PLoS ONE (Jan 2014)

Optimal brain MRI protocol for new neurological complaint.

  • William A Mehan,
  • R Gilberto González,
  • Bradley R Buchbinder,
  • John W Chen,
  • William A Copen,
  • Rajiv Gupta,
  • Joshua A Hirsch,
  • George J Hunter,
  • Scott Hunter,
  • Jason M Johnson,
  • Hillary R Kelly,
  • Mykol Larvie,
  • Michael H Lev,
  • Stuart R Pomerantz,
  • Otto Rapalino,
  • Sandra Rincon,
  • Javier M Romero,
  • Pamela W Schaefer,
  • Vinil Shah

DOI
https://doi.org/10.1371/journal.pone.0110803
Journal volume & issue
Vol. 9, no. 10
p. e110803

Abstract

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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.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.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).A 4-pulse sequence brain MRI study is sufficient to evaluate patients with a new neurological complaint except when contrast or angiography is indicated.