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Lang M, Clifford B, Lo WC, Applewhite BP, Tabari A, Filho ALMG, Hosseini Z, Longo MGF, Cauley SF, Setsompop K, Bilgic B, Feiweier T, Lev MH, Schaefer PW, Rapalino O, Huang SY, Conklin J. Clinical Evaluation of a 2-Minute Ultrafast Brain MR Protocol for Evaluation of Acute Pathology in the Emergency and Inpatient Settings. AJNR Am J Neuroradiol 2024; 45:379-385. [PMID: 38453413 PMCID: PMC11288578 DOI: 10.3174/ajnr.a8143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/07/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND AND PURPOSE The use of MR imaging in emergency settings has been limited by availability, long scan times, and sensitivity to motion. This study assessed the diagnostic performance of an ultrafast brain MR imaging protocol for evaluation of acute intracranial pathology in the emergency department and inpatient settings. MATERIALS AND METHODS Sixty-six adult patients who underwent brain MR imaging in the emergency department and inpatient settings were included in the study. All patients underwent both the reference and the ultrafast brain MR protocols. Both brain MR imaging protocols consisted of T1-weighted, T2/T2*-weighted, FLAIR, and DWI sequences. The ultrafast MR images were reconstructed by using a machine-learning assisted framework. All images were reviewed by 2 blinded neuroradiologists. RESULTS The average acquisition time was 2.1 minutes for the ultrafast brain MR protocol and 10 minutes for the reference brain MR protocol. There was 98.5% agreement on the main clinical diagnosis between the 2 protocols. In head-to-head comparison, the reference protocol was preferred in terms of image noise and geometric distortion (P < .05 for both). The ultrafast ms-EPI protocol was preferred over the reference protocol in terms of reduced motion artifacts (P < .01). Overall diagnostic quality was not significantly different between the 2 protocols (P > .05). CONCLUSIONS The ultrafast brain MR imaging protocol provides high accuracy for evaluating acute pathology while only requiring a fraction of the scan time. Although there was greater image noise and geometric distortion on the ultrafast brain MR protocol images, there was significant reduction in motion artifacts with similar overall diagnostic quality between the 2 protocols.
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Affiliation(s)
- Min Lang
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Bryan Clifford
- Siemens Medical Solutions (B.C., W.-C.L., Z.H., S.F.C.), Boston, Massachusetts
| | - Wei-Ching Lo
- Siemens Medical Solutions (B.C., W.-C.L., Z.H., S.F.C.), Boston, Massachusetts
| | - Brooks P Applewhite
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Azadeh Tabari
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | | | - Zahra Hosseini
- Siemens Medical Solutions (B.C., W.-C.L., Z.H., S.F.C.), Boston, Massachusetts
| | - Maria Gabriela Figueiro Longo
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Stephen F Cauley
- Siemens Medical Solutions (B.C., W.-C.L., Z.H., S.F.C.), Boston, Massachusetts
- Harvard-MIT Health Sciences and Technology (S.F.C., B.B., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Kawin Setsompop
- Departments of Radiology and Electrical Engineering (K.S.), Stanford University, Stanford, California
| | - Berkin Bilgic
- Harvard-MIT Health Sciences and Technology (S.F.C., B.B., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | | | - Michael H Lev
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Pamela W Schaefer
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Otto Rapalino
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Susie Y Huang
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
- Harvard-MIT Health Sciences and Technology (S.F.C., B.B., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - John Conklin
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
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5
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Kuoy E, Glavis-Bloom J, Hovis G, Yep B, Biswas A, Masudathaya LA, Norrick LA, Limfueco J, Soun JE, Chang PD, Chu E, Akbari Y, Yaghmai V, Fox JC, Yu W, Chow DS. Point-of-Care Brain MRI: Preliminary Results from a Single-Center Retrospective Study. Radiology 2022; 305:666-671. [PMID: 35916678 PMCID: PMC9713449 DOI: 10.1148/radiol.211721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 05/13/2022] [Accepted: 06/03/2022] [Indexed: 11/11/2022]
Abstract
Background Point-of-care (POC) MRI is a bedside imaging technology with fewer than five units in clinical use in the United States and a paucity of scientific studies on clinical applications. Purpose To evaluate the clinical and operational impacts of deploying POC MRI in emergency department (ED) and intensive care unit (ICU) patient settings for bedside neuroimaging, including the turnaround time. Materials and Methods In this preliminary retrospective study, all patients in the ED and ICU at a single academic medical center who underwent noncontrast brain MRI from January 2021 to June 2021 were investigated to determine the number of patients who underwent bedside POC MRI. Turnaround time, examination limitations, relevant findings, and potential CT and fixed MRI findings were recorded for patients who underwent POC MRI. Descriptive statistics were used to describe clinical variables. The Mann-Whitney U test was used to compare the turnaround time between POC MRI and fixed MRI examinations. Results Of 638 noncontrast brain MRI examinations, 36 POC MRI examinations were performed in 35 patients (median age, 66 years [IQR, 57-77 years]; 21 women), with one patient undergoing two POC MRI examinations. Of the 36 POC MRI examinations, 13 (36%) occurred in the ED and 23 (64%) in the ICU. There were 12 of 36 (33%) POC MRI examinations interpreted as negative, 14 of 36 (39%) with clinically significant imaging findings, and 10 of 36 (28%) deemed nondiagnostic for reasons such as patient motion. Of 23 diagnostic POC MRI examinations with comparison CT available, three (13%) demonstrated acute infarctions not apparent on CT scans. Of seven diagnostic POC MRI examinations with subsequent fixed MRI examinations, two (29%) demonstrated missed versus interval subcentimeter infarctions, while the remaining demonstrated no change. The median turnaround time of POC MRI was 3.4 hours in the ED and 5.3 hours in the ICU. Conclusion Point-of-care (POC) MRI was performed rapidly in the emergency department and intensive care unit. A few POC MRI examinations demonstrated acute infarctions not apparent at standard-of-care CT examinations. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Anzai and Moy in this issue.
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Affiliation(s)
- Edward Kuoy
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Justin Glavis-Bloom
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Gabrielle Hovis
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Brian Yep
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Arabdha Biswas
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Lu-Aung Masudathaya
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Lori A. Norrick
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Julie Limfueco
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Jennifer E. Soun
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Peter D. Chang
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Eleanor Chu
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Yama Akbari
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Vahid Yaghmai
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - John C. Fox
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Wengui Yu
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
| | - Daniel S. Chow
- From the Department of Radiological Sciences (E.K., J.G.B., B.Y.,
L.A.N., J.L., J.E.S., P.D.C., E.C., V.Y., D.S.C.), Center for Artificial
Intelligence in Diagnostic Medicine (A.B., L.A.M., P.D.C., D.S.C.), Department
of Neurology (Y.A., W.Y.), and Department of Emergency Medicine (J.C.F.),
University of California, Irvine, 101 The City Drive South, Orange, CA 92868;
and University of California, Irvine School of Medicine, Irvine, Calif
(G.H.)
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