title: Optimal brain MRI protocol for new neurological complaint.
abstract: OBJECTIVE
  Patients with neurologic complaints are imaged with MRI protocols that may include many pulse sequences. It has not been documented which sequences are essential. We assessed the diagnostic accuracy of a limited number of sequences in patients with new neurologic complaints.
  
  
  METHODS
  996 consecutive brain MRI studies from patients with new neurological complaints were divided into 2 groups. In group 1, reviewers used a 3-sequence set that included sagittal T1-weighted, axial T2-weighted fluid-attenuated inversion recovery, and axial diffusion-weighted images. Subsequently, another group of studies were reviewed using axial susceptibility-weighted images in addition to the 3 sequences. The reference standard was the study's official report. Discrepancies between the limited sequence review and the reference standard including Level I findings (that may require immediate change in patient management) were identified.
  
  
  RESULTS
  There were 84 major findings in 497 studies in group 1 with 21 not identified in the limited sequence evaluations: 12 enhancing lesions and 3 vascular abnormalities identified on MR angiography. The 3-sequence set did not reveal microhemorrhagic foci in 15 of 19 studies. There were 117 major findings in 499 studies in group 2 with 19 not identified on the 4-sequence set: 17 enhancing lesions and 2 vascular lesions identified on angiography. All 87 Level I findings were identified using limited sequence (56 acute infarcts, 16 hemorrhages, and 15 mass lesions).
  
  
  CONCLUSIONS
  A 4-pulse sequence brain MRI study is sufficient to evaluate patients with a new neurological complaint except when contrast or angiography is indicated.
authors.affiliation: Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: William A
authors.initials: WA
authors.lastname: Mehan
authors.affiliation: Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: R Gilberto
authors.initials: RG
authors.lastname: González
authors.affiliation: Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Bradley R
authors.initials: BR
authors.lastname: Buchbinder
authors.affiliation: Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: John W
authors.initials: JW
authors.lastname: Chen
authors.affiliation: Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: William A
authors.initials: WA
authors.lastname: Copen
authors.affiliation: Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Hirsch
authors.affiliation: Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: George J
authors.initials: GJ
authors.lastname: Hunter
authors.affiliation: Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Scott
authors.initials: S
authors.lastname: Hunter
authors.affiliation: Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Johnson
authors.affiliation: Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Hillary R
authors.initials: HR
authors.lastname: Kelly
authors.affiliation: Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Mykol
authors.initials: M
authors.lastname: Larvie
authors.affiliation: Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Lev
authors.affiliation: Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Pomerantz
authors.affiliation: Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Otto
authors.initials: O
authors.lastname: Rapalino
authors.affiliation: Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Sandra
authors.initials: S
authors.lastname: Rincon
authors.affiliation: Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Javier M
authors.initials: JM
authors.lastname: Romero
authors.affiliation: Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Pamela W
authors.initials: PW
authors.lastname: Schaefer
authors.affiliation: Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Vinil
authors.initials: V
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001933:Brain Stem / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003710:Demography; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000473:pathology; D055815:Young Adult