title: The Addition of MRI to CT Based Stroke and TIA Evaluation Does Not Impact One year Outcomes.
abstract: BACKGROUND
  The 2010 American Academy of Neurology guideline for the diagnosis of acute ischemic stroke recommends MRI with diffusion weighted imaging (DWI) over noncontrast head CT. No studies have evaluated the influence of imaging choice on patient outcome. We sought to evaluate the variables that influenced one-year outcomes of stroke and TIA patients, including the type of imaging utilized.
  
  
  METHODS
  Patients were identified from a prospectively collected stroke and TIA database at a single primary stroke center during a one-year period. Data were abstracted from patient electronic medical records. The primary outcome measure was death, myocardial infarction, or recurrent stroke within the following year. Secondary outcome measures included predictors of getting an MRI study.
  
  
  RESULTS
  727 consecutive patients with a discharge diagnosis of stroke or TIA were identified (616 and 111 respectively); 536 had CT and MRI, 161 had CT alone, 29 had MRI alone, and one had no neuroimaging. On multiple logistic regression analysis, there were no differences in primary or secondary outcome measures among different imaging strategies. Predictors of the primary outcome measure included age and NIHSS, while performance of a CT angiogram (CTA) predicted a decreased odds of death, stroke, or MI. The strongest predictor of having an MRI was admission to a stroke unit.
  
  
  CONCLUSIONS
  These results suggest that long-term (one-year) patient outcomes may not be influenced by imaging strategy. Performance of a CTA was protective in this cohort. A randomized trial of different imaging modalities should be considered.
authors.affiliation: Henry Ford Hospital, 2799 W. Grand Blvd. Detroit MI 48202, USA.
authors.forename: Hebah
authors.initials: H
authors.lastname: Hefzy
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Neil
authors.forename: Patricia
authors.initials: P
authors.lastname: Penstone
authors.forename: Meredith
authors.initials: M
authors.lastname: Mahan
authors.forename: Panayiotis
authors.initials: P
authors.lastname: Mitsias
authors.forename: Brian
authors.initials: B
authors.lastname: Silver
keywords: CT.; Imaging modality; MRI; Outcomes; Stroke
references.citation: Stroke. 2009 Jun;40(6):2276-93
references.pmid: 19423857
references.citation: JAMA. 2000 Jun 21;283(23):3102-9
references.pmid: 10865305
references.citation: Neurology. 2010 Jul 13;75(2):177-85
references.pmid: 20625171
references.citation: J Neurol Neurosurg Psychiatry. 2005 Nov;76(11):1528-33
references.pmid: 16227545
references.citation: Lancet. 1981 Jul 11;2(8237):53-7
references.pmid: 6113437
references.citation: Circulation. 2011 Feb 1;123(4):e18-e209
references.pmid: 21160056
references.citation: Stroke. 2010 Sep;41(9):1907-13
references.pmid: 20634480
references.citation: Stroke. 2012 Dec;43(12):3343-51
references.pmid: 23160884
references.citation: Lancet. 2007 Jan 27;369(9558):293-8
references.pmid: 17258669
references.citation: J Neurol Neurosurg Psychiatry. 2007 Jul;78(7):690-3
references.pmid: 17056623
references.citation: BMJ. 2011 Jan 31;342:d124
references.pmid: 21282258
references.citation: N Engl J Med. 1995 Dec 14;333(24):1581-7
references.pmid: 7477192
references.citation: Stroke. 2009 Feb;40(2):350-4
references.pmid: 19023098
references.citation: Stroke. 2004 Feb;35(2):502-6
references.pmid: 14739410
references.citation: JAMA. 2004 Oct 20;292(15):1823-30
references.pmid: 15494579
references.citation: Proc R Soc Med. 1973 Aug;66(8):833-4
references.pmid: 4733985
references.citation: Neurology. 2010 Jan 12;74(2):128-35
references.pmid: 20018608
references.citation: Stroke. 2007 May;38(5):1655-711
references.pmid: 17431204
references.citation: AJNR Am J Neuroradiol. 1990 May;11(3):423-9
references.pmid: 2161612
references.citation: Stroke. 2000 Feb;31(2):456-62
references.pmid: 10657422
references.citation: Int J Stroke. 2009 Dec;4(6):448-53
references.pmid: 19930054
references.citation: N Engl J Med. 2008 Sep 25;359(13):1317-29
references.pmid: 18815396