title: Routine Cross-Sectional Head Imaging Before Electroconvulsive Therapy: A Tertiary Center Experience.
abstract: OBJECTIVE
  Electroconvulsive therapy (ECT) is generally contraindicated in patients with intracranial mass lesions or in the presence of increased intracranial pressure. The purpose of this study was to determine the prevalence of incidental abnormalities on routine cross-sectional head imaging, including CT and MRI, that would preclude subsequent ECT.
  
  
  METHODS
  This retrospective study involved a review of the electronic medical records of 105 patients (totaling 108 imaging studies) between April 27, 2007, and March 20, 2015, referred for cranial CT or MRI with the primary indication of pre-ECT evaluation. The probability of occurrence of imaging findings that would preclude ECT was computed. A cost analysis was also performed on the practice of routine pre-ECT imaging.
  
  
  RESULTS
  Of the 105 patients who presented with the primary indication of ECT clearance (totaling 108 scans), 1 scan (0.93%) revealed findings that precluded ECT. None of the studies demonstrated findings that indicated increased intracranial pressure. A cost analysis revealed that at least $18,662.70 and 521.97 relative value units must be expended to identify one patient with intracranial pathology precluding ECT.
  
  
  CONCLUSIONS
  The findings of this study demonstrate an extremely low prevalence of findings that preclude ECT on routine cross-sectional head imaging. The costs incurred in identifying a potential contraindication are high. The authors suggest that the performance of pre-ECT neuroimaging be driven by the clinical examination.
authors.affiliation: University of Maryland Medical Center, Baltimore, Maryland.
authors.forename: Payam I
authors.initials: PI
authors.lastname: Sajedi
authors.affiliation: University of Maryland Medical Center, Baltimore, Maryland.
authors.forename: Jason
authors.initials: J
authors.lastname: Mitchell
authors.affiliation: University of Maryland Medical Center, Baltimore, Maryland.
authors.forename: Edward H
authors.initials: EH
authors.lastname: Herskovits
authors.affiliation: University of Maryland Medical Center, Baltimore, Maryland. Electronic address: praghavan@umm.edu.
authors.forename: Prashant
authors.initials: P
authors.lastname: Raghavan
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging; D001927:Brain Diseases / Q000000981:diagnostic imaging* / Q000191:economics* / Q000453:epidemiology; D000075202:Contraindications; D003955:Diagnostic Tests, Routine / Q000191:economics* / Q000379:methods; D004565:Electroconvulsive Therapy / Q000191:economics*; D005260:Female; D006257:Head; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000191:economics; D008297:Male; D008396:Maryland / Q000453:epidemiology; D001523:Mental Disorders / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers / Q000191:economics*; D014057:Tomography, X-Ray Computed / Q000191:economics
keywords: Electroconvulsive therapy; cost analysis; diagnostic yield; pre-electroconvulsive therapy evaluation; routine head imaging