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Identification of White Matter Hyperintensities in Routine Emergency Department Visits Using Portable Bedside Magnetic Resonance Imaging
Adam de Havenon, Nethra R. Parasuram, Anna L. Crawford, Mercy H. Mazurek, Isha R. Chavva, Vineetha Yadlapalli, Juan Eugenio Iglesias, Matthew Scott Rosen et al.. Journal of the American Heart Association, 2023-05-23
Topic: Risk, prevention and care in population studies
Background White matter hyperintensity (WMH) on magnetic resonance imaging (MRI) of the brain is associated with vascular cognitive impairment, cardiovascular disease, and stroke. We hypothesized that portable magnetic resonance imaging (pMRI) could successfully identify WMHs and facilitate doing so in an unconventional setting. Methods and Results In a retrospective cohort of patients with both a conventional 1.5 Tesla MRI and pMRI, we report Cohen's kappa (κ) to measure agreement for detection of moderate to severe WMH (Fazekas ≥2). In a subsequent prospective observational study, we enrolled adult patients with a vascular risk factor being evaluated in the emergency department for a nonstroke complaint and measured WMH using pMRI. In the retrospective cohort, we included 33 patients, identifying 16 (49.5%) with WMH on conventional MRI. Between 2 raters evaluating pMRI, the interrater agreement on WMH was strong (κ=0.81), and between 1 rater for conventional MRI and the 2 raters for pMRI, intermodality agreement was moderate (κ=0.66, 0.60). In the prospective cohort we enrolled 91 individuals (mean age, 62.6 years; 53.9% men; 73.6% with hypertension), of which 58.2% had WMHs on pMRI. Among 37 Black and Hispanic individuals, the Area Deprivation Index was higher (versus White, 51.8±12.9 versus 37.9±11.9; P <0.001). Among 81 individuals who did not have a standard‐of‐care MRI in the preceding year, we identified WMHs in 43 of 81 (53.1%). Conclusions Portable, low‐field imaging could be useful for identifying moderate to severe WMHs. These preliminary results introduce a novel role for pMRI outside of acute care and the potential role for pMRI to reduce disparities in neuroimaging.
Key findings
- Background White matter hyperintensity (WMH) on magnetic resonance imaging (MRI) of the brain is associated with vascular cognitive impairment, cardiovascular disease, and stroke.
- Methods and Results In a retrospective cohort of patients with both a conventional 1.5 Tesla MRI and pMRI, we report Cohen's kappa (κ) to measure agreement for detection of moderate to severe WMH (Fazekas ≥2).
- Among 37 Black and Hispanic individuals, the Area Deprivation Index was higher (versus White, 51.8±12.9 versus 37.9±11.9; P <0.001).
- These preliminary results introduce a novel role for pMRI outside of acute care and the potential role for pMRI to reduce disparities in neuroimaging.
Why it matters
Portable bedside MRI in the emergency department detected white matter hyperintensities with strong agreement between raters, and over half of enrolled patients had them. This is about detecting a marker linked to vascular cognitive impairment, not about treating or preventing Alzheimer's disease.
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Study details
- Study designprospective cohort
- Participants33
- Effect size49.5%; 53.9%; 73.6%
- Evidence strengthModerate
How this study scored 62/100
Published in a peer-reviewed journal, and it is a prospective cohort study, followed forward from enrollment. Scored zero for randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of the American Heart Association) |
| Journal's citation record | 2 / 4 | Journal of the American Heart Association: journal h-index 200 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A prospective cohort study, followed forward from enrollment |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2023 — within 6 year(s) of the newest study here |
| Sample size | 1 / 4 | 33 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 3 / 7 | Cited 26 times (OpenAlex, 2026-10-10) |
| Citations per year | 2 / 5 | 5.2 citations a year over 5 year(s) since 2023 |
| Impact for its field and year | 3 / 6 | Cited 3.8× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 4 other studies in this library |
| Still being cited | 2 / 4 | Cited 24 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Kevin Navin Sheth: h-index 78 (OpenAlex, whole career) |
| Institution's track record | 3 / 3 | Harvard University: institution h-index 3,235 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 5 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 37218590) |
| Free to read | 2 / 2 | Free to read |
| Total | 62 / 100 | — |
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Read the original
- DOI: 10.1161/jaha.122.029242
- PubMed: 37218590
- Original source →
- Free full text: Journal of the American Heart Association →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
de Havenon, A., Parasuram, N. R., Crawford, A. L., Mazurek, M. H., Chavva, I. R., Yadlapalli, V., et al. (2023). Identification of White Matter Hyperintensities in Routine Emergency Department Visits Using Portable Bedside Magnetic Resonance Imaging. Journal of the American Heart Association. https://doi.org/10.1161/jaha.122.029242
Vancouver
de Havenon A, Parasuram NR, Crawford AL, Mazurek MH, Chavva IR, Yadlapalli V, et al. Identification of White Matter Hyperintensities in Routine Emergency Department Visits Using Portable Bedside Magnetic Resonance Imaging. Journal of the American Heart Association. 2023. doi:10.1161/jaha.122.029242. PMID: 37218590.
BibTeX
@article{dehavenon2023-37218590,
author = {de Havenon, Adam and Parasuram, Nethra R. and Crawford, Anna L. and Mazurek, Mercy H. and Chavva, Isha R. and Yadlapalli, Vineetha and Iglesias, Juan Eugenio and Rosen, Matthew Scott and others},
title = {{Identification of White Matter Hyperintensities in Routine Emergency Department Visits Using Portable Bedside Magnetic Resonance Imaging}},
journal = {Journal of the American Heart Association},
year = {2023},
doi = {10.1161/jaha.122.029242},
pmid = {37218590},
url = {https://doi.org/10.1161/jaha.122.029242}
}
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