Content area
Purpose
We assessed the current clinical imaging practice in the primary evaluation of neuromuscular disorders (NMD), with respect to standardized imaging, evaluation and reporting through a European and extra-European-wide survey.
Methods
An online questionnaire was emailed to all European Society of Neuroradiology (ESNR) members (n = 1662) who had expressed their interest in NMD. The questionnaire featured 40 individual items. Information was gathered on the context of the practices, available and preferred imaging modalities, applied imaging protocols and standards for interpretation, reporting and communication.
Results
A total of 30 unique entries from European and extra-European academic and non-academic institutions were received. Of these, 70% were neuroradiologists, 23% general radiologists and 7% musculoskeletal radiologists. Of the 30 responding institutes, 40% performed from 20 to 50 neuromuscular scans per year for suspected NMD. The principal modality used for a suspected myopathy was magnetic resonance imaging (MRI) (50%) or “mainly MRI” (47%). The primary imaging modality used for the evaluation of patients suspected of a neuropathy was MRI in 63% of all institutions and “mainly MRI” in 37%. For both muscle and nerve pathology, pelvic girdle and inferior limbs are the most scanned parts of the body (28%), followed by the thigh and leg (24%), whole body MR (24%), scapular girdle (16%), and the thigh in just 8% of institutions. Multiplanar acquisitions were performed in 50% of institutions. Convectional sequences used for muscle MRI included T2-STIR (88%), 2D T1weighted (w) (68%), T1 Dixon or equivalent (52%), T2 Dixon (40%), DWI (36%), 2D T2w (28%), T1 3D and T2 3D (20% respectively). For nerve MRI conventional sequences included T2-STIR (80%), DWI (56%), T2 3D (48%), 2D T2w (48%), T1 3D (44%), T1 Dixon or equivalent (44%), 2D T1 (36%), T2 Dixon (28%). Quantitative sequences were used regularly by 40% respondents. While only 28% of institutions utilized structured reports, a notable 88% of respondents expressed a desire for a standardized consensus structured report. Most of the respondents (93%) would be interested in a common MRI neuromuscular protocol and would like to be trained (87%) by the ESNR society with specific neuromuscular sessions in European annual meetings.
Conclusions
Based on the survey findings, we can conclude that the current approach to neuromuscular imaging varies considerably among European and extra-European countries, both in terms of image acquisition and post-processing. Some of the challenges identified include the translation of research achievements (related to advanced imaging) into practical applications in a clinical setting, implementation of quantitative imaging post-processing techniques, adoption of structured reporting methods, and communication with referring physicians.
Details
; D’Anna, Gennaro 3 ; Castellano, Antonella 4 ; Vernooij, Meike W. 5 ; Yousry, Tarek 6 ; Pichiecchio, Anna 7 1 ASST Papa Giovanni XXIII, Head Diagnostic Imaging Department, Head Neuroradiology Unit, Bergamo, Italy (GRID:grid.460094.f) (ISNI:0000 0004 1757 8431)
2 Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Pediatric Neurology Unit, Rome, Italy (GRID:grid.411075.6) (ISNI:0000 0004 1760 4193)
3 ASST Ovest Milanese, Neuroimaging Unit, Legnano, Italy (GRID:grid.411075.6)
4 IRCCS Ospedale San Raffaele Vita-Salute San Raffaele University, Neuroradiology Unit and CERMAC, Milan, Italy (GRID:grid.15496.3f) (ISNI:0000 0001 0439 0892)
5 Department of Radiology & Nuclear Medicine Department of Epidemiology, Rotterdam, The Netherlands (GRID:grid.15496.3f)
6 UCL IoN, NHNN, Clinical Research Centre, UCLH, Institute of Neurology, BRR Department, London, UK (GRID:grid.415052.7) (ISNI:0000 0004 0606 323X)
7 University of Pavia, Department of Brain and Behavioural Sciences, Pavia, Italy (GRID:grid.8982.b) (ISNI:0000 0004 1762 5736); IRCCS Mondino Foundation, Neuroradiology Department, Pavia, Italy (GRID:grid.419416.f) (ISNI:0000 0004 1760 3107)