The misinterpretation rates of radiology residents on emergent neuroradiology magnetic resonance (MR) angiogram studies: correlation with level of residency training.

The purpose of this study was to determine the discrepancy rates of radiology residents interpreting emergent neck and Circle of Willis magnetic resonance angiography (MRA) studies and to detect any adverse clinical outcomes. Three hundred seventeen MRA studies given preliminary reading by radiology residents were retrospectively reviewed over a 2-year period. Discrepancies were classified as either false negatives (failure to diagnose abnormalities) or false positives (misinterpreting normal scans as abnormal). The overall discrepancy rate was 12.1% for Circle of Willis MRA and 7.9% for neck MRA. Fourth-year residents had the lowest discrepancy rates (7.7%), but this was not statistically significant. The most common misses were stenosis greater than 70% (n = 9) and aneurysm (n = 12). No adverse clinical outcome was detected mainly due to rapid turnaround time for final reporting.

Discrepancy rates of on-call radiology residents' interpretations of CT angiography studies of the neck and circle of Willis.

OBJECTIVE: The purpose of our study was to determine the discrepancy rates of radiology residents' interpretations of emergent CT angiography (CTA) studies of the neck and circle of Willis and to assess any adverse clinical outcomes. MATERIALS AND METHODS: Five hundred thirty-eight CTA studies (287 circle of Willis and 251 neck) ordered emergently after hours and given preliminary readings by radiology residents from January 1, 2006, through December 31, 2007, were retrospectively reviewed. Discrepancies between the interpretations of radiology residents and the final reports of neuroradiology attending physicians were classified as either false-negatives (failure to recognize abnormalities) or false-positives (misinterpreting normal scans as abnormal). Discrepancies that could affect patient care or clinical care were considered major. RESULTS: Overall, the discrepancy rate was 13.6% for circle of Willis CTA and 13.5% for neck CTA. The misinterpretation rate of first-year residents was 19.5%, which was statistically significant compared with more senior-level residents (p = 0.05). There were 57 false-negative interpretations. The most common misses were stenosis greater than 50% (n = 16) and aneurysm (n = 15), and the most common false-positive was overcalling a potential intracranial aneurysm (n = 7). No adverse clinical outcomes were detected. CONCLUSION: The discrepancy rate between interpretations by on-call radiology residents and attending physicians of neuroradiology CTA studies was higher than expected at 13.6%, with a statistically significant greater miss rate among the most junior residents, which may be mitigated by recent changes with respect to the radiology residents' overnight call. No adverse clinical outcome was detected.

Serial follow-up MRI of indeterminate cystic lesions of the pineal region: experience at a rural tertiary care referral center.

OBJECTIVE: The purpose of this study was to retrospectively assess the outcomes of temporal MRI follow-up of indeterminate cystic lesions of the pineal region. MATERIALS AND METHODS: Cases of indeterminate pineal lesions were identified by a computerized search of radiology reports at our institution from 1998 to 2007. Twenty-six indeterminate pineal lesions, one each in 26 patients (six males and 20 females), were followed in the current study. Cases were included in the study if the radiology report detailed an incidentally noted but indeterminate or worrisome cystic lesion of the pineal region and if temporal follow-up MRI was recommended by the interpreting neuroradiologist. For a case to be included in our data set, a follow-up MRI study must have been obtained at least 6 months after the initial study. RESULTS: Follow-up imaging ranged from 7 months to 8 years. Lesions ranged in description and appearance from "probable benign cyst" with typical cystic imaging features to "pineal mass" with features of solid enhancement. We found that, within the limitations of the technique, there were no significant changes in the size or character of any indeterminate pineal region lesion followed at our institution over the time interval of 1998-2007. CONCLUSION: In our study, all pineal lesions found incidentally and for which follow-up imaging had been recommended were stable over time. These data suggest that neoplastic lesions of the pineal region either are too rare or grow too slowly to be identified by traditional temporal imaging follow-up. With increasing interest in optimal allocation of health care resources, our findings suggest that incidentally identified pineal region cystic lesions, both typical and atypical, can be followed clinically.