VIENNA, AT – (HealthTech Wire / News) – Technical refinements within radiology have greatly improved the management of neurological emergencies, and thus the chances of full recovery, by speeding up the diagnostic process and enabling earlier treatment.

But technological advances alone are not enough, and the person performing the examination must have the requisite knowledge, and know what to do when things do not go as planned, according to Prof. Paul M. Parizel, President of the European Society of Neuroradiology (ESNR) and Chairman of the Department of Radiology at Antwerp University Hospital.

Comprehensive neurological imaging to provide information

“Thanks to advances in technology, we have quick and comprehensive neurological imaging that can provide information to guide patient treatment in many serious emergency settings. But the technology is wasted without the background knowledge,” said Prof. Parizel, who, together with other specialists, will today focus on the radiological management of traumatic emergencies, one of the six categorical courses on emergencies in neuroradiology taking place at ECR 2012.

Posterior reversible encephalopathy syndrome (PRES), a rare acute condition, exemplifies the difficulty of reaching a diagnosis without prior experience. PRES can occur in cases of neurotoxicity, often coinciding with eclampsia, cyclosporine after transplantation, or severe hypertension.

“The clinical presentation of PRES can be puzzling to the neurologist or oncologist taking care of the patient. It is a diagnosis that relies very heavily on imaging, because of its unique CT or MRI appearance. Within minutes, imaging can change the whole course of treatment for the patient, but obviously you also need a person who is able to recognise what there is to see, so that they can actually alter the management of the patient,” he said.

Multi-parametric modality

Not so long ago, radiologists would only perform a CT examination to rule out haemorrhage in a patient presenting with acute stroke. This examination would be the main element in the decision tree. New developments then pushed MR imaging to the forefront and radiologists then began to use diffusion-weighted imaging to show ischaemic brain tissue in the early stages. CT has, since then, become a multi-parametric modality and it is now the most frequently used tool in acute situations. Non-contrast CT is still used to rule out haemorrhage, but it is followed by perfusion CT to look for ischaemic brain tissue and identify thresholds for salvageable penumbra with thrombolytic therapy, or by CT angiography to show occlusion of a major blood vessel.

But as a lot more can now be done much faster in an emergency, it has become a great deal more complicated, especially in smaller hospitals or less specialised centres. Radiologists with numerous responsibilities might not be so aware of precisely which course of action is necessary or the implications of the decisions they make. However, in this particular situation, these decisions can have a very serious impact on patient recovery. Today′s course is thus aimed not only at experienced neuroradiologists, but all radiologists.

Terms of imaging procedures and image-guided treatments

“The experience of professionals who encounter neuroradiology varies greatly, and this is one reason why it is so important to take this course. It should serve as an update for neuroradiologists who are in the business, as I think it gives an excellent current overview. But perhaps even more importantly it should serve as a primer for those radiologists who have not trained specifically as neuroradiologists but who, by circumstance, are required to care for these patients once in a while. There are definitely some important knowledge gaps to be filled here, because there is so much new information and so many more things we can offer in terms of imaging procedures and image-guided treatments,” said Parizel.

Radiologists need to be confident in their decision making and should know which imaging modalities need to be performed first and why, and what the second line should be, he added, stressing that anybody with an interest in the brain, spine, or emergencies should also attend the course.

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Source: HealthTech Wire