Posted on 07/09/2023 11:27:19 AM PDT by ConservativeMind
According to a study, patients discharged from the emergency department (ED) after CT with CTA alone could have benefitted from an alternative or additional MRI evaluation, including using a specialized abbreviated protocol for the modality.
Compared with those patients discharged after CT with CTA only, "the use of MRI in select patients presenting to the ED with dizziness was associated with greater frequency of critical neuroimaging results, greater use of echocardiography, and greater frequency of a change in secondary stroke prevention medications," concluded Long H. Tu, MD.
The study included 1,917 patients (776 men and 1,141 women; mean age, 59.5 years) presenting to the ED with dizziness from January 1, 2018 to December 31, 2021. The initial propensity score matching analysis incorporated demographic characteristics, medical history, systems review, physical examination findings, as well as clinical symptoms to construct matched patients discharged from the ED after undergoing head CT with head and neck CTA alone and patients who underwent brain MRI—with or without CT and CTA.
Upon comparing those outcomes, a secondary assessment matched patients discharged after CT with CTA alone and patients who underwent specialized abbreviated MRI (i.e., multiplanar high-resolution DWI with ≤3 mm slice thickness) for increased sensitivity for posterior circulation stroke.
Ultimately, patients with dizziness undergoing MRI, versus CT with CTA alone, showed greater frequency of change in secondary stroke prevention medication (9.6% vs. 3.2%) and subsequent echocardiography (6.4% vs. 1.0%). Again, versus CT with CTA alone, Tu and colleagues' specialized abbreviated MRI protocol was also associated with lower frequency of 90-day ED readmissions (12.0% vs. 28.0%).
"When available," the authors acknowledged, "use of MRI may motivate clinically impactful management changes in patients presenting with dizziness."
(Excerpt) Read more at medicalxpress.com ...
CT scans with contrast can’t handle a variety of soft tissue concerns as well as MRIs. That said, with contrast, CTs/CTA do help.
Computed Tomography Angiography (CTA) is a medical test that combines a CT scan with an injection of a special dye to produce pictures of blood vessels and tissues in a part of the body
According to an ER doctor whom I met (in an ER) the most common cause of ER presentations of dizziness in people over 50 is vertigo. I'm only a superannuated manufacturing engineer, but I fail to see how either MRI or CTA would show that up in any case.
The report mentions changes in stroke medication.
IF you go to an ER with a headache and you’re if the elderly category stroke will be one the first things that is thought of. Hence the look at the brain to see if there’s a bleed
Shame on me - I missed that paragraph reading the link.
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