Concordance between a gastrointestinal consultant radiologist,a consultant radiologist and qualified reporting radiographers interpreting abdominal radiographs

IntroductionRadiographers can accurately report musculoskeletal and chest radiographs, but there is paucity of research comparing the performance of reporting radiographers (RRs) with consultant radiologists when interpreting and reporting abdominal radiographs. This study assessed interobserver agreement in the clinical setting between reporting radiographers and a consultant radiologist compared to an expert gastrointestinal radiologist in a District General Hospital. Major discordant reports affecting patient management were also examined.Methods126 abdominal radiographs reported by 3 RRs in clinical practice were randomly selected and reported by a consultant radiologist and index gastrointestinal radiologist. The reports of the RRs and consultant radiologist were compared against the reports made by the index radiologist for agreement by a colorectal consultant surgeon. All 126 reports were scored as being in either complete agreement, minor disagreement or major disagreement which would have resulted in a change to patient management.ResultsThere was no significant difference in overall agreement between the consultant radiologist (CR) and RRs when compared to the index radiologist (CR: n = 90/126, 71.4% and RRs: n = 94/126, 74.6%. p = 0.57). Major disagreements were found, but there was no significant difference between both groups (CR: n = 23/126, 18.3% and RRs: n = 17/126, 13.5%. p = 0.30).ConclusionRRs can report abdominal radiographs to a comparable level of agreement as a consultant radiologist in the clinical setting. There was no significant difference in reports deemed to affect patient management.Implications for practiceThis study addresses the gap in assessing the performance of RRs reporting abdominal radiographs. This small scale study indicates that radiographers could provide additional support in the reporting of abdominal radiographs. This would help to reduce radiologist workload and enhance the role of the reporting radiographer.ClassificationAgreement between reporting radiographers and radiologists interpreting and reporting abdominal radiographs.     

Agreement in the reporting of General Practitioner requested musculoskeletal radiographs: Reporting radiographers and consultant radiologists compared with an index radiologist

IntroductionThis study assessed the inter-observer agreement of reporting radiographers and consultant radiologists compared with an index radiologist when reporting General Practitioner (GP) requested musculoskeletal radiographs. The potential effect of discordant reports on patient management and outcome was also examined.MethodsThree reporting radiographers, three consultant radiologists and an index radiologist reported on a retrospective randomised sample of 219 GP requested musculoskeletal radiographs, in conditions simulating clinical practice. A speciality doctor in radiology compared the observers’ reports with the index radiologist report for agreement and assessed whether any discordance between reports was clinically important.ResultsOverall agreement with the index radiologist was 47.0% (95% CI, 40.5–53.6) and 51.6% (95% CI, 45.0–58.1) for the consultant radiologists and reporting radiographers, respectively. The results for the appendicular and axial skeleton were 48.6% (95% CI, 41.3–55.9) and 40.9% (95% CI, 27.7–55.6) for the radiologists, and 52.6% (95% CI, 45.2–59.8) and 47.7% (95% CI, 33.8–62.1) for the radiographers, respectively. The difference in overall observer agreement between the two professional groups with the index radiologist was not statistically significant (p = 0.34). Discordance with the index radiologist's reports was judged to be clinically important in less than 10% of the observer's reports.ConclusionReporting radiographers and consultant radiologists demonstrate similar levels of concordance with an index radiologist when reporting GP requested musculoskeletal radiographs.Implications for practiceThese findings contribute to the wider evidence base that selected radiographers with appropriate postgraduate education and training are proficient to report on musculoskeletal radiographs, irrespective of referral source.     

