Published March 18, 2021 as 10.3174/ajnr.A7065 LETTERS he use of rapid MRI techniques to avoid CT in patients with aware of the utility of rapid MRI techniques and encourage work- Tindwelling shunt catheters is a well-known means of reducing flow strategies that allow for fast MRI to be performed emer- radiation exposure to a vulnerable population. Fast MRIs of the gently, especially because these patients are often subject to brain avoid the risks related to sedation, can be accomplished multiple imaging examinations to evaluate these devices. This quickly, and provide a sensitive means to assess ventricular size. In may serve as an opportunity to create MRI volume overnight, 2012, Koral et al estimated that the use of fast MRI of the brain which can justify staffing of MRI personnel during an era in instead of standard CT could prevent 1 excess fatal cancer per 97 which hospitals are increasingly demanding extended coverage pediatric patients. for radiology services. If the fast MRI is the most appropriate test Ordering providers and radiology departments may fail to pro- for a patient, and the patient needs the examination emergently, mote the use of this technique for patients requiring emergent then it seems reasonable to ensure that the patient has access to shunt evaluation despite this benefit, as CT is simply faster and that examination. more convenient. At the institution described by Koral et al, 86% of the 679 fast brain MRIs ordered for ventricular size evaluation in REFERENCE 2016 were performed on an outpatient basis, while only 3% were 1. Koral K, Blackburn T, Bailey AA, et al. Strengthening the argument orderedbythe emergencydepartment, and22 patients receivedat for rapid brain MR imaging: estimation of reduction in lifetime least 5 head CTs for shunt evaluation during the year. During the attributable risk of developing fatal cancer in children with same year, the emergency department requested 71% of the 502 shunted hydrocephalus by instituting a rapid brain MR imaging head CTs performed for shunt evaluation, even though 90% of the protocol in lieu of head CT. AJNR Am J Neuroradiol 2012;33:1851– CTs were ordered during a shift when an MRI technologist was 54 CrossRef Medline available on site. This means that the cancer-reducing benefit of the C.M. Pfeifer fast brain MRI was rarely realized by patients presenting to the N. Karbhari emergency department with a need for shunt evaluation. Department of Radiology While it is unlikely that fast MRIs for ventricle evaluation will University of Texas Southwestern Medical Center Dallas, Texas replace CT entirely, radiologists should ensure that providers are http://dx.doi.org/10.3174/ajnr.A7065 AJNR Am J Neuroradiol : 2021 www.ajnr.org 1 Copyright 2021 by American Society of Neuroradiology.
American Journal of Neuroradiology – American Journal of Neuroradiology
Published: Mar 18, 2021
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