Headache and Neuroimaging: Why We Continue to Do It

Jordan, John E.; Flanders, Adam E.

doi:10.3174/ajnr.a6591

Cited by 16 publications

(15 citation statements)

References 40 publications

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“…Our findings are consistent with our prediction that the neuroanatomy of patients who receive negative clinical brain MRIs does not in general diverge from that of research participants recruited as healthy controls. The most common indication for scan in the SLIP dataset was headache: the lifelong prevalence of headache is reported at >95% in the general population, and most scans for headache without focal neurological symptoms are unremarkable (Jordan and Flanders 2020). Similarly, research case-control studies of quantitative anatomical MRI phenotypes in headache including migraine have generally been inconclusive (Sheng et al 2021; Henn et al 2022).…”

Section: Discussionmentioning

confidence: 99%

Brain growth charts of “clinical controls” for quantitative analysis of clinically acquired brain MRI

Schabdach

Schmitt

Sotardi

et al. 2023

Preprint

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Background: Brain MRIs acquired in clinical settings represent a valuable and underutilized scientific resource for investigating neurodevelopment. Utilization of these clinical scans has been limited because of their clinical acquisition and technical heterogeneity. These barriers have curtailed the interpretability and scientific value of retrospective studies of clinically acquired brain MRIs, compared to studies of prospectively acquired research quality brain MRIs. Purpose: To develop a scalable and rigorous approach to generate clinical brain growth chart models, to benchmark neuroanatomical differences in clinical MRIs, and to validate clinically-derived brain growth charts against those derived from large-scale research studies. Materials and Methods: We curated a set of clinical MRI Scans with Limited Imaging Pathology (SLIP) - so-called "clinical controls" - from an urban pediatric healthcare system acquired between 2005 and 2020. The curation process included manual review of signed radiology reports, as well as automated and manual quality review of images without gross pathology. We measured global and regional volumetric imaging phenotypes in the SLIP sample using two alternative, advanced image processing pipelines, and quantitatively compared clinical brain growth charts to research brain growth charts derived from >123,000 MRIs. Results: The curated SLIP dataset included 372 patients scanned between the ages of 28 days post-birth and 22.2 years across nine 3T MRI scanners. Clinical brain growth charts were highly similar to growth charts derived from large-scale research datasets, in terms of the normative developmental trajectories predicted by the models. The clinical indication of the scans did not significantly bias the output of clinical brain charts. Tens of thousands of additional healthcare system scans meet inclusion criteria to be included in future brain growth charts. Conclusion: Brain charts derived from clinical-controls are highly similar to brain charts from research-controls, suggesting that curated clinical scans could be used to supplement research datasets.

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Section: Discussionmentioning

confidence: 99%

Brain growth charts of “clinical controls” for quantitative analysis of clinically acquired brain MRI

Schabdach

Schmitt

Sotardi

et al. 2023

Preprint

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“…Physicians could be incentivized to expand the margin of eligibility, whether based on financial motives or uncertainty concerning a patient’s condition [ 32 ]. Even if physicians initially conclude that MRI is unnecessary, they could be pressured into offering MRI due to patient demand [ 33 , 34 ]. Thus, the existence of explicit rationing criteria is unlikely to be a major source of discrepancy between our results and reality.…”

Section: Discussionmentioning

confidence: 99%

Increase in Potential Low-value Magnetic Resonance Imaging Utilization Due to Out-of-pocket Payment Reduction Across Income Groups in Korea: An Experimental Vignette Study

Shin

Lee

Kyung

2022

J Prev Med Public Health

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Objectives: This study examined the effect of out-of-pocket (OOP) payment reduction on the potential utilization of low-value magnetic resonance imaging (MRI) across income groups.Methods: We conducted an experimental vignette survey using a proportional quota-based sample of individuals in Korea (n=1229). In two hypothetical vignettes, participants were asked whether they would be willing to use MRI if they had uncomplicated headache and non-specific low back pain, each before and after OOP payment reduction. To account for the possible role of physician inducement, half of the participants were initially presented with vignettes that included a physician recommendation for low-value care. The predicted probability, slope index of inequality (SII), and relative index of inequality (RII) were calculated using logistic regression.Results: Before OOP payment reduction, the lowest income quintile was least likely to use low-value MRI regardless of physician inducement (36.7-49.6% for low back pain; 30.5-39.3% for headache). After OOP payment reduction, almost all individuals in each income quintile were willing to use low-value MRI (89.8-98.0% for low back pain; 78.1-90.3% for headache). Absolute and relative inequalities concerning potential low-value MRI utilization decreased after OOP payments were reduced, even without physician inducement (SII: from 8.15 to 5.37%, RII: from 1.20 to 1.06 for low back pain; SII: from 6.99 to 0.83%, RII: from 1.20 to 1.01 for headache).Conclusions: OOP payment reduction for MRI has the potential to increase low-value care utilization among all income groups while decreasing inequality in low-value care utilization.

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“…Defensive medicine may be reduced if clinicians are shielded by law when practicing evidence-based medicine in accordance with published guidelines. 35 The practitioner plays an important role in the initial clinical assessment as serious illness can be detected despite normal imaging. 36 Further, a normal investigation does not eliminate the need for further follow up and appropriate management of headache.…”

Section: Discussionmentioning

confidence: 99%

The association between headache presentation, normal examination and neuroimaging findings: a retrospective analysis of patients presenting to a tertiary referral centre

Moodley¹,

Bhigjee²

2022

Afr H. Sci.

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Background: There is a high worldwide burden of headaches. Selection of patients with headaches for neuroimaging, in the absence of traditional red flags, is imperative in guiding further management. Objectives: Determine the yield of neuroimaging findings in patients with headache and normal examination; and potentially identifying additional red flags. Methods: A retrospective consecutive chart review of patients with a main complaint of headaches and normal clinical examination were assessed at a tertiary hospital, over a 10-year period. Results: Cohort consisted of 114 patients. Unexpected or normal variants found in 20.2% of patients (23/114) and 11.4% (13/114) required change in management. The absence of nausea and vomiting (p=0.009) and absence of sharp type headaches in unexpected or normal variants group (p=0.03) were statistically significant. There was a higher chance of an abnormal neuroimaging study in men and HIV seropositive patients. Conclusions: Decision to neuroimage should be determined on an individual basis (demographic factors, history of headache and examination) as normal examination cannot preclude patients from unexpected findings on neuroimaging. Headache with nausea and vomiting in isolation may be associated with normal neuroimaging reflecting primary type headaches. Findings support a lower threshold to neuroimage men and HIV seropositive patients with headaches despite normal clinical examination. Keywords: Headache; normal clinical examination; neuroimaging; headache red flags.

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Headache and Neuroimaging: Why We Continue to Do It

Cited by 16 publications

References 40 publications

Brain growth charts of “clinical controls” for quantitative analysis of clinically acquired brain MRI

Brain growth charts of “clinical controls” for quantitative analysis of clinically acquired brain MRI

Increase in Potential Low-value Magnetic Resonance Imaging Utilization Due to Out-of-pocket Payment Reduction Across Income Groups in Korea: An Experimental Vignette Study

The association between headache presentation, normal examination and neuroimaging findings: a retrospective analysis of patients presenting to a tertiary referral centre

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