Background At our local hospital MRI scans of children with developmental disabilities are reviewed by radiologists who provide the preliminary report. It is the choice of the treating paediatrician to seek further specialist paediatric neuroradiologist’s opinion.
Aim Did differences in local and specialist opinion impact on diagnosis?
Method Concurrent MRI scan reports of children with neurodisabilities from the local radiologist and the neuroradiologist were compared.
Result 63 children had reports from local and specialist radiologist. All had neurodevelopmental difficulties from mild to severe range.
The results were divided into three categories:
Group 1: Where there was significant difference in opinion: 26 reports (41%) Periventricular leucomalacia (PVL) was detected in 11 of which 10 had spastic cerebral palsy. Other cases included the following: antenatal hypoxic Ischaemic encephalopathy (3), thinning or agenesis of corpus callosum (4), disorder of myelination (3). The specialist was more likely to detect disturbances of myelination, (delay, loss or degeneration) The specialist also ruled out (6%) white matter loss (3) and absent corpus callosum (1) reported by the local radiologist.
Group 2: Where there was no difference in opinion: 29 reports (47%) The majority of these children (15) had global developmental delay without spasticity. Other cases included tonsilar herniation (2) Corpus callosum dysgenesis (2) hypoxic ischaemic encephalopathy (1) periventricular leucomalacia PVL (2), Cytomegalovirus infection (2) and hemisphere infarct (1) autism (2).
Group 3: Only subtle differences in report which did not impact on diagnosis: 8 reports (13%) These included arachnoid cysts, aberrant patterns of myelination, age consistent delay in myelination and benign extra cerebral space enlargement.
Conclusion This study showed that a paediatric neuroradiologist’s opinion is important and could impact on the diagnosis very significantly. They detected and ruled out abnormalities in 41% of cases resulting in conclusive diagnosis compatible with clinical findings. Periventricular leucomalacia (PVL) was more likely to be detected by the neuroradiologist and was the commonest finding contributing to clinical diagnosis. In children with global delay with no spasticity the reports were likely to be similar. Subtle white matter abnormalities were also more likely to be detected by the specialist.
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