Clinical Neuroradiology

Abstract

Clinical neuroradiology requires dedicated (formal) training in nervous system disorders in terms of presentation and differential diagnosis. The choice of the appropriate imaging strategy and radiological techniques critically depends on the mode of presentation, the presumed localization (brain, spine, plexus, nerves), and the potential differential diagnosis. The request form (and when available – the medical history and lab results) are the starting point of the consultation, and the associated differential diagnosis will inform the choice of imaging modality, the region to be examined, the scan protocol, and possible need for contrast material administration. We briefly discuss the most common clinical scenarios by mode of presentation (acute vs. chronic) and manifesting symptoms to determine the type (and presumed location) of pathology to be considered. Standardized image interpretation and reporting are important to rule out specific diseases and narrow down the differential diagnosis once pathology is detected; checklists for reporting are provided to exclude disorders that might be expected in the particular setting in a semi-structured fashion. International diagnostic criteria and classification schemes should be used to facilitate communication to the referring neurologist, psychiatrist, or neurosurgeon. The conclusion of the neuroradiological report should take the a priori chances of finding (a certain) pathology into account and help referring clinicians to dismiss incidental findings and provide a certainty level; when appropriate additional tests, follow-up imaging, or neuro-interventions should be recommended. Communication may be enhanced by the use of sample reports provided and participation in multidisciplinary meetings; the latter are central to optimizing patient management and are also a crucial element of continuing medical education and evaluation of protocols, diagnostic performance, and cost-effectiveness.

This publication is endorsed by: European Society of Neuroradiology (www.esnr.org).