Ultrafast Brain Magnetic Resonance Imaging in Acute Neurological Emergencies Diagnostic Accuracy and Impact on Patient Management

Kazmierczak, Philipp M.; Duehrsen, Max; Forbrig, Robert; Patzig, Maximilian; Klein, Matthias; Pomschar, Andreas; Kunz, Wolfgang G.; Puhr-Westerheide, Daniel; Ricke, Jens; Solyanik, Olga und Cyran, Clemens C. (2020): Ultrafast Brain Magnetic Resonance Imaging in Acute Neurological Emergencies Diagnostic Accuracy and Impact on Patient Management. In: Investigative Radiology, Bd. 55, Nr. 3: S. 181-189

Abstract

Objectives: The aim of this study was to investigate diagnostic accuracy and impact on patient management of an ultrafast (4:33 minutes/5 sequences) brain magnetic resonance imaging (MRI) protocol for the detection of intracranial pathologies in acute neurological emergencies. Materials and Methods Four hundred forty-nine consecutive emergency patients with acute nontraumatic neurological symptoms were evaluated for this institutional review board-approved prospective single-center trial. Sixty patients (30 female, 30 male;mean age, 61 years) with negative head CT were included and underwent emergency brain MRI at 3 T subsequent to CT. MRI included the ultrafast protocol (ultrafast-MRI;sag T1 GRE, ax T2 TSE, ax T2 TSE Flair, ax T2* EPI-GRE, ax DWI SS-EPI;TA, 5 minutes) and an equivalent standard-length protocol (TA, 15 minutes) as reference standard. Two blinded board-certified neuroradiologists independently analyzed the MRI with regard to image quality (1, nondiagnostic;2, substantial artifacts;3, satisfactory;4, minor artifacts;5, no artifacts) and intracranial pathologies. Sensitivity and specificity for the detection of intracranial pathologies were calculated accordingly. Results: Ninety-three additional intracranial lesions (acute ischemia, n = 21;intracranial hemorrhage/microbleeds, n = 27;edema, n = 2;white matter lesion, n = 38;chronic infarction, n = 3;others, n = 2) were detected by ultrafast-MRI, whereas 101 additional intracranial lesions were detected by the standard-length protocol (acute ischemia, n = 24;intracranial hemorrhage/microbleeds, n = 32;edema, n = 2;white matter lesion, n = 38;chronic infarction, n = 3;others, n = 2). Image quality was equivalent to the standard-length protocol. Ultrafast-MRI demonstrated high diagnostic accuracy (sensitivity, 0.939 [0.881-0.972];specificity, 1.000 [0.895-1.000]) for the detection of intracranial pathologies. MRI led to a change in patient management in 10% compared with the initial CT. Conclusions: Ultrafast-MRI enables time-optimized diagnostic workup in acute neurological emergencies at high sensitivity and specificity compared with a standard-length protocol, with direct impact on patient management. Ultrafast MRI protocols are a powerful tool in the emergency setting and may be implemented on various scanner types based on the optimization of individual acquisition parameters.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0020-9996
• Sprache: Englisch