Elsevier

Clinical Radiology

Volume 58, Issue 3, March 2003, Pages 234-237
Clinical Radiology

Audit of a Policy of Magnetic Resonance Imaging with Diffusion-weighted Imaging as First-line Neuroimaging for In-patients with Clinically Suspected Acute Stroke

https://doi.org/10.1016/S0009-9260(02)00463-4Get rights and content

Abstract

AIM: To audit the feasibility and use of diffusion-weighted (DW) magnetic resonance imaging (MRI) as initial neuroimaging for in-patients with clinically suspected acute stroke.

MATERIALS AND METHODS: In April 2000, MRI with DW and T2-weighted sequence was locally instituted as initial neuroimaging for patients with clinically suspected acute stroke. This retrospective study reviewed imaging performed for in-patients with suspected acute stroke over a 9-month period. Data were collected on image type, result and need for repeat imaging.

RESULTS: During the study period, 124 patients had neuroimaging for suspected cerebrovascular accident, and 119 were MRI safe. Eighty-eight (73.9%) patients underwent DW MRI as first-line investigation. Five patients were not MRI safe and 31 had computed tomography (CT) as first-line imaging due to lack of available MRI capacity. Repeat neuroimaging was performed in 16 (12.9%) patients. Study times were comparable for both types of neuroimaging: a mean of 13 min for MRI and 11 min for CT.

CONCLUSION: The audit standard was achieved in 88 (73.9%) patients. The use of DW MRI as a first-line investigation for patients with a clinical diagnosis of acute stroke is achievable in a district general hospital setting.

Section snippets

Methods

The Departments of Neurology and Radiology formally agreed that DW MRI be instituted as first-line neuroimaging for patients with suspected acute stroke in April 2000, in patients with no contraindication to MRI based on published evidence 7, 8, 9, 10, 11, 12. Patients with suspected subarachnoid haemorrhage, decreased levels of consciousness or acute confusional states were excluded.

A 1.5 T Siemens Symphony system (Erlangen, Germany) with Quantum gradients was used to perform MRI studies. The

Results

A total of 382 in-patient requests for neuroimaging were identified in the study period, 124 of which queried acute stroke. One hundred and nineteen patients were suitable for having MRI as first-line study, of whom 31 patients were examined using CT (due to lack of MR capacity), indicating the audit standard was achieved in 73.9% of patients (Table 1). For a variety of reasons (including several patients who were too confused to answer the MRI safety questionnaire and a patient with a

Discussion

DW MRI for detection of stroke is more sensitive than conventional CT and has greater interobserver agreement [14]. The high contrast on B1000 images simplifies the diagnosis of acute stroke. The major issues in using MRI over CT for suspected stroke are: selection of MRI sequences used, patient safety, identification of haemorrhage and timely availability of MRI.

The choice of MRI sequences will determine diagnostic accuracy and length of examination. DW MRI detects acute stroke in 94% of

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