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Transcript of Pediatric brain MRI: Is axial T2-weighted imaging enough for a diagnosis? Matthias W. Wagner ¹,...
![Page 1: Pediatric brain MRI: Is axial T2-weighted imaging enough for a diagnosis? Matthias W. Wagner ¹, Marinos Kontzialis ¹, Daniel Seeburg ¹, Steven E. Stern.](https://reader035.fdocuments.in/reader035/viewer/2022081516/56649f285503460f94c41299/html5/thumbnails/1.jpg)
Pediatric brain MRI: Is axial T2-weighted imaging enough for a diagnosis?
Matthias W. Wagner ¹, Marinos Kontzialis ¹, Daniel Seeburg ¹, Steven E. Stern 2, Alexander Oshmyansky 1,2, Andrea Poretti ¹,
Thierry A.G.M. Huisman ¹¹Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan
Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; ²School of Mathematical Sciences, Faculty of Science and
Engineering, Queensland University of Technology, Brisbane, QLD, Australia
EP-144
ASNR 53rd Annual Meeting, Chicago, April 25-30, 2015
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Disclosure
We have nothing to disclose No relevant financial relations interfering
with the presentation
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Introduction↑ financial constraints in health care
need for rapid imaging protocols Our experience: T2w images most helpful in
children: ↑ water content of pediatric brain ↑ signal/noise + contrast/noise ratio↑ anatomical resolution + ↑ high sensitivity for
many pediatric brain diseases Consequently: T2w images ↑ potential for an
initial screening tool in pediatric neuroradiology
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Purpose
To determine the sensitivity and specificity of axial T2 weighted images in the evaluation of pediatric brain MRI studies
Axial T2 Full studyversus
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Inclusion criteria
1. Age at MRI < 18 years
2. Consecutively acquired head MRIs at the Johns Hopkins Hospital only
3. Studies with final diagnoses confirmed by neuroimaging, laboratory tests, genetic analysis, and/or pathology
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Methods 1
1. Evaluation of axial T2 weighted images alone first diagnosis noted
2. Without time lapse: Evaluation of the full study second diagnosis notedDiagnoses noted as “normal” or “abnormal”Calculation of sensitivity and specificity for abnormal studies
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Methods 2 Standard of reference: final report of neuroradiology
attendings as available in the PACS
Three readers with different levels of experience Reader 1: 20 years pediatric neuroradiology Reader 2: neuroradiology fellow Reader 3: 4th year radiology resident
Readers were blinded for clinical diagnoses and study indication
161 children (6 children scanned twice) 167 studies per reader
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Results 1
Mean age of children: 7.44 ± 5.71 years
Standard of reference: 91 studies “abnormal” 76 studies “normal” Normal study: absence of any pathology
except sinus / mastoid effusion
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Results 2
All readers T2 Full study p-Value
Specificity 92.1% 90.4% 0.343
Sensitivity 83.2% 92.3% <0.001
NPV 82.0% 90.7%
PPV 92.7% 92.0%
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Results 3Individually T2 Full study p-Value
Reader 1(20 years)
Specificity 92.1% 93.4% 1.00
Sensitivity 87.9% 94.5% 0.041NPV 86.4% 93.4%
PPV 93.0% 94.5%
Reader 2(2 years)
Specificity 92.1% 92.1% 1.00
Sensitivity 84.6% 93.4% 0.013NPV 83.3% 92.1%
PPV 92.8% 93.4%
Reader 3(4th year resident)
Specificity 92.1% 85.5% 0.131
Sensitivity 76.9% 89.0% 0.003NPV 76.9% 86.7%
PPV 92.1% 88.0%
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Results 4
3 groups of false negative studies:
1. Group 1: lack of an additional plane Sagittal: Chiari 1 / hypoplastic corpus callosum
2. Group 2: lack of additional sequences DWI: acute stroke SWI/T2*: blood products
3. Group 3: limited reader experience
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False negatives on axial T2 Group 1: additional plane
Chiari malformation type 1Sagittal T1w
Tonsillar herniationAxial T2w
“Unremarkable”
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False negatives on axial T2 Group 2: additional sequences
Hemorrhagic diffuse axonal injuryAxial T2*w
Hypointense lesionsAxial T2w
Unremarkable
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False negatives on axial T2 Group 3: reader experience
Axial T2w: moyamoya disease
Axial T2w: systemic lupus with cerebral atrophy
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Results 5
Classification of 14 clinical indications in 2 groups: Group 1: acute clinical findings potentially immediate
consequences for patient care Group 2: non-acute clinical indications
4 false negative diagnoses in Group 1 (acute stroke, diffuse axonal injury, intraaxial hemorrhage)
2 non-acute clinical indications without misread on axial T2-screening (including >1 study):
1. Question of malformation 2. Follow-up for hypoxic-ischemic encephalopathy (HIE)
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Studies divided by indicationNumber of
studiesFalse negative studies on axial T2 only
Reader 1 Reader 2 Reader 3
Group 1: Acute clinical indication 191. Question of stroke 8 0 0 12. Question of tumor 7 0 0 03. Trauma 4 3 1 2
Group 2: Non-acute clinical indication 1484. Non-acute neurological findings 34 0 1 35. Tumor follow-up 26 3 4 46. Seizure correlate 19 1 3 37. Question of malformation 18 0 0 08. Malformation follow-up 18 2 2 49. Phakomatosis follow-up 12 2 2 210. Developmental delay 11 1 1 111. HIE follow-up 7 0 0 012. Infectious disease follow-up 1 0 0 013. Question of phakomatosis 1 0 0 014. Stroke follow-up 1 0 0 0
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Conclusion 1
1a. Axial T2-weighted images alone can identify abnormal studies with high reliability
1b. High level of experience further increases sensitivity and specificity
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Conclusion 22a. False negative results make introduction of
solitary axial T2-screening currently unfeasible
2b. Additional DWI + SWI sequences to a 3D- T2w sequence: ↑ imaging time, but still faster than standard protocols possible new screening tool in children with neurologic symptoms (as alternative to CT)