Portable MRI for the Neurosurgical ICU

ABSTRACT

INTRODUCTION: Neuroimaging in the intensive care unit (ICU) may be difficult to acquire given the safety concerns and challenges involved in moving critically ill patients. We report on the safety and clinical findings of a portable magnetic resonance imager (MRI) in a cohort of ICU patients who had Covid 19 with suspected neurologic injury. METHODS: This is a prospective, non-randomized, observational study at one institution utilizing portable MRI in patients with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, known as Covid-19. Patients selected for imaging had any of the following 1) unexplained encephalopathy or coma, 2) seizures, 3) focal neurologic deficit, and 4) abnormal head CT. Imaging was performed in each patient's ICU room with a portable, selfshielding, 0.064 Tesla (T) MRI. RESULTS: Among 19 patients, a total of 20 MRI scans in seven ICUs were acquired between April 13 and April 23, 2020. No adverse events to patients or staff from MRI acquisition were reported. In 12 patients, abnormal findings were seen, which included increased fluid attenuated inversion recovery (FLAIR) signal (n = 12), hemorrhage (n = 3), and diffusion-weighted imaging (DWI) positivity (n = 3). Imaging led to a change in clinical management in five patients, including 3 lumbar punctures, a resumption of anticoagulation therapy, and one previously unplanned move to palliative care. CONCLUSION: This study provides the first report on the use of a novel, portable, self-shielding MRI to image patients. In critically ill patients, the use of portable MRI is safe, feasible, and leads to changes in clinical management. This technique can be applied to any ICU patients whose care requires imaging of the brain.