Routine Cross-Sectional Head Imaging Before Electroconvulsive Therapy: A Tertiary Center Experience

Area of Science:

• Neurology
• Radiology
• Psychiatry

Background:

• Electroconvulsive therapy (ECT) is typically contraindicated in patients with intracranial mass lesions or elevated intracranial pressure.
• Routine cross-sectional head imaging (CT/MRI) is often performed to screen for these contraindications prior to ECT.

Purpose of the Study:

• To determine the prevalence of incidental abnormalities on routine head imaging that would contraindicate ECT.
• To assess the cost-effectiveness of routine pre-ECT neuroimaging.

Main Methods:

• Retrospective review of 108 head CT/MRI scans from 105 patients evaluated for pre-ECT clearance between 2007 and 2015.
• Calculation of the probability of identifying ECT-precluding findings.
• Cost analysis of the practice.

Main Results:

• Only 1 out of 108 scans (0.93%) showed findings precluding ECT.
• No scans indicated increased intracranial pressure.
• Identifying one patient with a contraindication costs at least $18,662.70 and 521.97 relative value units.

Conclusions:

• The prevalence of intracranial abnormalities precluding ECT on routine head imaging is extremely low.
• The cost of identifying these rare contraindications is high.
• Pre-ECT neuroimaging should be guided by clinical examination findings rather than routine screening.