Visa Opportunities for International Medical Graduates Applying for U.S. Academic Radiology Department Faculty Positions: A National Survey.

BACKGROUND. International medical graduates (IMGs) are a source of physicians who could help alleviate radiologist workforce shortages in the United States. However, IMGs may face barriers in obtaining appropriate visas (e.g., H-1B or O-1 visas) to allow faculty employment. OBJECTIVE. The purpose of this study was to assess the policies and experiences of U.S. academic radiology departments in offering visas to IMGs applying for faculty positions. METHODS. A web-based survey on policies and experiences in offering visas to IMG faculty candidates was distributed to chairs of U.S. radiology departments with a diagnostic radiology training program recognized by the National Resident Matching Program. Individual survey questions were optional. The initial survey and subsequent reminders were sent from October 7, 2022, through November 7, 2022. RESULTS. The survey response rate was 81% (143/177). A total of 24% (28/115), 38% (44/115), 17% (20/115), and 20% (23/115) of departments offered H-1B visas to IMG faculty frequently, sometimes, rarely, and never, respectively; 3% (3/113), 27% (31/113), 22% (25/113), and 48% (54/113) of departments offered O-1 visas frequently, sometimes, rarely, and never, respectively. However, 41% (46/113) and 5% (6/113) of departments had default policies of offering H-1B and O-1 visas for IMG faculty candidates, respectively. The most common reasons given for why departments did not offer visas included, for both H-1B and O-1 visas, the time-consuming process, lack of reliability of candidates' starting time, and the expense of the visa application; for O-1 visas, the reasons given also included lack of expertise. A total of 15% (16/108) of departments set their own visa policies, 75% (81/108) followed institutional policies, and 10% (11/108) followed policies set by other entities (e.g., state government). CONCLUSION. Although to at least some extent most U.S. academic radiology departments offer H-1B and O-1 visas for IMGs seeking faculty positions, use of such visas typically is not the departments' default policy. A variety of barriers contributed to visas not being offered. The departments' visa policies were primarily determined at the institutional level. CLINICAL IMPACT. The identified barriers faced by U.S. academic radiology departments in offering visas to IMG faculty candidates impact the role of IMGs in helping to address radiologist workforce shortages.

Olfactory system measurements in COVID-19: a systematic review and meta-analysis.

PURPOSE: The neurotropism of SARS-CoV-2 and the consequential damage to the olfactory system have been proposed as one of the possible underlying causes of olfactory dysfunction in COVID-19. We aimed to aggregate the results of the studies which reported imaging of the olfactory system of patients with COVID-19 versus controls. METHODS: PubMed and EMBASE were searched to identify relevant literature reporting the structural imaging characteristics of the olfactory bulb (OB), olfactory cleft, olfactory sulcus (OS), or olfactory tract in COVID-19 patients. Hedge's g and weighted mean difference were used as a measure of effect size. Quality assessment, subgroup analyses, meta-regression, and sensitivity analysis were also conducted. RESULTS: Ten studies were included in the qualitative synthesis, out of which seven studies with 183 cases with COVID-19 and 308 controls without COVID-19 were enrolled in the quantitative synthesis. No significant differences were detected in analyses of right OB volume and left OB volume. Likewise, right OS depth and left OS depth were also not significantly different in COVID-19 cases compared to non-COVID-19 controls. Also, we performed subgroup analysis, meta-regression, and sensitivity analysis to investigate the potential effect of confounding moderators. CONCLUSION: The findings of this review did not confirm alterations in structural imaging of the olfactory system, including OB volume and OS depth by Covid-19 which is consistent with the results of recent histopathological evaluations.

Value of CTA/MRA in the setting of intraparenchymal hemorrhage in the emergency department.

