MRI referrals

Access to MRI is still limited apart from the brain imaging direct access pathway.

For all other requests, the appropriate specialist advice and guidance must be sought and the need for imaging agreed.

Brain imaging direct access pathway

The pathway is split into three options:

• Very strong suspicion of cancer
• Chronic headache (≥6 weeks)
• Brain scan suggested by Neurology advice and guidance

Very strong suspicion of cancer

The patient should fit the two week wait criteria. A request should be made using the brain imaging referral form, selecting the urgent brain imaging (two week wait) referral option.

Essential criteria:

• Evidence of progressive, sub-acute loss of neurological and/or cognitive function
• No red flags requiring hospital admission
  • If there are any red flags that may require hospital admission the patient should be sent to the local Emergency Department
• No known primary cancer
• No suspected dementia
  • If the patient has suspected dementia please refer to the Memory Clinic

Chronic headache

The patient must have suffered a chronic headache for at least six weeks to use this referral method.

A request should be made using the brain imaging referral form selecting the routine brain imaging referral option.

Brain scan suggested by Neurology advice and guidance

For all other brain related queries, please contact the Neurology advice and guidance team.

If brain imaging is warranted, the Neurology team will document this in their response along with the degree of urgency. This evidence should then be attached to/embedded in the brain imaging referral form, selecting the routine brain imaging referral via neurology advice and guidance option.

Brain imaging referral guidance

Referral form

The MRI brain imaging referral form:

• can be used by any medical practitioner in primary care only
• should be used for adult patients (aged ≥16 years) who are suspected of having brain cancer and have not had a scan in the last six weeks

Prior to referral, GPs need to ensure the patient is aware that they are being investigated for cancer and may be recalled for further tests.

Who should not be referred using this form?

Patients:

• that have undergone a scan which shows a suspected brain tumour need to be referred to the correct MDT or specialist service. If you are unsure service to select, please submit an advice and guidance request to Neurology who will facilitate this
• with known conditions that predispose to intracranial or spinal problems (e.g. active cancer or HIV, who develop a new headache should be discussed with the relevant team first)
• with proven or suspected acoustic neuromas (new unilateral hearing loss and/or tinnitus) are not in this pathway. They should be referred to ENT at their local DGH on a routine basis
• with suspected temporal arteritis should not be referred through this pathway. There is a separate GCTA pathway
• who have had a suspected seizure need to be referred to Neurology first fit clinic

The following are considered emergency presentations and patients should be sent to the nearest Emergency Department:

• Sudden onset headache (thunderclap) – suspected sub-arachnoid haemorrhage
• High temperature and stiff neck – suspected meningitis
• newly identified papilloedema – suspected space occupying lesion with critical mass effect
• pregnant or has just given birth with new headache, seizures, focal neurological signs, or visual or cognitive impairment – suspected venous sinus thrombosis
• sudden onset weakness, speech arrest, visual loss or ataxia – suspected stroke

Scan outcome

If the scan is normal or has findings other than a brain cancer, the patient will be referred back to their GP for further management if required. If the problem persists, please refer to Neurology services locally or through choose and book.

The MRI scan will be used as a screen for brain cancer only. It will not detect other pathology such as sub-acute stroke or MS. If you suspect something other than a brain tumour, refer to local Neurology services or discuss the case with the on call neurology registrar.

The more information we have the better, please include any old records that you feel are relevant.