Bedside detection of intracranial midline shift using portable magnetic resonance imaging

• Published in: Scientific reports Vol. 12; no. 1; p. 67
• Main Authors: Sheth, Kevin N., Yuen, Matthew M., Mazurek, Mercy H., Cahn, Bradley A., Prabhat, Anjali M., Salehi, Sadegh, Shah, Jill T., By, Samantha, Welch, E. Brian, Sofka, Michal, Sacolick, Laura I., Kim, Jennifer A., Payabvash, Seyedmehdi, Falcone, Guido J., Gilmore, Emily J., Hwang, David Y., Matouk, Charles, Gordon-Kundu, Barbara, RN, Adrienne Ward, Petersen, Nils, Schindler, Joseph, Gobeske, Kevin T., Sansing, Lauren H., Sze, Gordon, Rosen, Matthew S., Kimberly, W. Taylor, Kundu, Prantik
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 07-01-2022; Nature Publishing Group; Nature Portfolio
• Subjects: 692/617; 692/617/375/534; 692/700/139; 692/700/1421; Aged; Brain - diagnostic imaging; Computed tomography; Connecticut; Female; Hemorrhage; Humanities and Social Sciences; Humans; Intensive Care Units; Ischemia; Magnetic fields; Magnetic Resonance Imaging; Male; Middle Aged; multidisciplinary; Nervous system; Neuroimaging; Observational studies; Patients; Point-of-Care Systems; Point-of-Care Testing; Predictive Value of Tests; Prognosis; Prospective Studies; Reproducibility of Results; Science; Science (multidisciplinary); Stroke; Stroke - diagnostic imaging; Stroke - therapy; Connecticut
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-021-03892-7

Neuroimaging is crucial for assessing mass effect in brain-injured patients. Transport to an imaging suite, however, is challenging for critically ill patients. We evaluated the use of a low magnetic field, portable MRI (pMRI) for assessing midline shift (MLS). In this observational study, 0.064 T pMRI exams were performed on stroke patients admitted to the neuroscience intensive care unit at Yale New Haven Hospital. Dichotomous (present or absent) and continuous MLS measurements were obtained on pMRI exams and locally available and accessible standard-of-care imaging exams (CT or MRI). We evaluated the agreement between pMRI and standard-of-care measurements. Additionally, we assessed the relationship between pMRI-based MLS and functional outcome (modified Rankin Scale). A total of 102 patients were included in the final study (48 ischemic stroke; 54 intracranial hemorrhage). There was significant concordance between pMRI and standard-of-care measurements (dichotomous,
κ
 = 0.87; continuous,
ICC
 = 0.94). Low-field pMRI identified MLS with a sensitivity of 0.93 and specificity of 0.96. Moreover, pMRI MLS assessments predicted poor clinical outcome at discharge (dichotomous: adjusted OR 7.98, 95% CI 2.07–40.04
, p
 = 0.005; continuous: adjusted OR 1.59, 95% CI 1.11–2.49,
p
 = 0.021). Low-field pMRI may serve as a valuable bedside tool for detecting mass effect.