Agreement between expert thoracic radiologists and the chest radiograph reports provided by consultant radiologists and reporting radiographers in clinical practice: Review of a single clinical site

IntroductionTo compare the clinical chest radiograph (CXR) reports provided by consultant radiologists and reporting radiographers with expert thoracic radiologists.MethodsAdult CXRs (n = 193) from a single site were included; 83% randomly selected from CXRs performed over one year, and 17% selected from the discrepancy meeting. Chest radiographs were independently interpreted by two expert thoracic radiologists (CTR1/2).Clinical history, previous and follow-up imaging was available, but not the original clinical report. Two arbiters compared expert and clinical reports independently. Kappa (Ƙ), Chi Square (χ²) and McNemar tests were performed to determine inter-observer agreement.ResultsCTR1 interpreted 187 (97%) and CTR2 186 (96%) CXRs, with 180 CXRs interpreted by both experts. Radiologists and radiographers provided 93 and 87 of the original clinical reports respectively. Consensus between both expert thoracic radiologists and the radiographer clinical report was 70 (CTR1; Ƙ = 0.59) and 70 (CTR2; Ƙ = 0.62), and comparable to agreement between expert thoracic radiologists and the radiologist clinical report (CTR1 = 76, Ƙ = 0.60; CTR2 = 75, Ƙ = 0.62). Expert thoracic radiologists agreed in 131 cases (Ƙ = 0.48). There was no difference in agreement between either expert thoracic radiologist, when the clinical report was provided by radiographers or radiologists (CTR1 χ = 0.056, p = 0.813; CTR2 χ = 0.014, p = 0.906), or when stratified by inter-expert agreement; radiographer McNemar p = 0.629 and radiologist p = 0.701.ConclusionEven when weighted with chest radiographs reviewed at discrepancy meetings, content of CXR reports from trained radiographers were indistinguishable from content of reports issued by radiologists and expert thoracic radiologists.     

Observer agreement in the reporting of knee and lumbar spine magnetic resonance (MR) imaging examinations: Selectively trained MR radiographers and consultant radiologists compared with an index radiologist

Purpose

To assess agreement between trained radiographers and consultant radiologists compared with an index radiologist when reporting on magnetic resonance imaging (MRI) examinations of the knee and lumbar spine and to examine the subsequent effect of discordant reports on patient management and outcome.

Methods

At York Hospital two MR radiographers, two consultant radiologists and an index radiologist reported on a prospective, random sample of 326 MRI examinations. The radiographers reported in clinical practice conditions and the radiologists during clinical practice. An independent consultant radiologist compared these reports with the index radiologist report for agreement. Orthopaedic surgeons then assessed whether the discordance between reports was clinically important.

Results

Overall observer agreement with the index radiologist was comparable between observers and ranged from 54% to 58%; for the knee it was 46–57% and for the lumbar spine was 56–66%. There was a very small observed difference of 0.6% (95% CI −11.9 to 13.0) in mean agreement between the radiographers and radiologists (P = 0.860). For the knee, lumbar spine and overall, radiographers’ discordant reports, when compared with the index radiologist, were less likely to have a clinically important effect on patient outcome than the radiologists’ discordant reports. Less than 10% of observer's reports were sufficiently discordant with the index radiologist's reports to be clinically important.

Conclusion

Carefully selected MR radiographers with postgraduate education and training reported in clinical practice conditions on specific MRI examinations of the knee and lumbar spine to a level of agreement comparable with non-musculoskeletal consultant radiologists.     

Radiographer reporting of neurological magnetic resonance imaging examinations of the head and cervical spine: Findings of an accredited postgraduate programme

IntroductionTo analyse the objective structured examination (OSE) results of the first cohorts of radiographers (n = 13) who successfully completed an accredited postgraduate programme in clinical reporting of neurological magnetic resonance imaging (MRI) examinations of the head and cervical spine.MethodsForty MRI examinations were used in the OSE which included a range of abnormal cases (prevalence of abnormal examinations approximated 50%) and included: haemorrhage, infarction, demyelination disease, abscess, mass lesions (metastatic deposits, meningioma, glioma, astrocytoma); and disc disease, cord compression, stenosis, ligament rupture, syringomyelia appearances on patients referred from a range of referral sources. Normal variants and incidental findings were also included. True/false positive and negative fractions were used to mark the responses which were also scored for agreement with the previously agreed expected answers based on agreement between three consultant radiologists' reports.ResultsThe mean sensitivity, specificity and agreement rates for all head and cervical spine investigations (n = 520) combined were 98.86%, 98.08% and 88.37%, respectively. The highest scoring cases were cases which included astrocytoma, disc protrusion with cord compression and glioma. The most common errors were related to syringomyelia, ligament rupture and vertebral fracture.ConclusionsThese OSE results suggest that in an academic setting, and following an accredited postgraduate education programme, this group of radiographers has the ability to correctly identify normal MRI examinations of the head/cervical spine and are able to provide a report on the abnormal appearances to a high standard. Further work is required to confirm the clinical application of these findings.     

