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Evaluation of a Reduced MR Imaging Sequencing Protocol in Adult Patients with Stroke¹

¹ From the Mallinckrodt Institute of Radiology (A.J.J., D.K.K., M.M.B., M.H.G., B.C.P.L., C.J.M., F.J.W.), Department of Medicine (A.J.J., W.D.S., B.L.), and Division of Biostatistics (W.D.S.), Washington University School of Medicine, St Louis, Mo; the Department of Medicine, University of Vermont College of Medicine, Burlington (B.L.); and the Department of Radiology, University of Alabama at Birmingham (A.J.J.). Received April 12, 2000; revision requested June 5; revision received July 28; accepted August 29. Address correspondence to A.J.J., Indiana University Radiology Research Institute 714 N Senate Ave, 1st Floor, Indianapolis, IN 46202 (e-mail: annejohn@iupui.edu).

PURPOSE: To compare a reduced (three-sequence) magnetic resonance (MR) imaging protocol with a full (eight- to 10-sequence) MR imaging protocol in adults suspected of having stroke.

MATERIALS AND METHODS: Six neuroradiologists interpreted a consecutive sample of 265 MR images in patients suspected of having stroke. Each read reduced-protocol images in a discrete series of 40 patients (one read images in only 15) and corresponding full-protocol images 1 month later (reduced/full protocol). Five of the readers each read images in 10 additional cases, five each as full/full and reduced/reduced protocol controls. values between full and reduced protocols, reader assessment of protocol adequacy, confidence level, and need for additional sequences or examinations were evaluated.

RESULTS: In the reduced/full protocol, the value for detecting ischemia was 0.797; and that for detecting any clinically important abnormality, 0.635. Statistically similar values were found with the full/full control design ( = 0.802 and 0.715, respectively). The full protocol was judged more adequate than the reduced protocol (2.0 of 5.0 points vs 1.6, P < .001) and generated greater diagnostic confidence (8.6 of 10.0 points vs 8.9, P = .01), less need for additional sequences (2.7 of 6.0 points vs 1.5, P < .001), and more requests for additional examinations (28.4% vs 36.3%).

CONCLUSION: Disagreement between interpretations of reduced- and full-protocol images might be attributable to baseline-level intraobserver inconsistency, as demonstrated in control designs. A greater number of sequences did not lead to greater consistency.

Index terms: Brain, ischemia, 10.78 • Brain, MR, 10.121413, 10.121419

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