NeuroMix with MRA: A Fast MR Protocol to Reduce Head and Neck CTA for Patients with Acute Neurologic Presentations.

Autor:	Decker JH; From the Division of Neuroimaging and Neurointervention (J.H.D., A.T.M., A.B., N.F., G.Z.), Department of Radiology, Stanford University, Stanford, California jhdecker@stanford.edu., Mazal AT; From the Division of Neuroimaging and Neurointervention (J.H.D., A.T.M., A.B., N.F., G.Z.), Department of Radiology, Stanford University, Stanford, California., Bui A; From the Division of Neuroimaging and Neurointervention (J.H.D., A.T.M., A.B., N.F., G.Z.), Department of Radiology, Stanford University, Stanford, California., Sprenger T; MR Applied Science Laboratory Europe (T.S.), GE Healthcare, Stockholm, Sweden.; Department of Clinical Neuroscience (T.S., S.S.), Karolinska Institutet, Stockholm, Sweden., Skare S; Department of Clinical Neuroscience (T.S., S.S.), Karolinska Institutet, Stockholm, Sweden., Fischbein N; From the Division of Neuroimaging and Neurointervention (J.H.D., A.T.M., A.B., N.F., G.Z.), Department of Radiology, Stanford University, Stanford, California., Zaharchuk G; From the Division of Neuroimaging and Neurointervention (J.H.D., A.T.M., A.B., N.F., G.Z.), Department of Radiology, Stanford University, Stanford, California.
Jazyk:	angličtina
Zdroj:	AJNR. American journal of neuroradiology [AJNR Am J Neuroradiol] 2024 Nov 07; Vol. 45 (11), pp. 1730-1736. Date of Electronic Publication: 2024 Nov 07.
DOI:	10.3174/ajnr.A8386
Abstrakt:	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.)
Databáze:	MEDLINE
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