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Optimal Brain MRI Protocol for New Neurological Complaint

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. Metho... Full description

Journal Title: Mehan W. A., R. G. González, B. R. Buchbinder, J. W. Chen, W. A. Copen, R. Gupta, J. A. Hirsch, et al. 2014. “Optimal Brain MRI Protocol for New Neurological Complaint.” PLoS ONE 9 (10): e110803. doi:10.1371/journal.pone.0110803. http://dx.doi.org/10.1371/journal.pone.0110803.
Main Author: Mehan, William A.
Other Authors: González, R. Gilberto , Buchbinder, Bradley R. , Chen, John W. , Copen, William A. , Gupta, Rajiv , Hirsch, Joshua A. , Hunter, George J. , Hunter, Scott , Johnson, Jason M. , Kelly, Hillary R. , Larvie, Mykol , Lev, Michael H. , Pomerantz, Stuart R. , Rapalino, Otto , Rincon, Sandra , Romero, Javier M. , Schaefer, Pamela W. , Shah, Vinil
Format: Electronic Article Electronic Article
Language: English
Subjects:
ID: ISSN: 1932-6203 ; DOI: 10.1371/journal.pone.0110803
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title: Optimal Brain MRI Protocol for New Neurological Complaint
format: Article
creator:
  • Mehan, William A.
  • González, R. Gilberto
  • Buchbinder, Bradley R.
  • Chen, John W.
  • Copen, William A.
  • Gupta, Rajiv
  • Hirsch, Joshua A.
  • Hunter, George J.
  • Hunter, Scott
  • Johnson, Jason M.
  • Kelly, Hillary R.
  • Larvie, Mykol
  • Lev, Michael H.
  • Pomerantz, Stuart R.
  • Rapalino, Otto
  • Rincon, Sandra
  • Romero, Javier M.
  • Schaefer, Pamela W.
  • Shah, Vinil
subjects:
  • Medicine And Health Sciences
  • Diagnostic Medicine
  • Diagnostic Radiology
  • Magnetic Resonance Imaging
  • Radiology And Imaging
ispartof: Mehan, W. A., R. G. González, B. R. Buchbinder, J. W. Chen, W. A. Copen, R. Gupta, J. A. Hirsch, et al. 2014. “Optimal Brain MRI Protocol for New Neurological Complaint.” PLoS ONE 9 (10): e110803. doi:10.1371/journal.pone.0110803. http://dx.doi.org/10.1371/journal.pone.0110803.
description: 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.
language: eng
source:
identifier: ISSN: 1932-6203 ; DOI: 10.1371/journal.pone.0110803
fulltext: fulltext_linktorsrc
issn:
  • 1932-6203
  • 19326203
url: Link


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titleOptimal Brain MRI Protocol for New Neurological Complaint
creatorMehan, William A. ; González, R. Gilberto ; Buchbinder, Bradley R. ; Chen, John W. ; Copen, William A. ; Gupta, Rajiv ; Hirsch, Joshua A. ; Hunter, George J. ; Hunter, Scott ; Johnson, Jason M. ; Kelly, Hillary R. ; Larvie, Mykol ; Lev, Michael H. ; Pomerantz, Stuart R. ; Rapalino, Otto ; Rincon, Sandra ; Romero, Javier M. ; Schaefer, Pamela W. ; Shah, Vinil
ispartofMehan, W. A., R. G. González, B. R. Buchbinder, J. W. Chen, W. A. Copen, R. Gupta, J. A. Hirsch, et al. 2014. “Optimal Brain MRI Protocol for New Neurological Complaint.” PLoS ONE 9 (10): e110803. doi:10.1371/journal.pone.0110803. http://dx.doi.org/10.1371/journal.pone.0110803.
identifierISSN: 1932-6203 ; DOI: 10.1371/journal.pone.0110803
subjectMedicine And Health Sciences ; Diagnostic Medicine ; Diagnostic Radiology ; Magnetic Resonance Imaging ; Radiology And Imaging
descriptionBackground/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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titleOptimal Brain MRI Protocol for New Neurological Complaint
descriptionBackground/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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authorMehan, William A. ; González, R. Gilberto ; Buchbinder, Bradley R. ; Chen, John W. ; Copen, William A. ; Gupta, Rajiv ; Hirsch, Joshua A. ; Hunter, George J. ; Hunter, Scott ; Johnson, Jason M. ; Kelly, Hillary R. ; Larvie, Mykol ; Lev, Michael H. ; Pomerantz, Stuart R. ; Rapalino, Otto ; Rincon, Sandra ; Romero, Javier M. ; Schaefer, Pamela W. ; Shah, Vinil
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abstractBackground/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.
pubPublic Library of Science
doi10.1371/journal.pone.0110803
urlhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC4208779/pdf/
issue10
pagese110803
volume9
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