PURPOSE: To assess the diagnostic yield of computed tomography angiography (CTA)/magnetic resonance angiography (MRA) brain and neck ordered in the emergency department (ED) for patients who have intraparenchymal hemorrhage (IPH) on their initial noncontrast CT (NCCT) of the head. METHODS: In this retrospective study, we reviewed 156 patients presenting to the ED with nontraumatic IPH, documented on NCCT. We assessed if the subsequent CTA/MRA was positive, and collected data regarding the location of the bleed, patients' age group, and presence/absence of associated SAH/IVH. Two neuroradiologists were asked to predict, based on age and NCCT appearance, whether the CTA/MRA would be positive or negative for demonstrating a vascular etiology of the hemorrhage. RESULTS: The yield of CTA/MRA head for patients above 75 years old was 2% (1/49), as the etiology for IPH in such age group was more commonly related to hypertensive bleed or amyloid angiopathy. The concomitant presence of subarachnoid hemorrhage (SAH) and intraventricular hemorrhage (IVH), particularly in patients younger than 75 years, correlated with a higher likelihood of a positive CTA. Statistically, the neuroradiologists were able to exclude a vascular source of the IPH based on CT appearance, bleed location, and patient's age in over 92% of cases. CONCLUSION: CTA/MRA for IPH has a lower yield in patients at older age and with deep gray matter distribution without SAH. Neuroradiologists were accurate at excluding a vascular source of the IPH in most cases. This study suggests that CTA/MRA can be omitted in certain scenarios, thereby preventing overutilization, and leading to optimal use of health care resources.

Brain MRI in Autism Spectrum Disorder: Narrative Review and Recent Advances.

Autism spectrum disorder (ASD) is neuropsychiatric continuum of disorders characterized by persistent deficits in social communication and restricted repetitive patterns of behavior which impede optimal functioning. Early detection and intervention in ASD children can mitigate the deficits in social interaction and result in a better outcome. Various non-invasive imaging methods and molecular techniques have been developed for the early identification of ASD characteristics. There is no general consensus on specific neuroimaging features of autism; however, quantitative magnetic resonance techniques have provided valuable structural and functional information in understanding the neuropathophysiology of ASD and how the autistic brain changes during childhood, adolescence, and adulthood. In this review of decades of ASD neuroimaging research, we identify the structural, functional, and molecular imaging clues that most accurately point to the diagnosis of ASD vs. typically developing children. These studies highlight the 1) exaggerated synaptic pruning, 2) anomalous gyrification, 3) interhemispheric under- and overconnectivity, and 4) excitatory glutamate and inhibitory GABA imbalance theories of ASD. The application of these various theories to the analysis of a patient with ASD is mitigated often by superimposed comorbid neuropsychological disorders, evolving brain maturation processes, and pharmacologic and behavioral interventions that may affect the structure and function of the brain. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 3.

Neuroimaging in Attention-Deficit/Hyperactivity Disorder: Recent Advances.

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition that leads to impaired attention and impulsive behaviors diagnosed in, but not limited to, children. ADHD can cause symptoms throughout life. This article summarizes the structural (conventional, volumetric, and diffusion tensor imaging) and functional (task-based functional MRI [fMRI], resting-state fMRI, PET, and MR spectroscopy) brain findings in patients with ADHD. Consensus is lacking regarding altered anatomic or functional imaging findings of the brain in children with ADHD, likely because of the heterogeneity of the disorder. Most anatomic studies report abnormalities in the frontal lobes, basal ganglia, and corpus callosum; decreased surface area in the left ventral frontal and right prefrontal cortex; thinner medial temporal lobes; and smaller caudate nuclei. Using fMRI, researchers have focused on the prefrontal and temporal regions, reflecting perception-action mapping alterations. Artificial intelligence models evaluating brain anatomy have highlighted changes in cortical thickness and the shape of the inferior frontal cortex, bilateral sensorimotor cortex, left temporal lobe, and insula. Early intervention and/or normal brain maturation can alter imaging patterns and convert functional imaging studies to a normal pattern. Although imaging findings provide insight into the neuropathophysiology of the disease, no definitive structural or functional pattern defines the disorder from a neuroradiologic perspective.

Leveraging artificial intelligence in ischemic stroke imaging.

Artificial intelligence (AI) is having a disruptive and transformative effect on clinical medicine. Prompt clinical diagnosis and imaging are critical for minimizing the morbidity and mortality associated with ischemic strokes. Clinicians must understand the current strengths and limitations of AI to provide optimal patient care. Ischemic stroke is one of the medical fields that have been extensively evaluated by artificial intelligence. Presented herein is a review of artificial intelligence applied to clinical management of stroke, geared toward clinicians. In this review, we explain the basic concept of AI and machine learning. This review is without coding and mathematical details and targets the clinicians involved in stroke management without any computer or mathematics' background. Here the AI application in ischemic stroke is summarized and classified into stroke imaging (automated diagnosis of brain infarction, automated ASPECT score calculation, infarction segmentation), prognosis prediction, and patients' selection for treatment.

