Quality statement 3: Magnetic resonance imaging

Quality statement

Adults who meet the criteria for neuroimaging for epilepsy have magnetic resonance imaging.

Rationale

Magnetic resonance imaging (MRI) is shown by evidence to be the most sensitive and specific neuroimaging option in terms of identifying structural abnormalities in the brain, but access to MRI scanning and reporting facilities varies across the country.

Quality measure

Structure:

a) Evidence of local arrangements for adults who meet the criteria for neuroimaging for epilepsy to have MRI.

b) Evidence of local arrangements for adults with learning disabilities who meet the criteria for neuroimaging for epilepsy to have MRI.

Process: Proportion of adults who meet the criteria for neuroimaging for epilepsy who have MRI.

Numerator – the number of people in the denominator who have MRI.

Denominator – the number of adults who meet the criteria for neuroimaging for epilepsy.

What the quality statement means for each audience

Service providers ensure systems are in place for adults who meet the criteria for neuroimaging for epilepsy to have MRI.

Healthcare professionals ensure that adults who meet the criteria for neuroimaging for epilepsy to have MRI.

Commissioners ensure they commission services for adults who meet the criteria for neuroimaging for epilepsy to have MRI.

Adults who are having neuroimaging (taking pictures of the brain) for epilepsy have magnetic resonance imaging (a type of neuroimaging that uses magnetic fields to produce a picture of the brain; often shortened to MRI).

Source guidance

NICE clinical guideline 137 recommendation 1.6.20.

Data source

Structure: a) and b) Local data collection.

Process: Local data collection.

Definitions

Neuroimaging should be used to identify structural abnormalities that cause certain epilepsies. People diagnosed with idiopathic generalised epilepsy are unlikely to have any aetiologically relevant structural abnormalities and should not therefore undergo neuroimaging.

The criteria for MRI in adults are new-onset epilepsy or failure of first-line medication, unless there is a clear diagnosis of idiopathic generalised epilepsy.

In acute situations computed tomography may be used to determine whether a seizure has been caused by an acute neurological lesion or illness.

Equality and diversity considerations

The same services, investigations and therapies should be offered to adults with learning disabilities or challenging behaviour as are offered to the general population.

Adults with learning disabilities or challenging behaviour might need particular care and attention to help them tolerate investigations. Reasonable adjustment, such as offering open-bed scanners, sedation or general anaesthesia should be made if necessary to ensure all people who need MRI have access to it.