儿童急诊2.5分钟NeuroMix脑MRI与标准方案诊断可互换性
本研究回顾性纳入100例儿科急诊同时接受标准脑MRI与2.5分钟NeuroMix序列的患儿（44例阳性、56例对照），由3名放射科医师随机独立阅片。结果显示NeuroMix与标准方案对临床相关颅内病变检测达到诊断可互换性，总体诊断准确率均为87.7%，采集时间显著缩短且伪影更少。
要点
- NeuroMix序列中位采集时间2.67分钟，明显短于标准方案的15.26分钟（p<0.001）。
- 两种方案对临床相关颅内病变的诊断准确率均为87.7%，读片者可考虑在急诊场景使用NeuroMix。
- NeuroMix中重度伪影及重复序列采集发生率更低，有助于减少儿童镇静需求。
核心结论
- NeuroMix与标准儿科急诊脑MRI方案对临床相关颅内病变检测达到诊断可互换性，可互换性估计值为-3.1%（95%CI，-6.6%至+0.3%），在10%非劣效界值内。
- NeuroMix总体诊断准确率与标准方案相同，均为87.7%，且采集时间明显缩短、伪影更少。
研究设计与样本
- 回顾性研究，纳入一年内同时接受标准儿科急诊MRI方案与NeuroMix的连续儿科患者，构建发现富集队列100例（44例阳性、56例对照）。
- 3名放射科医师以随机批次独立审阅NeuroMix与标准方案图像集，采用基于一致性的混合效应模型评估诊断可互换性，非劣效界值为10%。
- 比较指标包括采集时间、检查完整性、伪影发生率、读片者间一致性与诊断效能，遵循STARD报告规范。
关键影像表现/征象
- NeuroMix中重度伪影发生率低于标准方案，重复序列采集次数更少。
- 两种方案对临床相关颅内病变的读片者间一致性均为实质性，NeuroMix κ=0.65，标准方案κ=0.73。
诊断标准与关键数值
- 诊断可互换性估计值为-3.1%（95%CI，-6.6%至+0.3%），处于10%非劣效界值内。
- NeuroMix与标准方案总体诊断准确率均为87.7%。
- NeuroMix读片者间一致性κ=0.65，标准方案κ=0.73。
- NeuroMix中位采集时间2.67分钟，标准方案15.26分钟，p<0.001。
临床应用与阅片要点
- 儿科急诊需要快速评估颅内病变时，NeuroMix可作为补充或替代方案，减少镇静与电离辐射暴露。
- 解读NeuroMix图像时应注意其与标准方案诊断准确率相当，但需结合临床场景判断是否可单独使用。
- 较短的采集时间和较低伪影率有助于提高急诊MRI检查完成率和流程效率。
局限性
- 回顾性研究设计，且采用发现富集队列而非真实连续临床样本。
- 单中心研究，结果外推需结合本机构设备与患儿人群进一步验证。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
BACKGROUND AND PURPOSE: Prolonged acquisition times and motion artifacts limit the use of MRI in the pediatric emergency department, frequently necessitating sedation and reducing workflow efficiency, or prompting the use of CT with associated ionizing radiation. Recent MRI advances enable fast, comprehensive neuroimaging without radiation exposure. This study evaluates the diagnostic interchangeability of a fast 2.5-minute MRI multicontrast sequence (NeuroMix) with a standard MRI protocol for detecting clinically relevant intracranial findings in the pediatric emergency department.
MATERIALS AND METHODS: We retrospectively identified sequential pediatric patients who underwent both a standard pediatric emergency department MRI protocol and NeuroMix over a one-year period. A finding-enriched cohort of 100 studies was constructed (44 positives and 56 controls). Three radiologists independently reviewed NeuroMix and standard protocol imaging sets in randomized batches. Diagnostic interchangeability was assessed using an agreement-based mixed-effects modeling approach using a noninferiority threshold of 10%. Acquisition times, examination completeness, artifact prevalence, interreader agreement, and diagnostic performance metrics were compared between protocols, in accordance with STARD.
RESULTS: NeuroMix demonstrated diagnostic interchangeability with the standard pediatric emergency MRI protocol for detection of clinically relevant findings, with an interchangeability estimate of -3.1% (95% CI, -6.6% to +0.3%), remaining within the noninferiority margin. Overall diagnostic accuracy was identical for NeuroMix and standard imaging (87.7%). Interreader agreement for detection of clinically relevant findings was substantial for both NeuroMix (κ = 0.65) and the standard protocol (κ = 0.73). Mean acquisition time was markedly shorter for NeuroMix when compared with the standard protocol (median 2.67 minutes vs 15.26 minutes, p < 0.001). Moderate to severe artifacts and repeat sequence acquisitions occurred less frequently with NeuroMix.
CONCLUSIONS: A 2.5-minute NeuroMix-based MRI protocol demonstrated diagnostic interchangeability with a standard pediatric emergency MRI protocol for clinically relevant intracranial findings with substantially reduced acquisition time and imaging artifacts. These results support NeuroMix as a fast, radiation-free approach that may serve, depending on the clinical scenario, as a supplementary or alternative neuroimaging protocol in pediatric emergency care.
引用
- Esmeraldo, Soares, Reis, et al. A Comprehensive 2.5-Minute Brain MRI Protocol in the Pediatric Emergency Department: Diagnostic Evaluation of the Multicontrast NeuroMix Sequence. AJNR Am J Neuroradiol. 2026. PMID: 42242728. doi:10.3174/ajnr.A9454
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。