Optimizing patient care in radiology through team-working: A case study from the United Kingdom

ObjectivesTo investigate how changes in service delivery within the radiology department of an acute district general hospital optimized imaging services for patients and referrers through a strong emphasis on team-working.MethodsData related to service delivery was collected for three consecutive years and interrogated by imaging modality and reporting practitioner (radiologist, reporting radiographer, sonographer) to explore how workload had changed over the cycle.ResultsDepartmental activity demonstrated consistent increases, both overall (13.3%) and for most modalities (MRI 43.7%, CT 22.8%) for the study period (March 2010–March 2013). Overall trend suggested significantly shorter waiting times (CT 0.7 weeks, MRI 1.3 weeks, non-obstetric ultrasound one week; all modalities p = 0.001). Some modality variation in reporting times was apparent, with CT (p = 0.06) and MRI (p = 0.01) decreasing but there was an increase in X-ray reporting times (p = 0.001). Reporting radiographers and sonographers reported the majority of X-ray and non-obstetric ultrasound interpretations (59% and 52%, respectively). A radiographer-led neonatal reporting service was implemented and the urology patient pathway redesigned. Effective team-working produced savings of three full-time consultant radiologist posts.ConclusionRadiologists and radiographers, working together, can deliver an effective service. Innovation, staff development and redesign of patient pathways, have produced significant improvements.     

MRI reporting by radiographers: Findings of an accredited postgraduate programme

AimTo analyse the objective structured examination (OSE) results of the first three cohorts of radiographers (n = 39) who completed an accredited postgraduate certificate (PgC) programme in reporting of general magnetic resonance imaging (MRI) investigations and to compare the agreement rates with those demonstrated for a small group of consultant radiologists.MethodForty MRI investigations were used in the OSE which included the following anatomical areas and abnormal appearances: knee; meniscal/ligament injuries, bone bruises, effusions and osteochondral defects; lumbar spine: intervertebral disc morphology, vertebral collapse, tumours (bone and soft tissue), spinal stenosis and/or nerve root involvement; internal auditory meati (IAM): acoustic neuroma. Incidental findings included maxillary polyp, arachnoid cyst, renal cyst, hydroureter, pleural effusion and metastases (adrenal, lung, perirenal and/or thoracic spine). Sensitivity, specificity and total percentage agreement rates were calculated for all radiographers (n = 39) using all reports (n = 1560). A small representative subgroup of reports (n = 27) was compared to the three consultant radiologists' reports which were produced when constructing the OSE. Kappa values were estimated to measure agreement in four groups: consultant radiologists only; radiographers and each of the consultant radiologists independently.ResultsThe sensitivity, specificity and agreement rates for the three cohorts (combined) of radiographers were 99.0%, 99.0% and 89.2%, respectively. For the majority (5/9) of anatomical areas and/or pathological categories no significant differences (p < 0.05) were found between the mean Kappa scores (K = 0.47–0.76) for different groups of observers, whether radiographers were included in the group analysis or not. Where differences were apparent, this was in cases (4/9) where the variation was either not greater than found between radiologists and/or of no clinical significance. These results suggest therefore that in an academic setting, these groups of radiographers have the ability to correctly identify normal investigations and are able to provide a report on the abnormal appearances to a high standard. Further work is required to confirm the clinical application of these findings.     

