MRI improves outcomes in suspected stroke patients

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Patients presenting to the emergency department (ED) with dizziness may benefit from an additional MRI exam over CT angiography (CTA) alone for diagnosing strokes, according to a recent study.

Researchers led by Long Tu, of Yale University in New Haven, CT, studied outcomes of patients who underwent head and neck CTA and patients who underwent brain MRI with or without CTA. They found a proportion of patients discharged after CTA may have benefitted from an additional MRI exam.

"The use of MRI in select patients presenting to the ED with dizziness was associated with greater frequency of critical neuroimaging results," the group wrote in an article published July 5 in the American Journal of Roentgenology

Detecting stroke as the cause of dizziness in patients presenting to EDs is challenging, with up to 40% of underlying strokes missed in these settings on first presentation, the authors explained. Although MRI is more sensitive than CT for stroke diagnosis, it is less commonly performed, they added.

Thus, to explore evidence on the use of MRI in these cases, the researchers gathered imaging data from 1,917 patients (776 men and 1,141 women; mean age, 59.5 years) who presented with dizziness at their hospital from January 1, 2018 to December 31, 2021. They used a statistical analysis method called propensity score matching to compare outcomes in patients. They also studied whether an abbreviated MRI protocol was effective.

Ultimately, patients with dizziness undergoing MRI versus CTA alone showed greater frequency of change in secondary stroke prevention medication (9.6% vs. 3.2%) and subsequent echocardiography (6.4% vs. 1.0%). In addition, the abbreviated MRI protocol was associated with lower frequency of 90-day ED readmissions (12% vs. 28%), according to the results.

"A proportion of patients discharged after CT with CTA alone may have benefitted from alternative or additional evaluation by MRI, including MRI using a specialized abbreviated protocol," the group wrote.

The researchers noted that at their institution, MRI is available on a 24/7 basis, although patients presenting to the ED must be transported to and from the ED to undergo MRI. Moreover, prior research has shown that abbreviated MRI is logistically feasible for patients who present to the ED with potential stroke, even if an MRI scanner is not present within the ED, they added.

"When available, use of MRI may motivate clinically impactful management changes in patients presenting with dizziness," the group concluded.

The full study can be accessed here.

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