Imaging Recommendations for Acute Stroke and Transient Ischemic Attack Patients: A Joint Statement by the American Society of Neuroradiology, the American College of Radiology, and the Society of NeuroInterventional Surgery

Multimodal CT Provides Improved Performance for Lacunar Infarct Detection

“…Therefore, although MR imaging triage is recommended by consensus, this is usually after a decision to treat based on NCCT. 33 We argue simply that CTA and CTP use improves initial detection over NCCT without precluding subsequent MR imaging use according to institutional resource availability. Dose is important in terms of overall population burden, and conscientious effort should be made to conform to "as low as reasonably achievable" principles and to reduce the dose in all patients.…”

“…The largest contributor to dose remains the CTA component, due to spatial coverage and exposure to the thyroid and lenses. MR imaging in acute ischemic stroke is considered a reference standard 33 and indeed provides superior infarct core delineation. Unfortunately, the overwhelming majority of tertiary stroke centers and other hospitals receiving patients with acute ischemic stroke do not have acute MR imaging access.…”

Optimal MRI Sequence for Identifying Occlusion Location in Acute Stroke: Which Value of Time-Resolved Contrast-Enhanced MRA?

“…It was therefore possible to initiate optimal management without delay. 12 The imaging protocol consisted of parenchymal brain imaging sequences (axial DWI, GRE T2, and FLAIR) and angiographic sequences (3D-TOF and TR-CE MRA). The MRA acquisition parameters are provided in Table 1.…”

“…Some studies have demonstrated that the extra time needed to perform this additional sequence does not adversely affect outcomes. 6,7 However, despite high sensitivity and specificity (85%-100% and 91%-100%, respectively) in identifying the absence of blood flow, [8][9][10][11] 3D-TOF cannot provide direct visualization of the thrombus 12 and may misidentify the occlusion location due to its lack of sensitivity to slow flow. 13,14 The gradient-echo T2 (GRE T2) sequence provides additional data at 77%-83% sensitivity for intracranial thrombus identification.…”

Utilization and likelihood of radiologic diagnostic imaging in patients with implantable cardiac defibrillators

“…For joint pain and lower back pain, MRI is cited as an appropriate diagnostic method by the American College of Radiology 5. For stroke, an MRI method known as diffusion‐weighted imaging (DWI), has emerged as a sensitive and specific technique 6, 7, 8. In these conditions and others, such as cardiomyopathy,9, 10, 11, 12 MRI has emerged as a preferred imaging modality because it provides excellent spatial resolution without exposing patients to ionizing radiation, iodinated contrast agents, and risks of invasive procedures 13…”