MOGAD: How It Differs From and Resembles Other Neuroinflammatory Disorders.

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a distinct CNS inflammatory disease with symptoms and imaging findings that overlap other neuroinflammatory disorders. We highlight the imaging characteristics of MOGAD and contrast them with neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS). Intracranial features that suggest MOGAD include childhood acute disseminated encephalomyelitis pattern with diffuse signal abnormality in the cortical gray matter, subcortical white matter, deep white matter, and deep gray matter on T2-weighted and FLAIR images; few bilateral T2-hyperintense fluffy and poorly demarcated lesions; pontine or thalamic involvement (or both); and cerebellar peduncle lesions in children. Intraorbitally, one sees edematous, enlarged, tortuous optic nerve or nerves; bilateral long-segment T2 hyperintensity of anterior segments of the optic nerve; sparing of the optic chiasm and retrochiasmatic pathways; and perioptic nerve sheath and surrounding orbital fat enhancement. Spinal involvement is seen as longitudinally extensive transverse myelitis with a sagittal T2-hyperintense intramedullary spinal line, the axial "H" spinal cord sign (central cord gray matter T2 hyperintensity), and conus medullaris involvement. Early accurate diagnosis of MOGAD is important because prognosis and treatment differ from those for NMOSD and MS.

How Do American Radiology Institutions Deal With Second Opinion Consultations on Outside Studies?

OBJECTIVE. Policies regarding how to handle the review of imaging studies performed at another institution (second opinion consultations) have not been uniform in academic radiology. Departments must decide whether to simply store outside studies in the PACS, report the studies officially, bill third-party payers, repeat such studies, or take a combination of these steps. The purpose of this study was to determine the current state of practice in dealing with second opinion consultations in academic radiology departments. SUBJECTS AND METHODS. A survey was conducted of the members of the Society of Chairs of Academic Radiology Departments (SCARD) and the Association of Administration in Academic Radiology (AAARAD) for their practices with respect to outside studies. RESULTS. Completed surveys were received from 91 of 160 (56.9%) SCARD and 35 of 106 (33.0%) AAARAD members. Of the 91 SCARD respondents, 70 (76.9%) added outside studies to their PACS, and 34 (37.4%) required formal internal reports on all outside studies. By contrast, 74 (81.3%) allowed at least some outside studies into their PACS without requiring an internal report. Many respondents interpreted outside studies only if specifically requested. Most (67/91 [73.6%]) billed insurers but not patients (61/91 [67.0%]) for the second opinion consultations. Fifteen (16.5%) preferred repeating studies rather than including outside studies in the PACS. With minimal exceptions, the AAARAD results paralleled the SCARD results. CONCLUSION. The survey showed that common practices in academic radiology are to add outside studies to the institutional PACS without mandating an internal report and to bill insurers but not patients for second opinion consultations.

Musculoskeletal Radiology Reports: Overlooked or Valuable?

The electronic medical record (EMR) can reveal preferences of clinicians regarding imaging services. We sought to evaluate viewing habits for reports and images of musculoskeletal (MSK) studies by ordering clinicians. We hypothesized that MSK reports are important to clinical management, especially for advanced imaging modalities. We tracked the image and report access of all MSK studies ordered in September 2016 over 8 months using logs of the EMR (Epic Systems, Verona, WI), and by an independent analysis of the institutional PACS (Picture Archiving and Communication Systems) (Carestream Health, Rochester, NY). The time stamps were extracted for when images and reports were viewed. We categorized MSK studies by modality and provider department. We also compared the rates of viewing reports and images among different modalities and departments using the chi-square test. Of the 8143 viewed MSK studies, 7842 (96.3%) reports (with/without images) and 3916 (48.1%) imaging data (with/without reports) were viewed. Viewing reports alone occurred in 4227 (51.9%) studies. CT and MRI reports alone views occurred more often in comparison to radiographs ([482/706; 68.3%] for CT and [981/1713; 57.3%] for MRI vs. [2764/5724; 48.3%] for radiography, p < 0.001). Orthopedists ordered the highest number of MSK studies and viewed reports 99.2% (3216/3242) of the time, including a 54.6% (1770/3242) rate of viewing reports alone and a 44.6% (1446/3242) rate of viewing both reports and images. They viewed images without reports in 0.8% (27/3242) of cases. MSK reports were viewed significantly more frequently than the images across all modalities and all relevant specialties.

