Item request has been placed!
×
Item request cannot be made.
×
Processing Request
NeuroMix with MRA: A Fast MR Protocol to Reduce Head and Neck CTA for Patients with Acute Neurologic Presentations.
Item request has been placed!
×
Item request cannot be made.
×
Processing Request
- Additional Information
- Source:
Publisher: American Society of Neuroradiology Country of Publication: United States NLM ID: 8003708 Publication Model: Electronic Cited Medium: Internet ISSN: 1936-959X (Electronic) Linking ISSN: 01956108 NLM ISO Abbreviation: AJNR Am J Neuroradiol Subsets: MEDLINE
- Publication Information:
Publication: Oak Brook, IL : American Society of Neuroradiology
Original Publication: Baltimore, Williams & Wilkins.
- Subject Terms:
- Abstract:
Background and Purpose: Overuse of CT-based cerebrovascular imaging in the emergency department and inpatient settings, notably CTA of the head and neck for minor and nonfocal neurologic presentations, stresses imaging services and exposes patients to radiation and contrast. Furthermore, such CT-based imaging is often insufficient for definitive diagnosis, necessitating additional MR imaging. Recent advances in fast MRI may allow timely assessment and a reduced need for head and neck CTA in select populations.
Materials and Methods: We identified inpatients or patients in the emergency department who underwent CTAHN (including noncontrast and postcontrast head CT, with or without CTP imaging) followed within 24 hours by a 3T MRI study that included a 2.5-minute unenhanced multicontrast sequence (NeuroMix) and a 5-minute intracranial time of flight MRA) during a 9-month period (April to December 2022). Cases were classified by 4 radiologists in consensus as to whether NeuroMix and NeuroMix + MRA detected equivalent findings, detected unique findings, or missed findings relative to CTAHN.
Results: One hundred seventy-four cases (mean age, 67 [SD, 16] years; 56% female) met the inclusion criteria. NeuroMix alone and NeuroMix + MRA protocols were determined to be equivalent or better compared with CTAHN in 71% and 95% of patients, respectively. NeuroMix always provided equivalent or better assessment of the brain parenchyma, with unique findings on NeuroMix and NeuroMix + MRA in 35% and 36% of cases, respectively, most commonly acute infarction or multiple microhemorrhages. In 8/174 cases (5%), CTAHN identified vascular abnormalities not seen on the NeuroMix + MRA protocol due to the wider coverage of the cervical arteries by CTAHN.
Conclusions: A fast MR imaging protocol consisting of NeuroMix + MRA provided equivalent or better information compared with CTAHN in 95% of cases in our population of patients with an acute neurologic presentation. The findings provide a deeper understanding of the benefits and challenges of a fast unenhanced MR-first approach with NeuroMix + MRA, which could be used to design prospective trials in select patient groups, with the potential to reduce radiation dose, mitigate adverse contrast-related patient and environmental effects, and lessen the burden on radiologists and health care systems.
(© 2024 by American Journal of Neuroradiology.)
- References:
Pediatr Radiol. 2021 Jan;51(1):45-56. (PMID: 32910229)
Am J Emerg Med. 2015 Jul;33(7):887-90. (PMID: 25912791)
Lancet. 2007 Jan 27;369(9558):283-92. (PMID: 17258668)
AJR Am J Roentgenol. 2023 Nov;221(5):673-686. (PMID: 37255044)
Lancet Neurol. 2013 Jan;12(1):65-71. (PMID: 23206553)
Br J Radiol. 2016;89(1061):20150868. (PMID: 26647958)
Radiology. 2024 Feb;310(2):e231938. (PMID: 38376403)
J Neurosurg Pediatr. 2014 Apr;13(4):440-7. (PMID: 24559278)
Emerg Radiol. 2020 Feb;27(1):41-44. (PMID: 31617107)
Ann Neurol. 2014 Jan;75(1):67-76. (PMID: 24085376)
J Magn Reson Imaging. 2019 Dec;50(6):1824-1833. (PMID: 30932287)
Am J Emerg Med. 2018 Feb;36(2):301-309. (PMID: 29100783)
Magn Reson Med. 2022 May;87(5):2178-2193. (PMID: 34904751)
Pediatrics. 2019 Oct;144(4):. (PMID: 31533974)
Magn Reson Med. 2022 May;87(5):2453-2463. (PMID: 34971463)
Stroke. 2023 Mar;54(3):e109-e121. (PMID: 36655570)
AJNR Am J Neuroradiol. 2017 Aug;38(8):1480-1485. (PMID: 28495948)
J Neuroradiol. 2023 Feb;50(1):1-2. (PMID: 36400241)
Semin Roentgenol. 2020 Apr;55(2):83-94. (PMID: 32438983)
Radiographics. 2021 May-Jun;41(3):E81-E89. (PMID: 33939543)
Radiographics. 2023 Jun;43(6):e220147. (PMID: 37167089)
J Am Coll Radiol. 2024 Jun;21(6):890-895. (PMID: 37722466)
AJNR Am J Neuroradiol. 2024 Apr 8;45(4):379-385. (PMID: 38453413)
Brain. 2009 Apr;132(Pt 4):982-8. (PMID: 19293244)
AJR Am J Roentgenol. 2022 Feb;218(2):370-374. (PMID: 34494444)
Ann Emerg Med. 2018 Mar;71(3):409-415. (PMID: 28754355)
AJR Am J Roentgenol. 2022 Mar;218(3):544-551. (PMID: 34585611)
J Am Coll Radiol. 2023 Dec;20(12):1207-1214. (PMID: 37543154)
BMC Emerg Med. 2019 Sep 4;19(1):49. (PMID: 31484499)
Acad Emerg Med. 2015 Jun;22(6):741-9. (PMID: 25998846)
J Environ Manage. 2024 Feb;351:119931. (PMID: 38154220)
Intern Emerg Med. 2024 Oct;19(7):2005-2013. (PMID: 38512433)
AJR Am J Roentgenol. 2024 Feb;222(2):e2330060. (PMID: 37937837)
J Neurosurg Pediatr. 2021 Jun 25;28(3):278-286. (PMID: 34171833)
Eur J Radiol. 2022 Apr;149:110195. (PMID: 35149337)
Stroke. 2014 Jul;45(7):1985-91. (PMID: 24916906)
Stroke. 2004 Feb;35(2):502-6. (PMID: 14739410)
JAMA. 2004 Oct 20;292(15):1823-30. (PMID: 15494579)
JAMA Netw Open. 2024 Apr 1;7(4):e247373. (PMID: 38639937)
Acad Radiol. 2021 Mar;28(3):297-306. (PMID: 33516590)
Neurology. 2017 Sep 19;89(12):1229-1236. (PMID: 28835400)
- Publication Date:
Date Created: 20240621 Date Completed: 20241107 Latest Revision: 20241109
- Publication Date:
20241114
- Accession Number:
PMC11543087
- Accession Number:
10.3174/ajnr.A8386
- Accession Number:
38906674
No Comments.