Have Clinicians Adopted the Use of Brain MRI for Patients with TIA and Minor Stroke?

Overview

Journal Neurology

Specialty Neurology

Date 2016 Dec 9

PMID 27927939

Citations 13

Authors

Seemant Chaturvedi

Susan Ofner

Fitsum Baye

Laura J Myers

Mike Phipps

Jason J Sico

Teresa Damush

Edward Miech

Mat Reeves

Jason Johanning

Linda S Williams

Greg Arling

Eric Cheng

Zhangsheng Yu

Dawn Bravata

Affiliations

Soon will be listed here.

Abstract

Background: Use of MRI with diffusion-weighted imaging (DWI) can identify infarcts in 30%-50% of patients with TIA. Previous guidelines have indicated that MRI-DWI is the preferred imaging modality for patients with TIA. We assessed the frequency of MRI utilization and predictors of MRI performance.

Methods: A review of TIA and minor stroke patients evaluated at Veterans Affairs hospitals was conducted with regard to medical history, use of diagnostic imaging within 2 days of presentation, and in-hospital care variables. Chart abstraction was performed in a subset of hospitals to assess clinical variables not available in the administrative data.

Results: A total of 7,889 patients with TIA/minor stroke were included. Overall, 6,694 patients (84.9%) had CT or MRI, with 3,396/6,694 (50.7%) having MRI. Variables that were associated with increased odds of CT performance were age >80 years, prior stroke, history of atrial fibrillation, heart failure, coronary artery disease, anxiety, and low hospital complexity, while blood pressure >140/90 mm Hg and high hospital complexity were associated with increased likelihood of MRI. Diplopia (87% had MRI, p = 0.03), neurologic consultation on the day of presentation (73% had MRI, p < 0.0001), and symptom duration of >6 hours (74% had MRI, p = 0.0009) were associated with MRI performance.

Conclusions: Within a national health system, about 40% of patients with TIA/minor stroke had MRI performed within 2 days. Performance of MRI appeared to be influenced by several patient and facility-level variables, suggesting that there has been partial acceptance of the previous guideline that endorsed MRI for patients with TIA.

Citing Articles

A Machine Learning Approach to Support Urgent Stroke Triage Using Administrative Data and Social Determinants of Health at Hospital Presentation: Retrospective Study.

Chen M, Tan X, Padman R J Med Internet Res. 2023; 25:e36477.

PMID: 36716097 PMC: 9926350. DOI: 10.2196/36477.

Trends in Utilization of Magnetic Resonance Imaging for Stroke Patients With Cardiac Rhythm Devices.

Culbertson C, Perino A, Gardner R, Balasubramanian V, Vora N Neurohospitalist. 2022; 12(4):624-631.

PMID: 36147760 PMC: 9485690. DOI: 10.1177/19418744221115004.

Clinical Diagnosis and Magnetic Resonance Imaging in Patients With Transient and Minor Neurological Symptoms: A Prospective Cohort Study.

Whiteley W, MacRaild A, Wang Y, Dennis M, Salman R, Gray A Stroke. 2022; 53(11):3419-3428.

PMID: 35942881 PMC: 9586820. DOI: 10.1161/STROKEAHA.122.039082.

Identifying transient ischemic attack (TIA) patients at high-risk of adverse outcomes: development and validation of an approach using electronic health record data.

Myers L, Perkins A, Zhang Y, Bravata D BMC Neurol. 2022; 22(1):256.

PMID: 35820867 PMC: 9275263. DOI: 10.1186/s12883-022-02776-1.

Increasing the Awareness of Stroke Among Canadian Women.

Alimi I, Archibald A, Nwankwo O, Palanichami D, Oladimeji T, Keku E Cureus. 2022; 14(3):e23159.

PMID: 35433145 PMC: 9007617. DOI: 10.7759/cureus.23159.

References

Burke J, Gelb D, Quint D, Morgenstern L, Kerber K . The impact of MRI on stroke management and outcomes: a systematic review. J Eval Clin Pract. 2012; 19(6):987-93. DOI: 10.1111/jep.12011. View

Coutts S, Modi J, Patel S, Demchuk A, Goyal M, Hill M . CT/CT angiography and MRI findings predict recurrent stroke after transient ischemic attack and minor stroke: results of the prospective CATCH study. Stroke. 2012; 43(4):1013-7. DOI: 10.1161/STROKEAHA.111.637421. View

Murchison A, Gilbert M, Savino P . Neuroimaging and acute ocular motor mononeuropathies: a prospective study. Arch Ophthalmol. 2011; 129(3):301-5. DOI: 10.1001/archophthalmol.2011.25. View

