A comparative MRI study for white matter hyperintensities detection: 2D-FLAIR, FSE PD 2D, 3D-FLAIR and FLAIR MIP.

OBJECTIVE: The main objective of this study was to not only determine the most appropriate sequence for the analysis of white matter hyperintensities (WMH) on MRI but also to confirm the advantage of three-dimensional (3D) acquisition, as it has been suggested in previous studies, and to test the convenience of using maximum intensity projection (MIP) algorithms on 3D-fluid-attenuated inversion-recovery (FLAIR) images for a quicker evaluation of brain MR studies. METHODS: The number of WMH was compared in 40 patients and a control group of 10 volunteers using 4 different imaging modalities: two dimensional (2D)-FLAIR, 2D fast spin echo proton density (FSE PD), 3D-FLAIR and FLAIR MIP. Four experienced radiologists took part in the imaging analysis. All studies were performed on a 1.5-T whole-body MR unit. RESULTS: A statistically significant difference between the number of lesions detected on 3D acquisitions (FLAIR CUBE® or FLAIR MIP sequences) compared with those on 2D-FLAIR or 2D FSE PD was demonstrated. There is no significant difference between 3D-FLAIR and FLAIR MIP, therefore both of them can be used with similar results. CONCLUSION: 3D-FLAIR sequences should replace conventional 2D-FLAIR and/or FSE PD sequences in the MR acquisition protocol when WMH are suspected. MIP reformat algorithms are less time consuming, therefore these can also be used to simplify the detection. ADVANCES IN KNOWLEDGE: 3D sequences are superior for WMH depiction. Moreover, MIP algorithms allow easier analyses with similar results.

Análisis de la adecuación de las indicaciones clínicas en los estudios de neurorradiología / Analysis of the appropriateness of the clinical indications for neuroimaging studies

Objetivos. Conocer las indicaciones clínicas más frecuentes que dan lugar a las distintas pruebas diagnósticas en neurorradiología. Analizar para cada tipo de exploración la rentabilidad diagnóstica de la prueba solicitada según la indicación clínica. Cuantificar el número de exploraciones radiológicas adicionales generadas como consecuencia de la detección de patología en el estudio inicial o de la solicitud de una exploración inadecuada por parte del médico peticionario. Material y métodos. Se ha revisado la indicación clínica y el informe radiológico de las exploraciones de tomografía computarizada (TC) y resonancia magnética (RM) de cerebro, cabeza y cuello realizadas durante un período de 30 días en tres hospitales de nivel intermedio de similares características. Se contabilizan los estudios que presentan hallazgos patológicos y los normales. Se recogen aquellos casos que precisaron de algún estudio radiológico adicional. Resultados. La TC de cerebro y la RM cerebral son las exploraciones más solicitadas. En el área de neurología son la cefalea, el traumatismo craneoencefálico y el déficit neurológico agudo las indicaciones que justifican la mayoría de los estudios. En el área otorrinolaringológica, la pérdida de audición es la indicación de mayor demanda. El porcentaje de exploraciones patológicas oscila entre el 6 y el 71% según la indicación clínica. En un 3,5% de los casos se precisaron exploraciones radiológicas adicionales. Conclusiones. La mayoría de las exploraciones neurorradiológicas derivan de un grupo de indicaciones clínicas especialmente prevalentes; sin embargo, en muchos casos el grado de concordancia entre el diagnóstico clínico y el radiológico presenta un amplio margen de mejora (AU)

Objectives. To determine the most common clinical indications for different diagnostic neuroimaging tests. To analyze the diagnostic yield for each type of test in function of its clinical indication. To quantify the number of additional imaging tests generated as a consequence of pathological findings on the initial study or of the physician's requesting an inappropriate study. Material and methods. We reviewed the clinical indications and radiological report for computed tomography (CT) and magnetic resonance imaging (MRI) studies of the brain, head, and neck carried out during a 30-day period in three intermediate level hospitals with similar characteristics. We counted the studies with pathological findings and those with normal findings. We recorded cases that required additional imaging studies. Results. CT and MRI studies of the brain are the most frequently requested neuroimaging studies. The most common indications for examinations requested from the neurology department were headache, head trauma, and acute neurological deficit. The most common indication for examinations requested from the ear, nose, and throat department was hearing loss. The percentage of examinations with pathological findings ranged from 6% to 71% depending on the clinical indication. Additional imaging studies were necessary in 3.5% of the cases. Conclusions. Most neuroimaging studies are performed for especially prevalent clinical indications; however, in many cases the degree of concordance between the clinical and radiological diagnosis shows there is much room for improvement (AU)

Analysis of the appropriateness of the clinical indications for neuroimaging studies.

OBJECTIVES: To determine the most common clinical indications for different diagnostic neuroimaging tests. To analyze the diagnostic yield for each type of test in function of its clinical indication. To quantify the number of additional imaging tests generated as a consequence of pathological findings on the initial study or of the physician's requesting an inappropriate study. MATERIAL AND METHODS: We reviewed the clinical indications and radiological report for computed tomography (CT) and magnetic resonance imaging (MRI) studies of the brain, head, and neck carried out during a 30-day period in three intermediate level hospitals with similar characteristics. We counted the studies with pathological findings and those with normal findings. We recorded cases that required additional imaging studies. RESULTS: CT and MRI studies of the brain are the most frequently requested neuroimaging studies. The most common indications for examinations requested from the neurology department were headache, head trauma, and acute neurological deficit. The most common indication for examinations requested from the ear, nose, and throat department was hearing loss. The percentage of examinations with pathological findings ranged from 6% to 71% depending on the clinical indication. Additional imaging studies were necessary in 3.5% of the cases. CONCLUSIONS: Most neuroimaging studies are performed for especially prevalent clinical indications; however, in many cases the degree of concordance between the clinical and radiological diagnosis shows there is much room for improvement.

Solución del caso 17. Tumor neuroectodérmico primitivo de la pared torácica / No disponible

No disponible