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Gradient echo MRI

Implementation of a training tutorial for intracranial hemorrhage diagnosis

From the Department of Neurology (B.R.C., C.S.K.), Georgetown University, Washington, DC; University of California at Los Angeles (J.S., J.L.S.); National Institute of Neurological Disorders and Stroke (S.W.), National Institutes of Health, Bethesda, MD; and Diagnostic Radiology Department (J.A.B.), The Clinical Center of the National Institutes of Health, Bethesda, MD.

Address correspondence and reprint requests to Dr. Chelsea S. Kidwell, 4000 Reservoir Road, Bldg. D, Suite 150, Washington, DC 20007 ck256{at}georgetown.edu

Background: Recent studies have demonstrated that gradient echo (GRE) MRI sequences are as accurate as CT for the detection of intracerebral hemorrhage (ICH) in the context of acute stroke. However, many physicians who currently read acute stroke imaging studies may be unfamiliar with interpretation of GRE images.

Methods: An NIH Web-based training program was developed including a pretest, tutorial, and posttest. Physicians involved in the care of acute stroke patients were encouraged to participate. The tutorial covered acute, chronic, and mimic hemorrhages as they appear on CT, diffusion-weighted imaging, and GRE sequences. Ability of users to identify ICH presence, type, and age on GRE was compared from the pretest to posttest timepoint.

Results: A total of 104 users completed the tutorial. Specialties represented included general radiology (42%), general neurology (16%), neuroradiology (15%), stroke neurology (14%), emergency medicine (1%), and other (12%). Median overall score improved pretest to posttest from 66.7% to 83.3%, p < 0.001. Improvement by category was as follows: acute ICH, 66.7%–100%, p < 0.001; chronic ICH, 33.3%–66.7%, p < 0.001; ICH negatives/mimics, 100%–100%, p = 0.787. Sensitivity for identification of acute hemorrhage improved from 68.2% to 96.4%.

Conclusions: Physicians involved in acute stroke care achieved significant improvement in gradient echo (GRE) hemorrhage interpretation after completing the NIH GRE MRI tutorial. This indicates that a Web-based tutorial may be a viable option for the widespread education of physicians to achieve an acceptable level of diagnostic accuracy at reading GRE MRI, thus enabling confident acute stroke treatment decisions.

Abbreviations: AHA/ASA = American Heart Association/American Stroke Association; CME = continuing medical education; DWI = diffusion-weighted imaging; GRE = gradient echo; ICH = intracerebral hemorrhage; tPA = tissue plasminogen activator.

Supported by the Intramural Research Program of the National Institutes of Health, National Institute of Neurological Disorders and Stroke.

Disclosure: The authors report no disclosures.

Received August 13, 2008. Accepted in final form February 6, 2009.