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The value of neuroimaging team meetings for patients in a district general hospital

Mark McCarron, Carrie Wade, Peter Flynn and Ferghal McVerry
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DOI: https://doi.org/10.7861/clinmedicine.18-3-206
Clin Med June 2018
Mark McCarron
AAltnagelvin Hospital, Derry, UK
Roles: consultant neurologist
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  • For correspondence: markmccarron@doctors.org.uk
Carrie Wade
BAltnagelvin Hospital, Derry, UK
Roles: medical secretary
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Peter Flynn
CRoyal Victoria Hospital, Belfast, UK
Roles: consultant neuroradiologist
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Ferghal McVerry
DAltnagelvin Hospital, Derry, UK
Roles: consultant neurologist
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  • Fig 1.
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    Fig 1.

    Examples of clinically important missed lesions and misinterpreted lesions. (a) CT scan of brain showing left Virchow Robin space, which was misinterpreted as a lacunar infarct. (b) MRI of brain with subdural collections (b1, which was identified in the initial report) and sagging of the brainstem (b2, not identified) suggesting intracranial hypotension. (c) MRI of brain right hemisphere gyrus with signal change of unclear significance (c1) that enlarged over 4 years (c2), making low-grade tumour the probable diagnosis. The enlargement had not been recognised. (d) MRI brain showing decussation of the superior cerebellar peduncles, which was misinterpreted as a midbrain infarct. (e) Right frontal low signal on gradient echo MRI of brain consistent with contusion but misinterpreted as a cavernoma. Clinically important lesions missed on initial reports included (f) right cerebellar stroke, (g) cerebral venous sinus thrombosis showing absence of contrast at the ­confluence of the venous sinuses, (h) torcula meningioma and (i) a spinal cord lesion at T1–2 consistent with demyelination. CT = computed tomography; MRI = magnetic resonance imaging

  • Fig 2.
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    Fig 2.

    Temporal changes over four years in: (a) all neuroimaging discrepancies; (b) clinically important neuroimaging discrepancies; and (c) the frequency of neuroimaging recommendations for further investigation with 95% confidence intervals.

Tables

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    Table 1.

    Frequency and classification of agreement and discrepancies in neuroimaging

    Discrepancy categoryDefinition of discrepancy categoryNumber of studies N=562 (%)
    1Agreement – no discrepancy396 (70.5)
    2Failure to detect a clinically unimportant abnormality38 (6.7)
    3Misinterpreting a clinically unimportant abnormality22 (3.9)
    4Failure to detect a clinically important abnormality47(8.3)
    5Misinterpreting a clinically important abnormality59 (10.5)
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    Table 2.

    Aetiology of agreement and discrepancy scan reports

    Radiological findingTotalAgreement/discrepancy frequencies
    1234 54 and 5 (%)
    Vascular179127126241034 (19%)
    Normal746115257 (9%)
    Miscellaneous73514331215 (21)
    Neoplastic4733115712 (26)
    Congenital472993246 (13)
    Demyelinating4227314711 (26)
    Trauma201420224 (20)
    Degenerative disc232010022 (9)
    Neurodegenerative211060325 (24)
    Inflammatory201111257 (35)
    Infection131100022 (15)
    Postoperative3201000 (0)
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The value of neuroimaging team meetings for patients in a district general hospital
Mark McCarron, Carrie Wade, Peter Flynn, Ferghal McVerry
Clinical Medicine Jun 2018, 18 (3) 206-211; DOI: 10.7861/clinmedicine.18-3-206

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The value of neuroimaging team meetings for patients in a district general hospital
Mark McCarron, Carrie Wade, Peter Flynn, Ferghal McVerry
Clinical Medicine Jun 2018, 18 (3) 206-211; DOI: 10.7861/clinmedicine.18-3-206
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