Multi-atlas tool for automated segmentation of brain gray matter nuclei and quantification of their magnetic susceptibility.

Quantification of tissue magnetic susceptibility using MRI offers a non-invasive measure of important tissue components in the brain, such as iron and myelin, potentially providing valuable information about normal and pathological conditions during aging. Despite many advances made in recent years on imaging techniques of quantitative susceptibility mapping (QSM), accurate and robust automated segmentation tools for QSM images that can help generate universal and sharable susceptibility measures in a biologically meaningful set of structures are still not widely available. In the present study, we developed an automated process to segment brain nuclei and quantify tissue susceptibility in these regions based on a susceptibility multi-atlas library, consisting of 10 atlases with T1-weighted images, gradient echo (GRE) magnitude images and QSM images of brains with different anatomic patterns. For each atlas in this library, 10 regions of interest in iron-rich deep gray matter structures that are better defined by QSM contrast were manually labeled, including caudate, putamen, globus pallidus internal/external, thalamus, pulvinar, subthalamic nucleus, substantia nigra, red nucleus and dentate nucleus in both left and right hemispheres. We then tested different pipelines using different combinations of contrast channels to bring the set of labels from the multi-atlases to each target brain and compared them with the gold standard manual delineation. The results showed that the segmentation accuracy using dual contrasts QSM/T1 pipeline outperformed other dual-contrast or single-contrast pipelines. The dice values of 0.77 ±â€¯0.09 using the QSM/T1 multi-atlas pipeline rivaled with the segmentation reliability obtained from multiple evaluators with dice values of 0.79 ±â€¯0.07 and gave comparable or superior performance in segmenting subcortical nuclei in comparison with standard FSL FIRST or recent multi-atlas package of volBrain. The segmentation performance of the QSM/T1 multi-atlas was further tested on QSM images acquired using different acquisition protocols and platforms and showed good reliability and reproducibility with average dice of 0.79 ±â€¯0.08 to manual labels and 0.89 ±â€¯0.04 in an inter-protocol manner. The extracted quantitative magnetic susceptibility values in the deep gray matter nuclei also correlated well between different protocols with inter-protocol correlation constants all larger than 0.97. Such reliability and performance was ultimately validated in an external dataset acquired at another study site with consistent susceptibility measures obtained using the QSM/T1 multi-atlas approach in comparison to those using manual delineation. In summary, we designed a susceptibility multi-atlas tool for automated and reliable segmentation of QSM images and for quantification of magnetic susceptibilities. It is publicly available through our cloud-based platform (www.mricloud.org). Further improvement on the performance of this multi-atlas tool is expected by increasing the number of atlases in the future.

Ethical Dilemmas in Radiology: Survey of Opinions and Experiences.

OBJECTIVE. The aim of this study was to assess trainees' and practicing radiologists' perceptions and experiences in handling ethical situations. We sought to identify frequently encountered ethical dilemmas and how they are addressed in daily practice. MATERIALS AND METHODS. A questionnaire on ethics was sent by email invitation to 1569 radiologists and radiology trainees in an institutional database maintained for continuing medical education purposes on three separate occasions between September 17, 2016, and October 31, 2016. The link to the survey was also posted on social media sites via the authors' and institutional accounts on Facebook, Twitter, Instagram, and Aunt Minnie as well as on American College of Radiology and Radiological Society of North America web blogs. RESULTS. A total of 424 radiologists and trainees responded to the survey, for a response rate of 27% (424/1569). Of them, 363 responded to a question asking whether they had witnessed an ethical dilemma; 203 (56%) had. The wording of reports when a miss was discovered was not handled in a consistent fashion. Regarding disclosure, trainees were more likely than practicing radiologists to report theirs and others' errors to the patient. Of the 362 respondents who responded to a question about whether they would report a negligent act by a colleague to the group director, 292 (81%) stated that they would, but trainees were less likely than practicing radiologists to do so. CONCLUSION. This study found many common ethical dilemmas in radiology practices remain without an appropriate, objective, and unified approach to effectively guide the radiologist's actions. These results highlight a need to provide more uniform recommendations to assist radiologists in addressing ethical issues in an appropriate manner.

