Identification of White Matter Hyperintensities in Routine Emergency Department Visits Using Portable Bedside Magnetic Resonance Imaging.
Identification of White Matter Hyperintensities in Routine Emergency Department Visits Using Portable Bedside Magnetic Resonance Imaging.
复制标题
使用便携式床旁磁共振成像识别常规急诊科就诊中的白色高信号。
DOI：
10.1161/jaha.122.029242
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发表时间：
2023-06-06
影响因子：
5.4
通讯作者：
Sheth, Kevin N. N.
中科院分区：
文献类型：
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作者：
de Havenon, Adam;Parasuram, Nethra R. R.;Crawford, Anna L. L.;Mazurek, Mercy H. H.;Chavva, Isha R. R.;Yadlapalli, Vineetha;Iglesias, Juan E. E.;Rosen, Matthew S. S.;Falcone, Guido J. J.;Payabvash, Seyedmehdi;Sze, Gordon;Sharma, Richa;Schiff, Steven J. J.;Safdar, Basmah;Wira, Charles;Kimberly, William T. T.;Sheth, Kevin N. N.
脑磁共振成像（MRI）上的白色高信号（WMH）与血管性认知障碍、心血管疾病和中风相关。我们假设便携式磁共振成像（pMRI）可以成功地识别WMH，并在非常规环境中促进这样做。在一项回顾性队列研究中，我们报告了使用Cohen kappa（κ）来衡量检测中重度WMH（Fazekas ≥ 2）的一致性。在随后的前瞻性观察性研究中，我们招募了在急诊室接受非卒中投诉评估的具有血管危险因素的成人患者，并使用pMRI测量WMH。在回顾性队列中，我们纳入了33例患者，在常规MRI上确定了16例（49.5%）WMH。在评价pMRI的2名评定者之间，WMH的评定者间一致性较强（κ = 0.81），常规MRI的1名评定者与pMRI的2名评定者之间，模态间一致性中等（κ = 0.66，0.60）。在前瞻性队列中，我们招募了91名个体（平均年龄62.6岁; 53.9%为男性; 73.6%患有高血压），其中58.2%在pMRI上患有WMH。在37名黑人和西班牙裔个体中，区域痴呆指数较高（与白色相比，51.8 ± 12.9比37.9 ± 11.9; P <0.001）。在前一年没有接受标准护理MRI的81名患者中，我们在81名患者中发现了43名（53.1%）WMH。便携式低场成像可用于识别中度至重度WMH。这些初步结果介绍了一个新的作用，急性护理以外的pMRI和pMRI的潜在作用，以减少神经影像学的差异。
White matter hyperintensity (WMH) on magnetic resonance imaging (MRI) of the brain is associated with vascular cognitive impairment, cardiovascular disease, and stroke. We hypothesized that portable magnetic resonance imaging (pMRI) could successfully identify WMHs and facilitate doing so in an unconventional setting. In a retrospective cohort of patients with both a conventional 1.5 Tesla MRI and pMRI, we report Cohen's kappa (κ) to measure agreement for detection of moderate to severe WMH (Fazekas ≥2). In a subsequent prospective observational study, we enrolled adult patients with a vascular risk factor being evaluated in the emergency department for a nonstroke complaint and measured WMH using pMRI. In the retrospective cohort, we included 33 patients, identifying 16 (49.5%) with WMH on conventional MRI. Between 2 raters evaluating pMRI, the interrater agreement on WMH was strong (κ=0.81), and between 1 rater for conventional MRI and the 2 raters for pMRI, intermodality agreement was moderate (κ=0.66, 0.60). In the prospective cohort we enrolled 91 individuals (mean age, 62.6 years; 53.9% men; 73.6% with hypertension), of which 58.2% had WMHs on pMRI. Among 37 Black and Hispanic individuals, the Area Deprivation Index was higher (versus White, 51.8±12.9 versus 37.9±11.9; P<0.001). Among 81 individuals who did not have a standard‐of‐care MRI in the preceding year, we identified WMHs in 43 of 81 (53.1%). Portable, low‐field imaging could be useful for identifying moderate to severe WMHs. These preliminary results introduce a novel role for pMRI outside of acute care and the potential role for pMRI to reduce disparities in neuroimaging.