Detection Rate of Contrast-enhanced Brain Magnetic Resonance Imaging in Patients With Cognitive Impairment
Leehi Joo, Chong Hyun Suh, Woo Hyun Shim, Seon-Ok Kim, Jae-Sung Lim, Jae-Hong Lee, Ho Sung Kim, Sang Joon Kim
The number of brain MRI with contrast media performed in patients with cognitive impairment has increased without universal agreement. We aimed to evaluate the detection rate of contrast-enhanced brain MRI in patients with cognitive impairment.
Dementia is a disorder characterized by a cognitive decline  and this global concern is continuously increasing with the aging of the population. [2, 3] Although guidelines may vary, structural neuroimaging is not always recommended to solely diagnose dementia. However, the American Academy of Neurology  recommends structural neuroimaging (noncontrast CT or MRI) in the initial evaluation of patients with suspected dementia as it may assist in the diagnosis, identifying other possible causes of cognitive decline such as brain neoplasm or subdural hematoma.
Materials and method
This single-institution and observational study was approved by our institutional review board. The requirement for a written informed consent was waived due to the retrospective study design. Our hospital’s electronic medical records were searched to identify patients who attended outpatient clinics for cognitive impairment evaluation and underwent brain MRI with or without contrast media from December 2015 to February 2020. Patients with cognitive impairment who attended outpatient clinics for the first time and underwent brain MRI with or without contrast media as an imaging workup within one month of attendance were included in the study. Contrast enhancement was solely determined according to referral physicians’ opinion and preference. Patients who already developed brain masses were excluded. Fig 1 presents the flow diagram of the study population.
Over 4,838 patients attended the outpatient clinic for cognitive impairment evaluation from December 2015 to February 2020, and 5,297 examinations were undergone as imaging workups. Thirty patients who already had known brain mass was excluded. As most of the patients had only one examination (4,609/4,838, 95%) 5,267 examinations of 4,838 patients with their initial examinations were included in the final analysis (Fig 1 and Table 1). Among them, 1203 patients underwent brain MRI with contrast media.
Increasing numbers of contrast enhancement studies have been performed for imaging evaluation of dementia without a widely established agreement. We evaluated the detection rates of brain MRI with or without contrast media in 4,838 consecutive patients who attended outpatient clinics for cognitive impairment evaluation. The overall detection rates of brain MRI with and without contrast media were 4.7% and 1.8%, respectively, (P < .001); individual matching demonstrated similar results (4.7% and 1.9%, respectively). Among the patients with contrast-enhanced images (n = 1,203), 43 patients (3.6%) had lesions that were only detectable with the aid of contrast media.
In conclusion, detection rate of brain MRI for lesions only detectable with contrast media in patients with cognitive impairment was not high enough and it is relatively reasonable not to use contrast media in patients with cognitive impairment. Further study is needed to develop a strategy for identifying patients whom would especially benefit with contrast media correlating with the factors such as atypical presentation, known malignancy, or older age.
Citation: Joo L, Suh CH, Shim WH, Kim S-O, Lim J-S, Lee J-H, et al. (2023) Detection rate of contrast-enhanced brain magnetic resonance imaging in patients with cognitive impairment. PLoS ONE 18(8): e0289638. https://doi.org/10.1371/journal.pone.0289638
Editor: Tai-Heng Chen, Kaohsuing Medical University Hospital, TAIWAN
Received: December 25, 2022; Accepted: July 22, 2023; Published: August 7, 2023
Copyright: © 2023 Joo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the paper and its Supporting Information files.
Funding: This work was funded by the National Research Foundation of Korea (NRF- 2021R1C1C1014413 to Chong Hyun Suh) and Ministry of Science and ICT (MSIT-2021R1A2C2007251 to Woo Hyun Shim) The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.