title: Emergency Department MRI Scanning of Patients with Multiple Sclerosis: Worthwhile or Wasteful?
abstract: The increasing use of the emergency department MR imaging scanner at our institution raises questions about its added value to certain patient groups. We hypothesized that the use of emergency department MR imaging for identifying active demyelination in MS patients presenting with new neurologic symptoms would be of low yield.
  
  
  
  Electronic medical records were reviewed for patients with MS who had emergency department MR imaging scans for a suspected MS exacerbation between March 1, 2014, and March 1, 2016. Details surrounding patient disposition, imaging, diagnosis, and management were determined.
  
  
  
  Of 115 patients in our study, 48 (41.7%) were ultimately diagnosed with an MS exacerbation. Nearly all patients with MS exacerbations (87.5%, 42/48) had active demyelination on their emergency department MR imaging, identified on 30.6% (33/108) of brain MRIs and 20.4% (19/93) of spinal MRIs. The presence of active demyelination at MRI was significantly associated with the ultimate diagnosis of an MS exacerbation (P < .001). MR imaging activity isolated to the spinal cord (ie, not found on concurrent brain MR imaging) was present in only 9 of 93 (9.7%) cases. Pseudoexacerbations accounted for 18 of the alternative diagnoses.
  
  
  
  Emergency department MR imaging is a worthwhile endeavor from a diagnostic standpoint for MS exacerbations despite not being part of the diagnostic criteria. This finding has corresponding downstream impact on management decisions to admit and/or administer intravenous steroids. However, we raise the question of whether clinicians over-rely on emergency department imaging for making exacerbation diagnoses. Additionally, spinal MR imaging is of questionable value as an addition to brain MR imaging due to a low yield of isolated spinal disease.
authors.affiliation: From the Division of Neuroradiology (J.P., I.I., L.L., D.M.Y.), Russell H. Morgan Department of Radiology and Radiological Science.
authors.forename: J
authors.identifier: 0000-0003-0517-9583
authors.initials: J
authors.lastname: Pakpoor
authors.affiliation: Department of Neurology (D.S., E.M.M.), Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: D
authors.identifier: 0000-0002-9297-0244
authors.initials: D
authors.lastname: Saylor
authors.affiliation: From the Division of Neuroradiology (J.P., I.I., L.L., D.M.Y.), Russell H. Morgan Department of Radiology and Radiological Science.
authors.forename: I
authors.identifier: 0000-0002-9845-5171
authors.initials: I
authors.lastname: Izbudak
authors.affiliation: From the Division of Neuroradiology (J.P., I.I., L.L., D.M.Y.), Russell H. Morgan Department of Radiology and Radiological Science.
authors.forename: L
authors.identifier: 0000-0002-5054-2372
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Neurology (D.S., E.M.M.), Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: E M
authors.identifier: 0000-0003-0623-5188
authors.initials: EM
authors.lastname: Mowry
authors.affiliation: From the Division of Neuroradiology (J.P., I.I., L.L., D.M.Y.), Russell H. Morgan Department of Radiology and Radiological Science dyousem1@jhu.edu.
authors.forename: D M
authors.identifier: 0000-0002-1222-6643
authors.initials: DM
authors.lastname: Yousem
mesh_terms: D000328:Adult; D003711:Demyelinating Diseases / Q000000981:diagnostic imaging*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging*; D012189:Retrospective Studies