Missed Opportunity: Neuroradiology Training Programs and Social Media.

OBJECTIVE. The purpose of this study was to ascertain the degree to which the academic neuroradiology community is embracing social media in its messaging. The hypothesis was that, compared with peer neurosurgery and neurology programs, a majority of neuroradiology programs would actively engage through Facebook and Twitter accounts. MATERIALS AND METHODS. An Internet search was conducted for Facebook, Twitter, LinkedIn, and Instagram accounts for the 75 National Resident Matching Program-registered U.S. neuroradiology fellowship programs and their division chiefs and for the neurosurgery and neurology social media accounts of the same institutions. The content and audience responses of the neuroradiology accounts were categorized. RESULTS. Only 8 of 75 neuroradiology programs had one or more social media accounts. Neurosurgery (odds ratio, 5.9; 95% CI, 2.5-14.0) and neurology (odds ratio, 3.2; 95% CI, 1.3-7.9) had a significantly greater social media presence than neuroradiology did. Larger neuroradiology programs (five or more fellowship positions) had significantly greater likelihood (odds ratio, 7.6,; 95% CI, 1.6-36.4) of having social media accounts compared with those with fewer than five positions. Division chiefs had accounts on LinkedIn more than other media. Few neuroradiology chiefs actively engaged professionally on Facebook and Twitter. Most neuroradiology programs used social media more for recruitment and program information than for education, research, or patient information. CONCLUSION. Most neuroradiology training programs do not have social media accounts and do not use social media for education, engagement, recruitment, or research promulgation. Neurosurgery and neurology programs have more but still limited World Wide Web representation. There is an opportunity for neuroradiology programs to have greater impact in this arena.

MRI findings in Parinaud's syndrome: a closer look at pineal masses.

PURPOSE: The association between MRI findings in patients with pineal lesions and the presence or absence of Parinaud's syndrome (PS) remains poorly described. We sought to better understand what MRI characteristics of a pineal lesion make PS more likely. Can these features predict prognosis for clinical resolution? Based on the anatomical relationship of the pineal gland and midbrain, we hypothesized that the degree of midbrain injury by a pineal mass as assessed by abutment, displacement, or intrinsic midbrain signal abnormality (IMSA) may predict PS. METHODS: We reviewed our institution's databases to find patients with MRI evidence of an intrinsic lesion of the pineal gland. Seventy-seven patients with intrinsic pineal gland lesions, 26 with PS and 51 without PS (NPS), were identified. Data regarding clinical history were collected, and an experienced neuroradiologist reviewed all MRI studies and recorded mass size, midbrain abutment, displacement by the pineal lesion, and presence or absence of IMSA. RESULTS: IMSA occurred with increased frequency in pineal lesions with PS (85%) when compared with NPS (39.2%) (p = 0.0001). Midbrain abutment, compression, and displacement occurred with similar frequencies in both groups, with no statistically significant difference. Hydrocephalus was present in 80.8% of patients with PS and 84% without PS (p = 0.75). CONCLUSION: IMSA in a patient with an intrinsic pineal gland mass is associated with PS. Other findings such as hydrocephalus and midbrain displacement are common in patients with pineal masses both with and without PS and do not have any predictive value.

Incidental findings on cervical spine computed tomography scans: overlooked and unimportant?

PURPOSE: Imaging of the cervical spine for trauma or degenerative disease includes multiple areas of the head and neck that may harbor incidental findings. We sought to determine the incidence of common "incidentalomas" on cervical spine CT scans, their importance, and how often these lesions are mentioned in reports. METHODS: We retrospectively reviewed the cervical spine CTs and reports of all patients scanned between October 2017 and January 2018 for Tornwaldt cysts (TC), thyroglossal duct cysts and remnants (TGDC), laryngoceles (LC), pharyngoceles (PC), carotid artery calcified stenosis (CACS), and aberrant right subclavian arteries (ARSA). Descriptive statistics were performed, and the incidence of cancers (in PC and LCs) and strokes (in high-grade carotid stenosis) was assessed. RESULTS: Among 2116 patients, the incidences of findings were TC 6.6% (138/2100), TGDC 6.3% (122/1770), LC 9.4% (197/2100), PC 6.4% (135/2100), CACS 4.7% (100/2114), and ARSA 0.86% (18/2097). Of the 2116 patients studied, 600/2116 (28.3%) had at least one incidental finding. Only 2.9% (20/701) of incidentalomas were mentioned in the official reports. CONCLUSION: Cervical incidentalomas vary in rates from ARSA (0.86%) to LC (9.4%). They are rarely mentioned in radiologists' reports. Whether improved vigilance and reporting of these incidentalomas would benefit patient care should be explored.

