School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Department of Radiology, University of Colorado Hospital, Aurora, Colorado, USA.
J Neuroimaging. 2021 Sep;31(5):874-878. doi: 10.1111/jon.12897. Epub 2021 Jun 10.
The diagnostic utility of contrast MR-imaging in adult new-onset seizures without clinically suspected neoplasia or infection is not well defined in the literature. Imaging guidelines consider both contrast and noncontrast MR-imaging examinations appropriate in this clinical scenario. The purpose of this study was to evaluate the utility of contrast MR-sequences in evaluation of seizure in patients without suspicion for neoplasia or infection.
Imaging and clinical data were reviewed for 103 consecutive patients admitted for phase-1 seizure monitoring with the following criteria: (1) MRI-brain performed with/without intravenous contrast; (2) no clinical suspicion for central nervous system (CNS) infection; and (3) no history of CNS neoplasia, or suspected metastatic disease. Readers designated cases as lesional or nonlesional. Lesional cases were further categorized as either visualized on noncontrast sequences only, contrast sequences only, or both.
29/103 (28%) patients had epileptogenic lesions, 74/103 (72%) were nonlesional studies. 29/29 (100%) lesional abnormalities were detected on noncontrast sequences (sensitivity 100% [95 confidence interval (CI): 88-100], specificity 100% [95 CI: 95-100]). 23/29 (79.3%) lesional cases were visualized on both noncontrast and postcontrast sequences. 6/29 (20.7%) were visualized only on noncontrast sequences. No lesional cases were detected exclusively on postcontrast MR sequences. With an observed nonlesional extraneous contrast MR-imaging rate of 72%, estimated excess cost of contrast MR-imaging per 1000 patients using Medicare data was $103,680 USD.
Contrast MR-imaging has limited diagnostic utility in initial screening of adult new-onset seizure patients without clinically suspected neoplasia or infection. More judicious use of contrast MR-imaging in this patient population may reduce unnecessary exposure to gadolinium and lower associated healthcare costs.
在没有临床怀疑肿瘤或感染的成人新发癫痫患者中，对比磁共振成像的诊断效用在文献中尚未明确界定。影像学指南认为，在这种临床情况下，对比和非对比磁共振成像检查都是合适的。本研究的目的是评估对比磁共振序列在没有肿瘤或感染临床怀疑的患者中评估癫痫发作的效用。
回顾了 103 例连续患者的影像学和临床数据，这些患者因进行 1 期癫痫监测而入院，符合以下标准：（1）进行了脑部磁共振成像检查，包括或不包括静脉内对比剂；（2）无中枢神经系统（CNS）感染的临床怀疑；（3）无 CNS 肿瘤史，或疑似转移性疾病。读者指定病例为病变或非病变。病变病例进一步分为仅在非对比序列上可见、仅在对比序列上可见或两者都可见。
103 例患者中，29 例（28%）有癫痫病灶，74 例（72%）为非病变研究。29 例（100%）病变异常均在非对比序列上检测到（敏感性 100%[95%置信区间（CI）：88-100]，特异性 100%[95%CI：95-100]）。29 例病变病例中有 23 例（79.3%）在非对比和对比后序列上均可见。6 例（20.7%）仅在非对比序列上可见。没有病变病例仅在对比后磁共振序列上检测到。根据 Medicare 数据，观察到非病变的额外对比磁共振成像率为 72%，估计每 1000 例患者使用对比磁共振成像的额外费用为 103680 美元。
在没有临床怀疑肿瘤或感染的成人新发癫痫患者的初步筛查中，对比磁共振成像的诊断效用有限。在这种患者人群中更明智地使用对比磁共振成像可能会减少不必要的钆暴露，并降低相关的医疗保健成本。