An economic evaluation of introducing a skills mix approach to CT head reporting in clinical practice

BackgroundComputed Tomography (CT) head examinations are a common diagnostic examination in National Health Service (NHS) acute hospital trusts. Current NHS England and Royal College of Radiologist (RCR) reports estimate the year on year increase of examinations to be 10%, with the designated workforce of radiologists disproportionate to the increase in demand of imaging reporting.ObjectiveTo determine an economic evaluation of cost, risk and feasibility of introducing skills mix CT head reporting by radiographers.DesignApplying a PICO framework study to evaluate the patient workflow demand from retrospective audit data of CT head examination attendance (n = 7266) at an acute NHS district general hospital (DGH) to model an example workflow demand over 12 months. Reviewing potential outcome risk data (diagnostic thresholds), and feasibility (workforce capacity) of both interventions. The economic evaluation calculated hourly unit costs for comparison estimation of consultant radiologists and reporting radiographers using Netten et al.'s Ready Reckoner. Report unit costs were calculated utilising the Gishen's Ready Reckoner to estimate the uninterrupted time of reporting a non-complex CT report using RCR, Centre for Workforce Intelligence (CfWI) and Department of Health (DoH) estimates for both interventions.ConclusionsThe economic evaluation of introducing a skills mix reporting service model to the benefit of service delivery with the NHS has shown a potential £299,359–£124,514 per annum cost saving using a generic acute DGH workload model. Research into recorded discrepancy/error audit data for potential detrimental risk to patient outcomes identified a paucity of evidence, and recommends further research is needed.     

Image interpretation by radiographers in brain,spine and knee MRI examinations: Findings from an accredited postgraduate module

IntroductionThe aim of the study was to evaluate the performance of radiographers in image interpretation of magnetic resonance imaging (MRI) brain, spine and knee examinations following a nine-month work based postgraduate MRI module.MethodsTwenty-seven participants each submitted 60 image commentaries taken from prospective clinical workloads. The image interpretations (n = 1620) comprised brain, spine, and knee MRI examinations. Prevalence of abnormal examinations approximated 53% (brain), 74% (spine), and 73% (knee), and included acute and chronic pathology, normal variants and incidental findings. Each image interpretation was graded against reference standard consultant radiologist definitive report.ResultsThe radiographer's performance on brain image interpretations demonstrated mean accuracy at 86.7% (95% CI 83.4–89.3) with sensitivity and specificity of 84% (95% CI 80.9–86.4) and 89.7% (95% CI 86.2–92.6) respectively. For spinal interpretations the mean accuracy was 86.4% (95% CI 83.4–89.0), sensitivity was 90.2% (95% CI 88.2–92), mean specificity was 75.3% (95% CI 69.4–80.4). The mean results for knee interpretation accuracy were 80.9% (95% CI 77.3–84.1), sensitivity was 83.3% (95% CI 80.8–85.5), with 74.3% specificity (95% CI 67.4–80.4).ConclusionsThe radiographer's demonstrated skills in brain, spine and knee MRI examination image interpretation. These skills are not to replace radiologist reporting but to meet regulating body standards of proficiency, and to assist decision making in communicating unexpected serious findings, and/or extend scan range and sequences. Further research is required to investigate the impact of these skills on adjusting scan protocols or flagging urgent findings in clinical practice.     

