Routine Cross-Sectional Head Imaging Before Electroconvulsive Therapy: A Tertiary Center Experience

详细信息    查看全文

• 作者：Payam I. Sajedi ; MD^a ; Jason Mitchell ; MD ; MPH^a ; Edward H. Herskovits ; MD ; PhD^a ; Prashant Raghavan ; MBBS^a ; ^{praghavan@umm.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Electroconvulsive therapy ; pre-electroconvulsive therapy evaluation ; diagnostic yield ; routine head imaging ; cost analysis
• 刊名：Journal of the American College of Radiology
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：13
• 期：4
• 页码：429-434
• 全文大小：248 K

文摘

Electroconvulsive therapy (ECT) is generally contraindicated in patients with intracranial mass lesions or in the presence of increased intracranial pressure. The purpose of this study was to determine the prevalence of incidental abnormalities on routine cross-sectional head imaging, including CT and MRI, that would preclude subsequent ECT.

Methods

This retrospective study involved a review of the electronic medical records of 105 patients (totaling 108 imaging studies) between April 27, 2007, and March 20, 2015, referred for cranial CT or MRI with the primary indication of pre-ECT evaluation. The probability of occurrence of imaging findings that would preclude ECT was computed. A cost analysis was also performed on the practice of routine pre-ECT imaging.

Results

Of the 105 patients who presented with the primary indication of ECT clearance (totaling 108 scans), 1 scan (0.93%) revealed findings that precluded ECT. None of the studies demonstrated findings that indicated increased intracranial pressure. A cost analysis revealed that at least $18,662.70 and 521.97 relative value units must be expended to identify one patient with intracranial pathology precluding ECT.

Conclusions

The findings of this study demonstrate an extremely low prevalence of findings that preclude ECT on routine cross-sectional head imaging. The costs incurred in identifying a potential contraindication are high. The authors suggest that the performance of pre-ECT neuroimaging be driven by the clinical examination.