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The Australian Diagnostic Criteria for Contrast-Induced Encephalopathy
Frederick P Mariajoseph1,2, Leon T Lai3,4, Adrian Praeger3,4
1Monash University, Melbourne , Australia. frederick.mariajoseph@gmail.com.
Insights
This study developed 14 diagnostic criteria for contrast-induced encephalopathy (CIE) using expert consensus. These criteria aim to improve the challenging diagnosis of CIE by providing clear guidelines for neurovascular specialists.
Area of Science:
- Neurology
- Radiology
- Clinical Diagnostics
Background:
- Contrast-induced encephalopathy (CIE) is a known complication of contrast media administration.
- Diagnosis of CIE is challenging due to overlapping symptoms with other neurological conditions and lack of formal diagnostic criteria.
Purpose of the Study:
- To establish formal diagnostic criteria for contrast-induced encephalopathy (CIE).
- To improve the diagnostic accuracy and consistency of CIE identification among clinicians.
Main Methods:
- A modified Delphi study involving 17 Australian neurovascular specialists.
- Iterative consensus rounds based on literature review and case analysis.
- Consensus defined as ≥75% agreement on diagnostic items.
Main Results:
- A 14-item diagnostic criteria for CIE was developed through expert consensus.
- Key exclusion criteria include symptom onset >24h post-contrast or alternative explanations.
- Supporting criteria involve symptom reversibility and imaging findings like contrast staining or edema.
Conclusions:
- The study proposes a novel 14-item diagnostic criteria for CIE based on Australian expert consensus.
- Further research is recommended to validate and refine CIE as a distinct clinical entity.
Introduction:
Contrast-induced encephalopathy (CIE) is a recognised complication of contrast administration, however diagnosis remains challenging due to its symptom overlap with other neurological conditions and the absence of formal diagnostic criteria.
Methods:
A modified Delphi study was performed. Consultant physicians with active clinical experience with CIE patients were invited from neurovascular centres in Australia. Initial diagnostic items were derived from an extensive literature review and analysis of local institutional cases across Australia. Three Delphi rounds were conducted. Consensus was defined as ≥ 75% agreement.
Results:
Seventeen neurovascular specialists from nine neurovascular centres participated (81.0% response rate) between May 2024 and July 2024. In round 1, 15 diagnostic items were presented to participants, which were revised and one additional criteria suggested. In round 2, 14/16 diagnostic items achieved consensus. In round three 14/14 items achieved consensus. Ultimately, a 14-item diagnostic criteria was developed based on participant consensus. The absolute criteria exclude CIE if symptom onset is more than 24 h after contrast administration, or if symptoms can be explained by vessel occlusion/territory ischaemia, intracranial haemorrhage, epilepsy, metabolic derangement, intracranial malignancy or head trauma. The supporting criteria indicate that CIE is more probable if symptoms are reversible, correspond with the distribution of contrast administration, or are associated with reversible contrast staining, cerebral oedema or cortical/subcortical MRI signal change.
Conclusion:
This study proposes a 14-item diagnostic criteria for CIE based on expert consensus in Australia. Further research is needed to refine CIE as a clinical entity.
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