Identification of White Matter Hyperintensities in Routine Emergency Department Visits Using Portable Bedside Magnetic Resonance Imaging
Year: 2023
Type: article
Study design: Observational Study
Abstract: Background 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. Methods and Results 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%). Conclusions 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.
Authors: Adam de Havenon, Nethra R. Parasuram, Anna L. Crawford, Mercy H. Mazurek, Isha R. Chavva, Vineetha Yadlapalli, Juan E. Iglesias, Matthew S. Rosen, Guido J. Falcone, Seyedmehdi Payabvash, Gordon Sze, Richa Sharma, Steven J. Schiff, Basmah Safdar, Charles Wira, William T. Kimberly, Kevin N. Sheth
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,700
Funders: American Heart Association, Bristol-Myers Squibb, Massachusetts General Hospital, Yale University, Biogen, Massachusetts Institute of Technology, Harvard University, TG Therapeutics, NGM Biopharmaceuticals, University College London, Novo Nordisk, Centre d'Imagerie BioMédicale, National Institutes of Health, Genentech, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Department of Physics, Harvard University, National Institute of Nursing Research, National Institute of Allergy and Infectious Diseases, National Institute of Neurological Disorders and Stroke, National Institute of Biomedical Imaging and Bioengineering, National Center for Advancing Translational Sciences, National Institute on Minority Health and Health Disparities, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: G1044130170, Metabolomic predictors of stroke in REGARDS, G1993194669, G2145263961, G4955396203, G6230834768, G6267479181, The Recovery in Stroke Using PAP (RISE UP) Study, Treatment Targets for Inflamed Intracranial Atherosclerosis on Vessel Wall MRI, Yale Clinical Site: Investigations For Improved Neurological Treatments at Yale (INFINITY), G8257205859, Intensive Blood Pressure Reduction in Deep Intracerebral Hemorrhage, Portable, Low Field Brain Magnetic Resonance Imaging (MRI) for Acute Stroke, Yale Clinical and Translational Science Award, G925120733
OpenAlex ID: W4377564018