Interpretation of magnetic resonance imaging in the chronic phase of traumatic brain injury: what is missed in the original reports?

PRIMARY OBJECTIVE: To find eventual differences in detecting the late stage TBI findings in MRI between two neuroradiologists and to compare the results with the original reports. METHODS AND PROCEDURE: Two neuroradiologists with different levels of experience (R1 and R2) reviewed 89 cranial 1.5 T MRI examinations of patients with clinically evident TBI. They recorded the nature, location and side of the finding and stated their view of traumatic axonal injury (TAI). The original reports were reviewed accordingly. MAIN OUTCOMES AND RESULTS: TAI was reported as being evident or possible in 51 patients with TBI. However, only 30 (76%) of these concerned the same patients. R1 reported more contusion findings, but both found the same number of spot-like haemorrhages. The most striking difference was in the reporting of localized atrophy. R1 reported atrophy in 51/178 (29%) frontal lobes, whereas R2 in 14/178 (8%). Many of the findings were missed in the original reports. CONCLUSIONS: The interpretation of TBI findings in late stage MRI yields significant variability between neuroradiologists. This may endanger diagnostics and lead to false treatment decisions and medico-legal problems. Standardized quantitative imaging analysis programs and advances in MRI technology should be utilized to improve radiological TBI diagnosis.

Reliability of diagnosis of traumatic brain injury by computed tomography in the acute phase.

The purpose of our study was to determine the accuracy and reliability of the computed tomographic (CT) diagnosis of acute traumatic brain injury (TBI) and to evaluate the inter-observer variation of CT reports of acute TBI between two experienced neuroradiologists and a neuroradiologist in training. One hundred cranial CT examinations of suspected TBI were chosen randomly from those taken during 1 year at a university central hospital, with institutional ethics committee approval. Two neuroradiologists and one neuroradiologist in training read the scans independently and were blinded to the clinical data. The original reports of radiologists on call, who were either radiology residents or general radiologists, were reviewed. Main outcome measures were false-positive and false-negative findings, and the congruency of different readers' reports. The reference standard was a group consensus formed by three neuroradiologists. Radiologists on call missed a significant number of brain contusions (67%), but with regard to intraventricular and subarachnoid hemorrhages and edema, their accuracy was moderate. They reported practically no false-positive brain contusion findings, and all readers found subdural hemorrhages reliably. The two experienced neuroradiologists had the smallest number of false-negative findings, but their reports differed significantly. Of the other neuroradiologists' mistakes, 75% were false-positive, nearly all of these concerning contusions, whereas the other made random mistakes. In conclusion, there was a marked variation between readers in the detection of brain contusion findings on acute brain CT. Experience increased accuracy, yet even between the reports of the most experienced readers, there were marked differences.