Radiology and Ethics Education.

OBJECTIVE: The purpose of this study is to assess medical ethics knowledge among trainees and practicing radiologists through an online survey that included questions about the American College of Radiology Code of Ethics and the American Medical Association Code of Medical Ethics. CONCLUSION: Most survey respondents reported that they had never read the American Medical Association Code of Medical Ethics or the American College of Radiology Code of Ethics (77.2% and 67.4% of respondents, respectively). With regard to ethics education during medical school and residency, 57.3% and 70.0% of respondents, respectively, found such education to be insufficient. Medical ethics training should be highlighted during residency, at specialty society meetings, and in journals and online resources for radiologists.

CT in the Evaluation of Acute Injuries of the Anterior Eye Segment.

OBJECTIVE: Slit-lamp ophthalmologic examination and ocular B-scan sonography of the globe are frequently constrained by technical limitations in the setting of traumatic orbital injury. The main purpose of this study was to evaluate the diagnostic performance of CT in acute anterior segment ocular injuries as an adjunctive diagnostic modality. MATERIALS AND METHODS: We retrospectively identified 122 patients who presented to the emergency department from April 2011 through April 2016 with recent direct trauma to the anterior segment of the eye. Deidentified multiplanar thin-slice CT images were reviewed by two subspecialty board-certified neuroradiologists for the presence of anterior segment rupture and hyphema, as well as lens, ciliary body, and lacrimal gland injury. The CT findings were compared to slit-lamp, B-scan ultrasound, or operative data as the reference standard. RESULTS: The neuroradiologists' CT evaluation showed high sensitivity of 87.2% (95% CI, 74.3-95.2%) and specificity of 97.3% (95% CI, 90.7-99.7%) in diagnosing anterior globe rupture with high interrater agreement (κ = 0.876; 95% CI, 0.787-0.965). Detection of lens dislocation and anterior hyphema showed a sensitivity and specificity of 88.0% and 90.7% and 77.4% and 88.4%, respectively. A shallow anterior chamber was detectable with a sensitivity of 89.2% and specificity of 87.1%. This critically important sign predicted anterior globe rupture in 39 of 47 patients (odds ratio, 68.25; p < 0.0001). CONCLUSION: Subtle ocular findings are readily detectable at CT and can provide valuable information to the ophthalmologist concerning acute trauma to the ocular anterior segment.

Follow-Up of Emergency Department MRI Scans Suggesting New Diagnosis of CNS Demyelination.

OBJECTIVE: The literature has shown that new cases of multiple sclerosis (MS) can be missed in the emergency department (ED), causing unnecessary delays for patients. In 2012, an MRI scanner was introduced into the ED of our institution. This study examines the potential value of the radiologists' MRI reports for patients with previously undiagnosed MS who presented to the ED. MATERIALS AND METHODS: In this retrospective study, electronic medical records were reviewed for patients without a prior diagnosis of a demyelinating disorder, who underwent imaging on the ED's MRI scanner between March 1, 2014, and March 1, 2016, and for whom the radiologist reported a possible demyelinating disorder. RESULTS: Patient encounters of 61 women and 31 men (mean age, 41.2 years) met the inclusion criteria. In 48 of 92 (52.2%) cases where the radiology report suggested a demyelinating diagnosis, the patient was also given such a diagnosis as the final outcome. Where a demyelinating disorder was placed as the only, first, second, or third (or later) differential diagnosis, the final diagnosis was concordant with demyelination in 84.3% (43/51), 37.5% (3/8), 18.2% (2/11), and 0% (0/22) of cases, respectively (p < 0.01). CONCLUSION: Radiologist-suggested demyelinating disease as the top differential diagnosis after MRI showed a high concordance rate with demyelinating disease being the final diagnosis. Scans in the ED for neurologic deficits can lead to early guidance for a diagnosis of demyelination to be made. Downstream effects may include reduced admission rates, avoidance of unnecessary use of other procedures, and early commencement of disease-modifying therapy.