Background

Neuroimaging has an increasingly important role in the early diagnosis of a range of neurodegenerative disorders. In their 2018 dementia guidelines, NICE recommend structural imaging to rule out reversible causes and assist with subtype diagnosis. In our district general hospital (DGH), a large proportion of outpatient CT brain studies relate to patients who are identified as at risk of a dementia diagnosis. Clinical request forms often request structured scores including global cortical atrophy (GCA), medial temporal atrophy (MTA) and Fazekas scales. In clinical practice, there is wide variability in report content relating to suspected dementia. This is especially true in DGH settings where imaging may be reported by general as opposed to neuroradiologists. The BSNR standards sub-committee has proposed a structured approach to dementia reporting.

Objective

1. To determine whether our reports meet the standards outlined by the BSNR proposed template. 2. To determine whether a structured reporting template would be a useful adjunct to dementia reports in our department.

Methods

A retrospective analysis of 60 representative cases was undertaken spanning a 6-month period. Radiology reports for routine CT brain studies that had a request form including phrases such as ‘dementia protocol’ or ‘cognitive decline’ satisfied inclusion criteria. Each report was examined in detail for comments on dementia-related findings such as atrophy patterns/scores and comments relating to differential diagnoses, amongst other criteria outlined by BSNR standards.

Results

GCA and MTA scores were reliably reported in the vast majority of cases. Comments on progression from earlier available imaging, description of dominant features and the offering of differential diagnoses was generally low. Furthermore, our preliminary results indicate that there is wide inter- and intraobserver variability in the content of dementia reports.

Conclusions

There is growing evidence for the use of structured reporting in radiology to allow for higher quality and reproducibility. Commonly used scoring systems such as GCA, MTA and Fazekas scale are reliably reported in the majority of cases, whilst comments on progression and differential diagnoses are less commonly offered. Our findings also indicate the presence of wide inter- and intraobserver variability in dementia reporting. We propose that a structured reporting template would be a useful adjunct to improve reporting variability and report quality in the DGH setting.