Implementing radiographic CT head reporting: The experiences of students and managers

IntroductionIn the face of growing demand in radiology, skill mix initiatives have sought to improve and expand service provision. Within the UK radiographer reporting is now widespread, although the growth in computerised tomography (CT) head reporting has not been as rapid as anticipated. The literature in this area is limited, but case studies have highlighted the successful implementation of this training through new radiographer roles in practice.MethodA cross-sectional survey was developed to elicit information from radiographers and managers on their experiences before, during and after post-graduate training in CT head reporting.ResultsSeventy one responses were received comprising 48 past students (n = 48/111; 43.2%) and 23 service managers (n = 23/67; 34.3%). Key factors for the development were personal continual professional development for students and departmental need for managers. Challenges during training included a lack of study time due to staff shortages and access to radiologist mentors. Only 48.8% of students responding have gone on to use the new skills in practice cited reasons include staff shortages, resistance from radiologists and increase in radiological staffing.ConclusionsThis qualitative study has demonstrated that those trusts who have implemented CT head reporting have evidenced perceptible benefits for both the department and individuals. Those radiographers who are successfully reporting have shown themselves to be highly motivated and persistent in their development.     

MRI reporting radiographers - A survey assessment of number and areas of practice within the United Kingdom

IntroductionThe aim of this study was to determine a baseline assessment of the national picture of MRI reporting radiographers within the United Kingdom.MethodA questionnaire was utilised using both open and closed questions, the twenty questions were based on four main themes of those in training, those trained, those no longer reporting and post qualification sign off and expectations. The questionnaire was sent out to multiple special interest and MRI specific groups.ResultsResponses were received from 46 trusts (n = 46) between September 2019 and May 2020. The majority of respondents were from English Trusts (n = 40/46). 31 radiographers from 21 different trusts were training in MRI reporting with the majority of those training to report thoraco-lumbar spines and knees. 80 radiographers from 38 trusts had completed training with 77 of those being trained at one south of England University. 57 radiographers from 35 trusts were in practice with the majority of these reporting thoraco-lumbar spines and knees.ConclusionThis survey provides an insight into the current status of MRI reporting radiographers in the UK. Although courses have been available since 2003, numbers are still low and there are significant geographical and working practice variations. Defined standards of practice and the implementation of a central register would benefit both those in practice and those looking to implement a MRI reporting radiographer service.Implications for practiceThis study gives some baseline evidence of the number and scope of practice of MRI reporting radiographers in the UK.     

Cognisance of magnetic resonance imaging-induced vertigo and supported care: A study among a cohort of MRI radiographers in a country in West Africa

IntroductionMagnetic resonance imaging (MRI) can induce vertigo in patients undergoing such examinations. The severity of the vertigo is thought to increase with higher magnetic field strengths and could cause a patient to fall.The study assessed the awareness levels on MRI-induced vertigo among a cohort of MRI radiographers and their perspectives on the care that should be administered to patients post MRI examinations.MethodsThe study utilized a quantitative cross-sectional research design and a questionnaire. Out of a total of 40 MRI-radiographers identified nationwide, 31 participated in the study. Statistical Package for Social Sciences v.21.0 was used to analyse the data.ResultsMost participants (n = 21, 67.7%) were aware of MRI-induced vertigo. Many knew that patients (able and weaker) need to be assisted off the couch (n = 28, 90.3%) and escorted to the changing rooms post MRI examinations (n = 31,100%). There were statistically significant associations between the size of magnetic field strength used by the participants and their level of awareness about MRI-induced vertigo (r = 0.691, p = 0.003), appreciation of the needed support for patients post MRI examinations (r = 0.530, p = 0.041) and the frequency of occurrence of MRI-induced vertigo among their patients (r = 0.530, p = 0.001).ConclusionThe radiographers were mostly cognisant of MRI-induced vertigo and the supported care they were supposed to administer to their patients. The size of magnetic field strength used by the participants correlated with their level of awareness about MRI-induced vertigo and their appreciation of the needed support for patients post MRI examinations.Implication for practiceThe study highlights the need for a refresher training to expand the knowledge-base of a few of the radiographers who were not very cognisant about MRI-induced vertigo.     

