Follow-Up of Emergency Department MRI Scans Suggesting New Diagnosis of CNS Demyelination

AJR Am J Roentgenol. 2017 Jul;209(1):171-175. doi: 10.2214/AJR.16.17279. Epub 2017 May 2.

Abstract

Objective: The literature has shown that new cases of multiple sclerosis (MS) can be missed in the emergency department (ED), causing unnecessary delays for patients. In 2012, an MRI scanner was introduced into the ED of our institution. This study examines the potential value of the radiologists' MRI reports for patients with previously undiagnosed MS who presented to the ED.

Materials and methods: In this retrospective study, electronic medical records were reviewed for patients without a prior diagnosis of a demyelinating disorder, who underwent imaging on the ED's MRI scanner between March 1, 2014, and March 1, 2016, and for whom the radiologist reported a possible demyelinating disorder.

Results: Patient encounters of 61 women and 31 men (mean age, 41.2 years) met the inclusion criteria. In 48 of 92 (52.2%) cases where the radiology report suggested a demyelinating diagnosis, the patient was also given such a diagnosis as the final outcome. Where a demyelinating disorder was placed as the only, first, second, or third (or later) differential diagnosis, the final diagnosis was concordant with demyelination in 84.3% (43/51), 37.5% (3/8), 18.2% (2/11), and 0% (0/22) of cases, respectively (p < 0.01).

Conclusion: Radiologist-suggested demyelinating disease as the top differential diagnosis after MRI showed a high concordance rate with demyelinating disease being the final diagnosis. Scans in the ED for neurologic deficits can lead to early guidance for a diagnosis of demyelination to be made. Downstream effects may include reduced admission rates, avoidance of unnecessary use of other procedures, and early commencement of disease-modifying therapy.

Keywords: MRI; emergency department; multiple sclerosis.

MeSH terms

  • Adult
  • Contrast Media
  • Diagnosis, Differential
  • Emergency Service, Hospital
  • Female
  • Humans
  • Magnetic Resonance Imaging / methods*
  • Male
  • Multiple Sclerosis / diagnostic imaging*
  • Retrospective Studies

Substances

  • Contrast Media