Can multicontrast ultrafast brain MRI assist residents to triage intracranial emergencies with structured reporting?

Purpose: Multicontrast ultrafast MRI brain is increasingly explored to triage acute intracranial emergencies. Since residents are at the forefront of emergency radiology in academic centers, it is critical to understand the suitability of ultrafast MRI for resident trainees. Further, structured radiology reportings have found foothold to communicate to the referring services and it will be beneficial to understand the capability of ultrafast MRI to facilitate such a structured reporting.

Methods: A retrospective analysis of 104 cases with multicontrast ultrafast MRI was performed in inpatient and emergency settings. Images were assessed independently by blinding to all charts by a second-year diagnostic radiology resident and a board-certified neuroradiology attending with over 20 years of experience. Fifteen anatomical variables were evaluated to emulate the structured reporting used in standard MRI brain studies. Clinical summary at discharge served as the reference standard to correlate the presence of acute intracranial emergency on ultrafast MRI.

Results: Inter-rater agreements for fifteen imaging variables ranged between 0.33 to 0.74 and Cohen's kappa of 0.92 (p < .001) to triage acute emergency. Percentage agreement for six anatomical landmarks ranged from 98 to 100%. The accuracy to distinguish acute from non-acute conditions was 96.2% for the resident and 99% for the experienced reviewer.

Conclusions: Multicontrast ultrafast MRI brain shows promise to triage acute intracranial emergencies with resident-level training. It can facilitate structured analysis of a majority of anatomical landmarks.