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Pannell JS, Corey AS, Shih RY, Austin MJ, Chu S, Davis MA, Ducruet AF, Hunt CH, Ivanidze J, Kalnins A, Lacy ME, Lo BM, Setzen G, Shaines MD, Soares BP, Soderlund KA, Thaker AA, Wang LL, Burns J. ACR Appropriateness Criteria® Cerebrovascular Diseases-Stroke and Stroke-Related Conditions. J Am Coll Radiol 2024; 21:S21-S64. [PMID: 38823945 DOI: 10.1016/j.jacr.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Cerebrovascular disease encompasses a vast array of conditions. The imaging recommendations for stroke-related conditions involving noninflammatory steno-occlusive arterial and venous cerebrovascular disease including carotid stenosis, carotid dissection, intracranial large vessel occlusion, and cerebral venous sinus thrombosis are encompassed by this document. Additional imaging recommendations regarding complications of these conditions including intraparenchymal hemorrhage and completed ischemic strokes are also discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Amanda S Corey
- Panel Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
| | - Robert Y Shih
- Panel Vice Chair, Uniformed Services University, Bethesda, Maryland
| | | | - Sammy Chu
- University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada
| | - Melissa A Davis
- Yale University School of Medicine, New Haven, Connecticut; Committee on Emergency Radiology-GSER
| | - Andrew F Ducruet
- Barrow Neurological Institute, Phoenix, Arizona, Neurosurgery expert
| | - Christopher H Hunt
- Mayo Clinic, Rochester, Minnesota; Commission on Nuclear Medicine and Molecular Imaging
| | | | | | - Mary E Lacy
- Washington State University, Spokane, Washington; American College of Physicians
| | - Bruce M Lo
- Sentara Norfolk General Hospital/Eastern Virginia Medical School, Norfolk, Virginia; American College of Emergency Physicians
| | - Gavin Setzen
- Albany ENT & Allergy Services, Albany, New York; American Academy of Otolaryngology-Head and Neck Surgery
| | - Matthew D Shaines
- Albert Einstein College of Medicine Montefiore Medical Center, Bronx, New York, Primary care physician
| | - Bruno P Soares
- Stanford University School of Medicine, Stanford, California
| | - Karl A Soderlund
- Uniformed Services University of the Health Sciences, Bethesda, Maryland; Naval Medical Center Portsmouth, Portsmouth, Virginia
| | | | - Lily L Wang
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Judah Burns
- Specialty Chair, Montefiore Medical Center, Bronx, New York
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Rapillo CM, Dunet V, Pistocchi S, Salerno A, Darioli V, Bartolini B, Hajdu SD, Michel P, Strambo D. Moving From CT to MRI Paradigm in Acute Ischemic Stroke: Feasibility, Effects on Stroke Diagnosis and Long-Term Outcomes. Stroke 2024; 55:1329-1338. [PMID: 38488367 PMCID: PMC11045552 DOI: 10.1161/strokeaha.123.045154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 01/23/2024] [Accepted: 02/05/2024] [Indexed: 04/24/2024]
Abstract
BACKGROUND The relative value of computed tomography (CT) and magnetic resonance imaging (MRI) in acute ischemic stroke (AIS) is debated. In May 2018, our center transitioned from using CT to MRI as first-line imaging for AIS. This retrospective study aims to assess the effects of this paradigm change on diagnosis and disability outcomes. METHODS We compared all consecutive patients with confirmed diagnosis of AIS admitted to our center during the MRI-period (May 2018-August 2022) and an identical number of patients from the preceding CT-period (December 2012-April 2018). Univariable and multivariable analyses were performed to evaluate outcomes, including the number and delay of imaging exams, the rate of missed strokes, stroke mimics treated with thrombolysis, undetermined stroke mechanisms, length of hospitalization, and 3-month disability. RESULTS The median age of the 2972 included patients was 76 years (interquartile range, 65-84), and 46% were female. In the MRI-period, 80% underwent MRI as first acute imaging. The proportion of patients requiring a second acute imaging modality for diagnostic ± revascularization reasons increased from 2.1% to 5% (Punadj <0.05), but it decreased in the subacute phase from 79.0% to 60.1% (Padj <0.05). In thrombolysis candidates, there was a 2-minute increase in door-to-imaging delay (Padj <0.05). The rates of initially missed AIS diagnosis was similar (3.8% versus 4.4%, Padj=0.32) and thrombolysis in stroke mimics decreased by half (8.6% versus 4.3%; Padj <0.05). Rates of unidentified stroke mechanism at hospital discharge were similar (22.8% versus 28.1%; Padj=0.99). The length of hospitalization decreased from 9 (interquartile range, 6-14) to 7 (interquartile range, 4-12) days (Padj=0.62). Disability at 3 months was similar (common adjusted odds ratio for favorable Rankin shift, 0.98 [95% CI, 0.71-1.36]; Padj=0.91), as well as mortality and symptomatic intracranial hemorrhage. CONCLUSIONS A paradigm shift from CT to MRI as first-line imaging for AIS seems feasible in a comprehensive stroke center, with a minimally increased delay to imaging in thrombolysis candidates. MRI was associated with reduced thrombolysis rates of stroke mimics and subacute neuroimaging needs.
