Abstract Details

Title Efficacy of Imaging vs. Textual Radiology Reports in Diagnosis of Cerebral Edema

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 121

Objective Cerebral edema after Middle Cerebral Artery Stroke: An overview of radiographic representations.

Background Cerebral edema is a life-threatening sequela of various neurologic injuries including ischemic stroke. However, there is limited standardization in how edema is reported on imaging, which can hamper clinical decision-making and research efforts. We conducted a review of 245 patients (1273 images) over the period of 2006-2015 with large Middle Cerebral Artery stroke, to determine the incidence, severity, and descriptions of cerebral edema. We hypothesized that radiology reports would tend to underreport cerebral edema verified by review of raw imaging.

Design/Methods We conducted a retrospective review of neuroradiology reports and images from 245 patients (1273 images) from Brigham and Women’s Hospital between 2006-2015. We manually labeled radiology reports characterizations of edema, including report of mass effect, midline shift and herniation. We categorized edema severity as mild (focal swelling with local mass effect), moderate (swelling with midline shift between 0-5 mm), severe (midline shift >5mm, mild ambient/crural cistern effacement) and life-threatening (midbrain compression, basilar cistern effacement). We then reviewed the corresponding images in a blinded fashion to rate edema severity by direct visualization. We report percent agreement between radiology-report-based versus direct-visualization edema categorization.

Results Among our cohort of 245 patients, edema severity was characterized from reports as mild in 60(24.5%), moderate in 51(20.9%) severe in 44(18%), and life-threatening in 69(28.2%) patients respectively. Median time to most severe radiographic edema was 62 hours after last seen well. When we characterized edema severity using image visualization, we found 65% agreement with radiology reports. Percent agreement was most discrepant on rating moderate edema (49.6%)

Conclusions Edema is inconsistently characterized in radiology reports, potentially hindering the adaptation of a standardized approach for making clinical decisions. Increased standardization may facilitate more consistent practice.

Authors/Disclosures
Hanife Saglam, MD (West Virginia University) PRESENTER	Dr. Saglam has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Asim Z. Mian, MD (Boston University)	Dr. Mian has received personal compensation for serving as an employee of Boston Imaging Core Lab. Dr. Mian has stock in Boston Imaging Core Lab. Dr. Mian has received intellectual property interests from a discovery or technology relating to health care.
Stelios M. Smirnakis, MD, PhD (Brigham and Women'S Hospital, Harvard Medical School)	An immediate family member of Dr. Smirnakis has received personal compensation for serving as an employee of Biogen Inc.. An immediate family member of Dr. Smirnakis has received stock or an ownership interest from Biogen. Dr. Smirnakis has received stock or an ownership interest from Photomedics Inc. The institution of Dr. Smirnakis has received research support from NIH. The institution of Dr. Smirnakis has received research support from Veterans Administration. The institution of Dr. Smirnakis has received research support from Emmetropia Inc. Dr. Smirnakis has received personal compensation in the range of $100,000-$499,999 for serving as a neurology staff with Veterans Administration.
David M. Greer, MD, F�鶹��ýӳ�� (Boston University School of Medicine)	Dr. Greer has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Thieme, Inc. Dr. Greer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for multiple. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has a non-compensated relationship as a Treasurer-Elect with American Neurological Association that is relevant to �鶹��ýӳ�� interests or activities. Dr. Greer has a non-compensated relationship as a President with Neurocritical Care Society that is relevant to �鶹��ýӳ�� interests or activities.
Charlene J. Ong, MD (Boston University)	Dr. Ong has nothing to disclose.

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