Use of neuroradiological diagnostic methods in evaluation of patients with headache : experiences in KBC Split

Abstract

CILJ ISTRAŽIVANJA: Glavni cilj našeg istraživanja je utvrditi učestalost i opravdanost korištenja multiplih slikovnih dijagnostičkih metoda (CT, MRI, MRA), a osobito MRA krvnih žila u obradi bolesnika s anamnezom glavobolje upućenih s Klinike za neurologiju Kliničkog bolničkog centra Split tijekom 2017. godine. ISPITANICI I METODE: Istraživanje je retrospektivnog karaktera. Istraživanjem su obuhvaćeni svi bolesnici Klinike za neurologiju koji su u razdoblju od 1.1.2017. do 31.12.2017. godine bili upućeni na slikovnu dijagnostičku pretragu MR angiografiju (MRA) mozga na Zavod za dijagnostičku i intervencijsku radiologiju.. Izvori podataka je pismohrana povijesti bolesti na Zavod za dijagnostičku i intervencijsku radiologiju. Uvidom u pismohranu istražilo se koliko je od navedenih bolesnika prije MRA bilo upućeno na snimanje pretrage CT i MR mozga. Rezultati su obrađeni kvantitativno i kvalitativno uvidom u nalaze navedenih pretraga. REZULTATI: Ukupno 161 bolesnik upućen je na snimanje MRA. Nalazi pretraga su u 89% slučajeva bili uredni bez naznaka patološkog supstrata, a u svega 11% bolesnika taj nalaz je ukazao na neki patološki supstrat. Kao najčešći supstrat prikazuje se aneurizme, zatim slijede intrakranijska krvarenja, arteriovenske malformacije i tumori. Uz učinjenu pretragu MRA, 53% bolesnika je također prethodno imalo nalaz CT mozga, 10% MR mozga, dok je 18% njih imalo nalaze sve tri spomenute pretrage. MRA bez prethodnih pretraga učinjena je u 19% bolesnika. Kvalitativna analiza prethodno učinjenih CT i MR pretraga je također bila uredna u većini slučajeva, pa kada govorimo o CT taj postotak je 65%, a kod MRI 88%. ZAKLJUČCI: Rezultati istraživanja pokazali su da je u većini slučajeva upućivanje neuroloških bolesnika koji su u povijesti bolesti imali glavobolju na multiple slikovne dijagnostičke metode bilo neopravdano. Većina glavobolja može biti dijagnosticirana pravilnom upotrebom smjernica za klasifikaciju istih. Provedeno istraživanje ukazuje na potrebu jasnog utvrđivanja smjernica za dijagnozu glavobolje s jasno definiranim točkama kada je opravdano korištenje metoda slikovne dijagnostike, kontinuiranu edukaciju i multidisciplinarni pristup kako bi se smanjilo nepotrebno izlaganje bolesnika zračenju, te sveukupni troškovi zdravstvene zaštite.OBJECTIVES: The main objective of this research was to determine frequency and justification of multple imaging diagnostic methods use (CT, MRI, MRA) and in particular the MRA in the treatment of patients with history of headaches that were referred from the Clinic for Neurology of the University Hospital of Split during 2017. SUBJECTS AND METHODS: Research is based on data sources from the archives of patients history from the Clinic of Radiology. Patients who meet the critera and whose data exists in the written protocol, but not in the archives, were excluded during the study. Out of the total number of 457 patients that underwent MRA, 161 were included in the studie and they were all patients reffered to the MRA at the the Department of Diagnostic and Interventional Radiology from the Clicinic for Neurology in the time period from January 1st, 2017 to December 31st, 2017. RESULTS: Research findings have shown that in most cases, the referral of a patient who has a history of disease has a headache on the diagnostic methods, and especially the MRA is not justified. Findings related to MRAs were in 89% of the cases without the indication of the pathological substrate, and in only 11% of the patients, this finding indicated a pathological substrate. The most common substrate is aneurysm, followed by intracranial bleeding, arteriovenous malformation and tumors. In addition to the MRA, 53% of patients also did a CT scan, 10% did a MRI and 18% had all three tests performed. Patients submitted only to MRA made 19% of patients. A qualitative analysis of previously performed CT and MR trials was made and it most of the cases there were no pathological findings, so when we talk about CT, the percentage was 65% of normal findings and in MRI it was 88%. CONCLUSION: The results of the research have shown that in most cases the referral of a patient who has history of a headache in their medical documentation to the neuroradiological diagnostic methods, and especially MRA is unjustified.The vast majority of the test preformed are unjustified with the patalogical finidings being found only in 11% of the scans when most of the headache can be diagnosed by proper use of guidelines. The counducted research suggests the need to cleary define guidelines for headache diagnosis with clearly defined point when it is justified to use diagnostic imaging methods