MRI Brain — Outpatient
MRIEpilepsy (NG217 Rec 1.3.1)
Offer MRI to ALL diagnosed epilepsy patients, with exceptions for idiopathic generalised epilepsy and self-limited epilepsy with centrotemporal spikes
- Offer MRI to ALL diagnosed epilepsy patientsNICE NG217 Rec 1.3.1
- Exceptions: idiopathic generalised epilepsy; self-limited epilepsy with centrotemporal spikes
- CT only if MRI contraindicatedNICE NG217 Rec 1.3.2
- Reports by neuroradiologistNICE NG217 Rec 1.3.4
Multiple sclerosis (NG220 Rec 1.1.3)
— ALL of the following must be met
- MRI essential for diagnosis using 2017 McDonald criteriaNICE NG220 Rec 1.1.3
- Dissemination in space and time on MRI
- 2024 update: optic nerve added as fifth anatomical location
TIA (NG128 Recs 1.2.1–1.2.2)
Do NOT offer CT brain for suspected TIA; consider MRI with DWI and blood-sensitive sequences same day as specialist assessment
- Do NOT offer CT brain for suspected TIANICE NG128 Rec 1.2.1
- Consider MRI with DWI and blood-sensitive sequences same day as specialist assessmentNICE NG128 Rec 1.2.2
Brain tumour (NG12 Rec 1.9.1; NG99)
— ANY of the following
- Urgent MRI (or CT if MRI contraindicated) within 2 weeks for progressive sub-acute loss of central neurological functionNICE NG12 Rec 1.9.1
- MRI preferred over CT
- Consider advanced MRI (perfusion, spectroscopy) for high-grade transformation
Dementia (NG97 Rec 1.2.12)
— ANY of the following
- Structural imaging (CT or MRI) to rule out reversible causesNICE NG97 Rec 1.2.12
- MRI preferred when vascular dementia suspected
Headache — NOTE ONLY (when NOT indicated)
Do NOT refer for neuroimaging for tension-type, migraine, cluster, or medication-overuse headache. Imaging IS indicated for red flags.
- Do NOT refer for neuroimaging for: tension-type, migraine, cluster, medication-overuse headacheNICE CG150
- Imaging IS indicated for red flags: thunderclap, new deficit, altered consciousness, positional, progressive
Pituitary
— ANY of the following
- MRI with dedicated pituitary protocol
Notes
Do NOT routinely image headache without red flags
NICE CG150MRI epilepsy reports must be by neuroradiologist
NICE NG217ABCD2 no longer recommended for TIA
NICE NG128MRI preferred over CT for all outpatient brain indications
MRI brain can be performed in pregnancy if clinically indicated. Gadolinium is contraindicated except when essential.
MRI preferred. Superior soft tissue contrast; no ionising radiation; preferred for all listed outpatient indications
Source: NG217; NG220; NG97; NG99; CG150