A Retrospective Chart Review of Clinical Characteristics and Magnetic Resonance Imaging Findings of Patients From a Psychiatric Facility in KwaZulu-Natal Province, South Africa

S Afr J Psychiatr. 2019 Nov 27;25(0):1387. doi: 10.4102/sajpsychiatry.v25i0.1387. eCollection 2019.

Abstract

Background: Many neurological conditions manifest with psychiatric symptoms and may be misdiagnosed. Structural neuroimaging, that is, computerised tomography (CT) and magnetic resonance imaging (MRI), can aid in the diagnosis or exclusion of these conditions. Magnetic resonance imaging is preferable in this regard, but is more expensive and less readily available than CT. The indications for requesting MRI in the clinical psychiatric setting remain poorly defined. All published literature on the clinical utility of neuroimaging in Africa is on CT scans.

Aim: The aim of this study was to describe the clinical characteristics and MRI findings in a cohort of patients presenting with psychiatric symptoms.

Setting: A specialist psychiatric training hospital, Townhill Hospital, in Pietermaritzburg, KwaZulu-Natal.

Methods: A retrospective chart review of all patients who underwent MRI between 01 October 2010 and 31 June 2016 was done. Magnetic resonance imaging findings were correlated with socio-demographic and clinical information, including psychiatric diagnosis, indication for MRI imaging and effect on clinical management.

Results: Fifty-three MRIs were performed. Thirty-three (62%) were abnormal. Patients with HIV, neurocognitive disorders, chronic mental illness and involuntary admission were more likely to have abnormal scans (83%, p = 0.089; 80%, p = 0.496; 71%, p = 0.089 and 79%, p = 0.021, respectively). The findings of 54% of abnormal MRIs (24% of all MRIs performed) resulted in referral to other disciplines. No statistically significant associations were found with socio-demographic or clinical factors.

Conclusion: Abnormalities on MRI scans in mentally ill patients were common and a quarter of patients required referral to other disciplines. Further studies are required to clarify the clinical utility of MRI in patients with psychiatric illness, which could assist in the development of a guide for the rational use of this modality in a resource-constrained environment.

Keywords: Africa; computerised tomography; magnetic resonance imaging; mental illness; structural neuroimaging.