To keep or reject,that is the question - A survey on radiologists and radiographers’ assessments of plain radiography images

IntroductionThis study aimed to survey radiographers and radiologists' assessment of plain radiographs to identify the imaging clinicians’ differences in acceptance of image quality.MethodAn online, questionnaire was distributed among radiographers (n = 116) and radiologists (n = 76) in a hospital trust in Norway, including 30 clinical cases (one image and a short referral text) that were divided into 3 categories; keep, could keep and reject, based on European guidelines. When rejecting, the respondents identified the main reason by ticking a list (positioning, collimation, centering, artifact or exposure error). Group differences were explored using 2-tailed chi-squared test. Inter-subjectivity was measured using Cohen's kappa for multi-rater sample.ResultsIn total, 36% of the radiographers (n = 42) and 14% of the radiologists (n = 14) responded to the survey. Total response rate was 30% (56/192). Analysis showed significant difference between radiographers and radiologists in the categories of Reject (χ² = 6.3, df = 1, p = 0.01), and Could keep (χ² = 6.3, df = 1, p = 0.01), identifying radiologists as keeping more images compared to radiographers. Agreement among radiographers (Cohen's κ: 0,39; 95% CI: 0.30–0.48; p < 0.001) and radiologists (Cohen's κ: 0,23; 95% CI: 0.09–0.37; p < 0.001) respectively, is fair. The most common reason for rejecting an image is suboptimal positioning. Suboptimal collimation constituted 15% of the rejected images among radiographers, compared to 5% among radiologists. Centering, artifacts and exposure error showed quite similar rates as reasons for rejection.ConclusionRadiographers and radiologists seem to agree on the assessment of good quality images, however, radiographers seem more reluctant to accept images of lower quality than radiologists.Implications for practiceFurther research on reasons for differences in image quality assessment between radiographers and radiologists is needed. This could enable reduction in reject rates and increase image quality in conventional X-ray examinations.     

Radiographers' assessment of referrals for CT and MR imaging using a web-based data collection tool

IntroductionThere is limited research related to the radiographers' role in assessing of radiology referrals to justify imaging. This study investigated radiographers' compliance with guidelines in the assessment of CT and MRI referrals and factors that influenced their performance.MethodsThis research was facilitated by the EFRS Research Hub at ECR 2019. Five radiology referral scenarios for CT and/or MRI were distributed to radiographers, as determined by their scope of practice, who volunteered at the Research Hub. A web-based data collection tool was used. The radiographers were required to determine the appropriateness of each referral, highlight any concerns and recommend suitable investigations if applicable. Linear regression analysis was used to determine whether postgraduate qualification, grade/role of the radiographer and use of guidelines influenced the radiographers' performance in assessing the referrals.ResultsParticipants originated from 24 countries (n = 51 CT, n = 40 MRI), the majority originating from the UK, Ireland, Italy, Spain, Norway and Austria. Responses consistent with guidelines were 58% and 57% for CT and MRI, respectively. Possession of an MSc qualification in CT was a significant factor of influence for a higher consistency with guidelines (p = 0.02) in CT. Employment as a radiographer in a lead professional role and/or educator was a significant factor of influence for a higher consistency with guidelines in MRI (p = 0.01).ConclusionA total of 58% for CT and 57% for MRI of the radiographers' responses complied with guidelines. Factors such as postgraduate education and leading professional roles are associated with better performance.Implications for practiceConsidering qualifications, experience and managerial role is vital before radiographers are delegated task of justifying CT and MR Imaging.     

Accuracy of appendicular radiographic image interpretation by radiographers and junior doctors in Ghana: Can this be improved by training?

