enhancing lesions and 2 vascular lesions identified on angiography. All 87 Level I findings were identified using limited sequence (56 acute infarcts, 16 hemorrhages, and 15 mass lesions). Conclusion A 4-pulse sequence brain MRI study is sufficient to evaluate patients with a new neurological complaint except when contrast or angiography is indicated.
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Affiliation(s)
- William A Mehan
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - R Gilberto González
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Bradley R Buchbinder
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - John W Chen
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - William A Copen
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Rajiv Gupta
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Joshua A Hirsch
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - George J Hunter
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Scott Hunter
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jason M Johnson
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Hillary R Kelly
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mykol Larvie
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Michael H Lev
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Stuart R Pomerantz
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Otto Rapalino
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sandra Rincon
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Javier M Romero
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Pamela W Schaefer
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Vinil Shah
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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Merhof K, Lang J, Dürr S, Stahl C, Gorgas D. Use of contrast-enhanced fluid-attenuated inversion recovery sequence to detect brain lesions in dogs and cats. J Vet Intern Med 2014; 28:1263-7. [PMID: 24962604 PMCID: PMC4857937 DOI: 10.1111/jvim.12384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 04/04/2014] [Accepted: 04/28/2014] [Indexed: 11/28/2022] Open
Abstract
Background The diagnostic value of a contrast‐enhanced T2‐weighted FLAIR sequence (ceFLAIR) in brain imaging is unclear. Hypothesis/Objectives That the number of brain lesions detected with ceFLAIR would be no greater than the sum of lesions detected with nFLAIR and ceT1W sequence. Animals One hundred and twenty‐nine animals (108 dogs and 21 cats) undergoing magnetic resonance imaging (MRI) of the head between July 2010 and October 2011 were included in the study. Methods A transverse ceFLAIR was added to a standard brain MRI protocol. Presence and number of lesions were determined based on all available MRI sequences by 3 examiners in consensus and lesion visibility was evaluated for nFLAIR, ceFLAIR, and ceT1W sequences. Results Eighty‐three lesions (58 intra‐axial and 25 extra‐axial) were identified in 51 patients. Five lesions were detected with nFLAIR alone, 2 with ceT1W alone, and 1 with ceFLAIR alone. Significantly higher numbers of lesions were detected using ceFLAIR than nFLAIR (76 versus 67 lesions; P = 0.04), in particular for lesions also detected with ceT1W images (53 versus 40; P =.01). There was no significant difference between the number of lesions detected with combined nFLAIR and ceT1W sequences compared to those detected with ceFLAIR (82 versus 76; P =.25). Conclusion and Clinical Importance Use of ceFLAIR as a complementary sequence to nFLAIR and ceT1W sequences did not improve the detection of brain lesions and cannot be recommended as part of a routine brain MRI protocol in dogs and cats with suspected brain lesions.
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Affiliation(s)
- K Merhof
- Division of Clinical Radiology, Department of Clinical Veterinary Medicine, Vetsuisse-Faculty Bern, Bern, Switzerland
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Saleh A, Wenserski F, Cohnen M, Fürst G, Godehardt E, Mödder U. Exclusion of brain lesions: is MR contrast medium required after a negative fluid-attenuated inversion recovery sequence? Br J Radiol 2004; 77:183-8. [PMID: 15020358 DOI: 10.1259/bjr/62546157] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We hypothesized that in patients with negative fluid-attenuated inversion recovery (FLAIR) images T(2) weighted fast spin-echo (FSE) images and T(1) weighted spin-echo (SE) images before and after intravenous administration of gadolinium-based contrast medium display no pathology either. Thus, we assessed the negative predictive value of FLAIR images to rule out MR-detectable brain lesions. 1026 consecutive cranial MR examinations were reviewed. Routine MRI of the brain included T(1) weighted coronal imaging before and after administration of gadopentetate dimeglumine, axial T(2) weighted FSE and fast-FLAIR imaging. The FLAIR images were rated by two radiologists into categories of 0 (without pathologic changes) and 1 (with pathologic changes). Two other radiologists analysed the complete examination. In 284 MR examinations of the brain no abnormalities were found (28%). FLAIR-ratings were false-negative in four cases and false-positive in 30 cases. Sensitivity and specificity of the FLAIR sequence for MR-detectable brain lesions were 99.5% and 89.4%. The unselective application of gadolinium avoided one false-negative MR-reading and improved the sensitivity of the MR-examination from 99.5% to 99.6%. Positive and negative predictive values were 96.1% and 98.4%, respectively. The interobserver reliability was kappa=0.93 for the FLAIR-readers and 0.89 for the readers who rated the complete examination. In conclusion, negative FLAIR images provide a high negative predictive value for MR-detectable brain lesions. Thus, in patients with negative FLAIR images the unselective application of gadolinium seems to be unnecessary.
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Affiliation(s)
- A Saleh
- Institute of Diagnostic Radiology, Clinic of Thoracic and Cardiovascular Surgery, University Hospital Düsseldorf, Germany
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Hashimoto K, Hasegawa H, Kida Y, Takeuchi Y. Correlation between neuroimaging and neurological outcome in periventricular leukomalacia: diagnostic criteria. Pediatr Int 2001; 43:240-5. [PMID: 11380916 DOI: 10.1046/j.1442-200x.2001.01374.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Periventricular leukomalacia (PVL) is the most important factor in cerebral palsy in preterm infants. METHODS In the present study, we investigated 747 preterm infants of less than 36 weeks gestation who were repeatedly examined by cranial ultrasonography and computed tomography (CT) scanning at around 40 weeks of corrected post-menstrual age. The clinical course of these infants was followed for more than 3 years and they were examined by magnetic resonance imaging (MRI) between 12 and 18 months of age. RESULTS Single examinations in early infancy were not sufficient to diagnose PVL, but the combination of ultrasonography, CT and MRI examinations allowed the clinical diagnosis of PVL. In preterm infants, clinical PVL could be predicted from cystic PVL and periventricular echogenicity (PVE) 3 or PVE 2 prolonged over 3 weeks on ultrasonography and confirmed by MRI after 11 months of corrected age. CONCLUSIONS We tried to determine diagnostic criteria for PVL by neuroimaging. Such criteria from neuroimaging for PVL may be useful for determining the exact occurrence rate of and clinical risk factors for PVL.
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Affiliation(s)
- K Hashimoto
- Division of Neonatal Medicine, Matsudo City Hospital, Matsudo, Chiba, Japan.
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