Easton J, Saver J, Albers G, Alberts M, Chaturvedi S, Feldmann E . Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on.... Stroke. 2009; 40(6):2276-93. DOI: 10.1161/STROKEAHA.108.192218. View

Giles M, Albers G, Amarenco P, Arsava E, Asimos A, Ay H . Early stroke risk and ABCD2 score performance in tissue- vs time-defined TIA: a multicenter study. Neurology. 2011; 77(13):1222-8. PMC: 3179650. DOI: 10.1212/WNL.0b013e3182309f91. View

Yaghi S, Rostanski S, Boehme A, Martin-Schild S, Samai A, Silver B . Imaging Parameters and Recurrent Cerebrovascular Events in Patients With Minor Stroke or Transient Ischemic Attack. JAMA Neurol. 2016; 73(5):572-8. PMC: 5022560. DOI: 10.1001/jamaneurol.2015.4906. View

Coutts S, Simon J, Eliasziw M, Sohn C, Hill M, Barber P . Triaging transient ischemic attack and minor stroke patients using acute magnetic resonance imaging. Ann Neurol. 2005; 57(6):848-54. DOI: 10.1002/ana.20497. View

Al-Khaled M, Eggers J . MRI findings and stroke risk in TIA patients with different symptom durations. Neurology. 2013; 80(21):1920-6. DOI: 10.1212/WNL.0b013e318293e15f. View

Fiebach J, Schellinger P, Jansen O, Meyer M, Wilde P, Bender J . CT and diffusion-weighted MR imaging in randomized order: diffusion-weighted imaging results in higher accuracy and lower interrater variability in the diagnosis of hyperacute ischemic stroke. Stroke. 2002; 33(9):2206-10. DOI: 10.1161/01.str.0000026864.20339.cb. View

10.

Merwick A, Albers G, Amarenco P, Arsava E, Ay H, Calvet D . Addition of brain and carotid imaging to the ABCD² score to identify patients at early risk of stroke after transient ischaemic attack: a multicentre observational study. Lancet Neurol. 2010; 9(11):1060-9. DOI: 10.1016/S1474-4422(10)70240-4. View

11.

Purroy F, Jimenez-Caballero P, Mauri-Capdevila G, Torres M, Gorospe A, Ramirez Moreno J . Predictive value of brain and vascular imaging including intracranial vessels in transient ischaemic attack patients: external validation of the ABCD3-I score. Eur J Neurol. 2013; 20(7):1088-93. DOI: 10.1111/ene.12141. View

12.

Coutts S, Cucchiara B . Stroke risk after TIA: DWI is only part of the answer. Neurology. 2013; 80(21):1914-5. DOI: 10.1212/WNL.0b013e318293e3ac. View

13.

Mitchell J, Ballard D, Whisnant J, Ammering C, Samsa G, Matchar D . What role do neurologists play in determining the costs and outcomes of stroke patients?. Stroke. 1996; 27(11):1937-43. DOI: 10.1161/01.str.27.11.1937. View

14.

Kidwell C, Alger J, Di Salle F, Starkman S, Villablanca P, Bentson J . Diffusion MRI in patients with transient ischemic attacks. Stroke. 1999; 30(6):1174-80. DOI: 10.1161/01.str.30.6.1174. View

15.

Amarenco P, Lavallee P, Labreuche J, Albers G, Bornstein N, Canhao P . One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke. N Engl J Med. 2016; 374(16):1533-42. DOI: 10.1056/NEJMoa1412981. View

16.

Burke J, Kerber K, Iwashyna T, Morgenstern L . Wide variation and rising utilization of stroke magnetic resonance imaging: data from 11 states. Ann Neurol. 2012; 71(2):179-85. PMC: 3297973. DOI: 10.1002/ana.22698. View

17.

Orme N, Fletcher J, Siddiki H, Harmsen W, OByrne M, Port J . Incidental findings in imaging research: evaluating incidence, benefit, and burden. Arch Intern Med. 2010; 170(17):1525-32. PMC: 3721142. DOI: 10.1001/archinternmed.2010.317. View

18.

Vernooij M, Ikram M, Tanghe H, Vincent A, Hofman A, Krestin G . Incidental findings on brain MRI in the general population. N Engl J Med. 2007; 357(18):1821-8. DOI: 10.1056/NEJMoa070972. View

19.

Roquer J, Rodriguez-Campello A, Cuadrado-Godia E, Vivanco-Hidalgo R, Jimenez-Conde J, Perich X . Acute brain MRI-DWI patterns and stroke recurrence after mild-moderate stroke. J Neurol. 2010; 257(6):947-53. DOI: 10.1007/s00415-009-5443-5. View