The Utility of Brain Magnetic Resonance Imaging/Angiography and Neck Magnetic Resonance Angiography in Patients with Suspected Acute Stroke

Abstract

In our health maintenance organization, we have seen a trend among our referring physicians to order simultaneous brain magnetic resonance imaging (MRI), head magnetic resonance angiography (MRA), and neck MRA in the evaluation of patients for acute stroke. However, there are little data to demonstrate any improvement in patient care resulting from ordering this triple study. The objective of this study was to analyze the utility of the triple MRI/MRA study for patients who experience stroke-like symptoms. We reviewed all triple-study cases between January 1, 2013 and December 31, 2016. We recorded whether or not an acute stroke occurred, the presence or absence of a major stenosis in the intracranial and/or neck arteries, subsequent percutaneous endovascular or open surgical intervention within 90 days, and any follow-up computed tomography angiography or carotid ultrasound studies within 30 days. During the studied period, 591 triple studies were ordered, and 162 patients (27.4%) were found to have moderate or severe stenosis. Of the patients who had an acute stroke, 100 (48.3%) also had a major stenosis. Of 591 patients, only 15 (2.5%) underwent percutaneous endovascular or open surgical intervention within 90 days. Of these, 4 patients had an intervention in less than a week; in all of the cases, the triple study did not need to be ordered simultaneously to achieve the same clinical outcome. Brain MRI, head MRA, and neck MRA studies should not be ordered simultaneously as a generalized response to patients presenting with acute stroke-like symptoms.