Increased rate of significant findings on brain MRI during the early stage of the COVID-19 pandemic

Objectives To assess the effect of the COVID-19 pandemic on the proportion of abnormal paediatric neuroimaging findings as a surrogate marker for potential underutilisation. Methods Consecutive paediatric brain MRIs performed between March 27th and June 19th 2019 (T-baseline) and March 23rd and June 1st 2020 (T-pandemic) were reviewed and classified according to presence or absence and type of imaging abnormality, and graded regarding severity on a 5-point Likert scale, where grade 4 was defined as abnormal finding requiring non-urgent intervention and grade 5 was defined as acute illness prompting urgent medical intervention. Non-parametric statistical testing was used to assess for significant differences between T-pandemic vs. T-baseline. Results Fewer paediatric MRI brains were performed during T-pandemic compared to T-baseline (12.2 vs 14.7 examinations/day). No significant difference was found between the two time periods regarding sex and age (T-baseline: 557 females (44.63%), 7.95 & PLUSMN; 5.49 years, T-pandemic: 385 females (44.61%), 7.64 & PLUSMN; 6.11 years; p = 1 and p = .079, respectively). MRI brain examinations during T-pandemic had a higher likelihood of being abnormal, 41.25% vs. 25.32% (p<.0001). Vascular abnormalities were more frequent during T-pandemic (11.01% vs 8.01%, p = .02), congenital malformations were less common (8.34% vs 12.34%, p = .004). Severity of MRI brain examinations was significantly different when comparing group 4 and group 5 individually and combined between T-baseline and T-pandemic (p = .0018, p < .0001, and p <.0001, respectively). Conclusions The rate of abnormality and severity found on paediatric brain MRI was significantly higher during the early phase of the pandemic, likely due to underutilisation.