Inattentional blindness to DWI lesions in spontaneous intracerebral hemorrhage

Purpose: Inattentional blindness refers to when an individual fails to recognize an event or object due to their awareness being engaged in a different task and has been described in radiology. The purpose of this study is to determine whether the sensitivity of detecting diffusion-weighted imaging (DWI) lesions in spontaneous intracerebral hemorrhage (sICH) is reduced due to inattentional blindness. Methods: Using a prospective observational cohort, select sICH patients received an MRI scan within 72 h of admission. The scans were subject to an “official read” that occurred as part of the routine workflow. Separately, each scan underwent two “preliminary research reads” with task-specific instructions to detect DWI lesions. A “final research read” via three-party adjudication was used to calculate sensitivity and specificity for detecting these lesions. Board-certified neuroradiologists blinded to the clinical history of the patients reviewed all imaging. Results: Amongst 121 sICH participants with research MRI scans, 49.6% (n = 60) scans were noted to have DWI lesion on their “final research read.” The “official read” detected these DWI lesions with a sensitivity of 65% (95% CI, 52–77%). In contrast, the “preliminary research read” sensitivity for readers 1 and 2 was 98% (CI 95%, 91 to 100%) and 87% (CI 95%, 75 to 94%), respectively. Both were significantly different (p < 0.05) from the sensitivity of the “official read.” Conclusions: Given the increased sensitivity with task-specific instructions, our results suggest that inattentional blindness may be leading to the decreased detection of DWI lesions in patients with concomitant sICH.