IntroductionAccess to image interpretation in Ghana remains a challenge with the limited number of radiologists. Radiographers with the right skills and knowledge in image interpretation could help address this challenge. The aims of the study were to determine and compare the ability (accuracy, sensitivity and specificity) of radiographers and junior doctors in interpreting appendicular trauma radiographs both before and after training.MethodsAn action research study involving a pre and post training test was carried out to determine the level of accuracy, sensitivity and specificity in abnormality detection by radiographers after undergoing training when compared to junior doctors. Eight radiographers and twelve junior doctors were invited to interpret an image bank of 30 skeletal radiographs, both before and upon completion of an educational program. The participants’ tests were scored against a reference standard provided by an experienced radiologist. Pre and post-test analysis were carried out for comparison.ResultsPost training mean accuracy (radiographers 83.3% vs 68.8%, p = 0.017; doctors 81.9% vs 71.6%, p = 0.003), sensitivity (radiographers 83.3% vs 69.2%, p = 0.042; doctors 77.2% vs 67.8% p = 0.025) and specificity (radiographers 83.3% vs 68.3%, p = 0.011; doctors 86.7% vs 75.6% p = 0.005) of both groups significantly improved. No significant differences were recorded between the radiographers and doctors after the training event.ConclusionThe study revealed that, with a well-structured training program, radiographers and junior doctors could improve on their accuracies in radiographic abnormality detection and commenting on trauma radiographs.     

Chest reporting by radiographers: Findings of an accredited postgraduate programme

AimTo analyse the objective structured examination (OSE) results of the first six cohorts of radiographers (n = 40) who successfully completed an accredited postgraduate programme in clinical reporting of adult chest radiographs.MethodsOne hundred chest radiographs were used in the OSE which included a range of abnormal cases (prevalence of abnormal examinations approximated 50%) and included: cardiac, pulmonary, pleural, interstitial, inflammatory, neoplastic and traumatic appearances on patients referred from a range of referral sources. Normal variants and incidental findings were also included. True/false positive and negative fractions were used to mark the responses which were also scored for agreement with the previously agreed expected answers based on agreement between three consultant radiologists' reports.ResultsMean sensitivity and specificity rates, for all six cohorts (4000 reports), was 95.4% (95% CI 94.4%–96.3%) and 95.9% (95% CI 94.9%–96.7%), respectively. The mean agreement rate was 89% (95% CI 88.0%–89.0%) and the most common errors were related to heart size, hilar enlargement or pleural effusion (false positive); and skeletal appearances or pneumothoraces (false negative).ConclusionsThese OSE results suggest therefore that in an academic setting, and following an accredited postgraduate education programme, this group of radiographers has the ability to correctly identify normal chest radiographs and are able to provide a report on the abnormal appearances to a high standard. Further work is required to confirm the clinical application of these findings.     

3 Tesla MRI in diagnosis and follow up of children with pneumonia

PurposeTo investigate the utilization of 3-Tesla (3 T) magnetic resonance imaging (MRI) in detection of pulmonary abnormalities in children with pneumonia.Materials and methodsForty-seven children with pneumonia prospectively underwent 3 T thoracic MRI and posteroanterior (PA) chest radiography (CR). Of these, 15 patients also underwent contrast-enhanced thorax computed tomography (CT) or high-resolution CT (HRCT). The MRI protocol included axial and coronal T2-weighted spectral presaturation with inversion recovery (SPIR) Multivane-XD and axial echo-planar diffusion-weighted imaging (EPI DWI) with respiratory gating. Kappa statistics, Cochran Q, and McNemar tests were used to investigate the results.ResultsAgreement between CR and MRI was substantial in detecting consolidation/infiltration (k = 0.64), peribronchial thickening (k = 0.64), and bronchiectasis (k = 1); moderate in detecting cavity (k = 0.54) and pleural effusion (k = 0.44); and fair in detecting empyema (0.32) and bilateral involvement of lungs (k = 0.23). MRI was superior to CR in detecting bilateral involvement (p < 0.001), lymph node (p < 0.001), pleural effusion (p < 0.001), and empyema (p = 0.003). MRI detected all the consolidation/infiltration also detected on CT imaging. A kappa test showed moderate agreement between MRI and CT in detecting pleural effusion and ground-glass opacity (GGO), and substantial or almost perfect agreement for all other pathologies. No statistically significant difference was observed between MRI and CT for detecting pneumonia-associated pathologies by the McNemar test.ConclusionThoracic 3 T MRI is an accurate and effective technique for evaluating children with pneumonia. MRI detected more pathologies than CR and had similar results to those of thorax CT.