PMID- 27758773
OWN - NLM
STAT- MEDLINE
DCOM- 20171116
LR  - 20171128
IS  - 1936-959X (Electronic)
IS  - 0195-6108 (Linking)
VI  - 38
IP  - 1
DP  - 2017 Jan
TI  - Emergency Department MRI Scanning of Patients with Multiple Sclerosis: Worthwhile
      or Wasteful?
PG  - 12-17
LID - 10.3174/ajnr.A4953 [doi]
AB  - BACKGROUND AND PURPOSE: The increasing use of the emergency department MR imaging
      scanner at our institution raises questions about its added value to certain
      patient groups. We hypothesized that the use of emergency department MR imaging
      for identifying active demyelination in MS patients presenting with new
      neurologic symptoms would be of low yield. MATERIALS AND METHODS: Electronic
      medical records were reviewed for patients with MS who had emergency department
      MR imaging scans for a suspected MS exacerbation between March 1, 2014, and March
      1, 2016. Details surrounding patient disposition, imaging, diagnosis, and
      management were determined. RESULTS: Of 115 patients in our study, 48 (41.7%)
      were ultimately diagnosed with an MS exacerbation. Nearly all patients with MS
      exacerbations (87.5%, 42/48) had active demyelination on their emergency
      department MR imaging, identified on 30.6% (33/108) of brain MRIs and 20.4%
      (19/93) of spinal MRIs. The presence of active demyelination at MRI was
      significantly associated with the ultimate diagnosis of an MS exacerbation (P <
      .001). MR imaging activity isolated to the spinal cord (ie, not found on
      concurrent brain MR imaging) was present in only 9 of 93 (9.7%) cases.
      Pseudoexacerbations accounted for 18 of the alternative diagnoses. CONCLUSIONS:
      Emergency department MR imaging is a worthwhile endeavor from a diagnostic
      standpoint for MS exacerbations despite not being part of the diagnostic
      criteria. This finding has corresponding downstream impact on management
      decisions to admit and/or administer intravenous steroids. However, we raise the 
      question of whether clinicians over-rely on emergency department imaging for
      making exacerbation diagnoses. Additionally, spinal MR imaging is of questionable
      value as an addition to brain MR imaging due to a low yield of isolated spinal
      disease.
CI  - (c) 2017 by American Journal of Neuroradiology.
FAU - Pakpoor, J
AU  - Pakpoor J
AUID- ORCID: http://orcid.org/0000-0003-0517-9583
AD  - From the Division of Neuroradiology (J.P., I.I., L.L., D.M.Y.), Russell H. Morgan
      Department of Radiology and Radiological Science.
FAU - Saylor, D
AU  - Saylor D
AUID- ORCID: http://orcid.org/0000-0002-9297-0244
AD  - Department of Neurology (D.S., E.M.M.), Johns Hopkins Medical Institutions,
      Baltimore, Maryland.
FAU - Izbudak, I
AU  - Izbudak I
AUID- ORCID: http://orcid.org/0000-0002-9845-5171
AD  - From the Division of Neuroradiology (J.P., I.I., L.L., D.M.Y.), Russell H. Morgan
      Department of Radiology and Radiological Science.
FAU - Liu, L
AU  - Liu L
AUID- ORCID: http://orcid.org/0000-0002-5054-2372
AD  - From the Division of Neuroradiology (J.P., I.I., L.L., D.M.Y.), Russell H. Morgan
      Department of Radiology and Radiological Science.
FAU - Mowry, E M
AU  - Mowry EM
AUID- ORCID: http://orcid.org/0000-0003-0623-5188
AD  - Department of Neurology (D.S., E.M.M.), Johns Hopkins Medical Institutions,
      Baltimore, Maryland.
FAU - Yousem, D M
AU  - Yousem DM
AUID- ORCID: http://orcid.org/0000-0002-1222-6643
AD  - From the Division of Neuroradiology (J.P., I.I., L.L., D.M.Y.), Russell H. Morgan
      Department of Radiology and Radiological Science dyousem1@jhu.edu.
LA  - eng
PT  - Journal Article
DEP - 20161006
PL  - United States
TA  - AJNR Am J Neuroradiol
JT  - AJNR. American journal of neuroradiology
JID - 8003708
SB  - IM
MH  - Adult
MH  - Demyelinating Diseases/*diagnostic imaging
MH  - Emergency Service, Hospital/utilization
MH  - Female
MH  - Humans
MH  - *Magnetic Resonance Imaging/methods
MH  - Male
MH  - Middle Aged
MH  - Multiple Sclerosis/*diagnostic imaging
MH  - Retrospective Studies
EDAT- 2016/10/21 06:00
MHDA- 2017/11/29 06:00
CRDT- 2016/10/21 06:00
PHST- 2016/06/10 00:00 [received]
PHST- 2016/08/11 00:00 [accepted]
PHST- 2016/10/21 06:00 [pubmed]
PHST- 2017/11/29 06:00 [medline]
PHST- 2016/10/21 06:00 [entrez]
AID - ajnr.A4953 [pii]
AID - 10.3174/ajnr.A4953 [doi]
PST - ppublish
SO  - AJNR Am J Neuroradiol. 2017 Jan;38(1):12-17. doi: 10.3174/ajnr.A4953. Epub 2016
      Oct 6.