PURPOSE: To compare a reduced (three-sequence) magnetic resonance (MR) imag
ing protocol with a full (eight- to 10-sequence) MR imaging protocol in adu
lts suspected of having stroke.
MATERIALS AND METHODS: Six neuroradiologists interpreted a consecutive samp
le of 265 MR images in patients suspected of having stroke. Each read reduc
ed-protocol images in a discrete series of 40 patients (one read images in
only 15) and corresponding full-protocol images 1 month later (reduced/full
protocol). Five of the readers each read images in 10 additional cases, fi
ve each as full/full and reduced/reduced protocol controls. kappa values be
tween full and reduced protocols, reader assessment of protocol adequacy, c
onfidence level, and need for additional sequences or examinations were eva
luated.
RESULTS: In the reduced/full protocol, the kappa value for detecting ischem
ia was 0.797; and that for detecting any clinically important abnormality,
0.635. Statistically similar kappa values were found with the full/full con
trol design (kappa = 0.802 and 0.715, respectively). The full protocol was
judged more adequate than the reduced protocol (2.0 of 5.0 points vs 1.6, P
<.001) and generated greater diagnostic confidence (8.6 of 10.0 points vs
8.9, P =.01), less need for additional sequences (2.7 of 6.0 points vs 1.5,
P <.001), and more requests for additional examinations (28.4% vs 36.3%).
CONCLUSION: Disagreement between interpretations of reduced- and full-proto
col images might be attributable to baseline-level intraobserver inconsiste
ncy, as demonstrated in control designs. A greater number of sequences did
not lead to greater consistency.