Time is Brain: CT vs. MRI for Stroke Imaging

The cost of inpatient stroke care has risen drastically since 1997, with the largest driver of that increase being neuroimaging. A recent study published in the Annals of Neurology found that 95% of stroke patients who received an MRI also had a CT scan.

When imaging potential stroke patients, ED physicians have always turned to CT first because of its speed. However, advancements in MRI (with 1.5-3T field strength, especially with diffusion-weighted imaging) have led many physicians to prefer the greater sensitivity of MRI over CT for acute ischemia. While an MRI scan can provide greater sensitivity, it takes longer and costs more than a CT. Time is extremely important in an acute ischemic stroke event, where 1.9 million neurons are lost each minute, translating to 4 years of again for every hour without treatment.

Neuroimaging practices for stroke are not standardized and in a time when healthcare costs are under serious scrutiny, should stroke patients be getting a CT and an MRI? What can be done to make MRI more available in the setting of acute stroke? What can be done to develop better standards of practice in stroke imaging in general?

By: Vishal Verma, MD

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