E4969. Caution! Avoiding Pitfalls in Emergency Brain Imaging
  1. Kevin Ryan Yu; St. Luke's Medical Center Global City
  2. Stacey Danica Gosiaco; St. Luke's Medical Center Global City
  3. Thurl Hugh Cledera; St. Luke's Medical Center Global City
  4. Anna Theresa Dantes; St. Luke's Medical Center Global City
  5. Maria Kristine Mendoza; St. Luke's Medical Center Global City
  6. Ron Pilotin; St. Luke's Medical Center Global City
Emergent critical findings in neuroimaging demand swift and accurate communication with the attending medical professional. CT and MRI have gained significant recognition as valuable tools in the accurate diagnosis and timely management of brain emergencies. However, no modality is free from errors, more so in the chaos of the emergency department where diagnostic accuracy may be compromised in favor of a rapid diagnosis. Missing or misinterpreting findings can have a pivotal impact in clinical practice. Therefore, explicit awareness of imaging pitfalls by practicing radiologists and trainees is crucial to help limit potentially avoidable errors, improving quality of patient care. This exhibit will discuss different types of errors, cognitive biases, and strategies for improving diagnostic accuracy. We will present a pictorial review of commonly misdiagnosed conditions in the interpretation of emergent brain imaging, as well as key teaching points to avoid these pitfalls.

Educational Goals / Teaching Points
After completing this educational exhibit, the learner will be able to identify different types of errors, as well as when and how they occur; recognize common pitfalls in emergency brain imaging; understand key features to discriminate between confusing imaging findings to avoid misdiagnosis; and identify other approaches and strategies to minimize diagnostic errors.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
When and how do errors occur? Types of errors: perceptual errors and cognitive errors. Avoiding common pitfalls. Nontraumatic: cerebrovascular disease (CT negative strokes, MRI negative strokes, CT hypodensity mimicking infarct, fogging phenomenon, cerebral venous thrombosis), intraparenchymal hemorrhage (CT hyperdensity mimicking bleed), and subarachnoid hemorrhage (pseduosubarachnoid hemorrhage). Traumatic: intracranial hemorrhage (lentiform subdural hematoma, isodense hematoma, falcine and tentorial subdural hematomas) and fractures (skull base fractures, fracture mimics). Additional error-reduction strategies: know the whole picture (history, physical examination, prior imaging, protocols, physics), perform a thorough search (view all windows/sequences, review areas, structured reports), and artificial intelligence.

Although hospitals and emergency centers are equipped with CT and MRI machines to ensure immediate neuroimaging accessibility for critically ill patients, recognizing findings that necessitate urgent treatment is imperative for prompt and effective medical intervention. Diagnostic errors are inevitable in this process, but awareness of common pitfalls and sources of error will equip radiologists with knowledge to enhance diagnostic accuracy and improve patient outcomes.