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Affiliation(s)
- Costanza Maria Rapillo
- Stroke Center, Service of Neurology, Department of Clinical Neuroscience (C.M.R., A.S., P.M., D.S.), University Hospital of Lausanne and University of Lausanne, Switzerland
- Stroke Unit, Careggi University Hospital, Florence, Italy (C.M.R.)
| | - Vincent Dunet
- Neuroradiology Unit, Service of Diagnostic and Interventional Radiology, Department of Medical Radiology (V. Dunet, S.P., B.B., S.D.H.), University Hospital of Lausanne and University of Lausanne, Switzerland
| | - Silvia Pistocchi
- Neuroradiology Unit, Service of Diagnostic and Interventional Radiology, Department of Medical Radiology (V. Dunet, S.P., B.B., S.D.H.), University Hospital of Lausanne and University of Lausanne, Switzerland
| | - Alexander Salerno
- Stroke Center, Service of Neurology, Department of Clinical Neuroscience (C.M.R., A.S., P.M., D.S.), University Hospital of Lausanne and University of Lausanne, Switzerland
| | - Vincent Darioli
- Emergency Department (V. Darioli) and Interventional Neuroradiological Unit, University Hospital of Lausanne and University of Lausanne, Switzerland
| | - Bruno Bartolini
- Neuroradiology Unit, Service of Diagnostic and Interventional Radiology, Department of Medical Radiology (V. Dunet, S.P., B.B., S.D.H.), University Hospital of Lausanne and University of Lausanne, Switzerland
| | - Steven David Hajdu
- Neuroradiology Unit, Service of Diagnostic and Interventional Radiology, Department of Medical Radiology (V. Dunet, S.P., B.B., S.D.H.), University Hospital of Lausanne and University of Lausanne, Switzerland
| | - Patrik Michel
- Stroke Center, Service of Neurology, Department of Clinical Neuroscience (C.M.R., A.S., P.M., D.S.), University Hospital of Lausanne and University of Lausanne, Switzerland
| | - Davide Strambo
- Stroke Center, Service of Neurology, Department of Clinical Neuroscience (C.M.R., A.S., P.M., D.S.), University Hospital of Lausanne and University of Lausanne, Switzerland
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Goyal MS, Vo KD. Beyond the AJR: Does MRI in Addition to CT Improve Outcomes in Patients With Established Stroke? AJR Am J Roentgenol 2023; 220:611. [PMID: 36043608 DOI: 10.2214/ajr.22.28428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Manu S Goyal
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 510 S Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110
| | - Katie D Vo
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 510 S Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110
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Hashimoto H, Maruo T, Kimoto Y, Nakamura M, Fujinaga T, Nakamura H, Ushio Y. The association between diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score and the outcome following mechanical thrombectomy of anterior circulation occlusion. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
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Almansour NSS, Alzamanan HY, Almutared ASM, Almansoor HHA, Alyami IAM, Alajmi SM, Ismail MAA, Abbas MASA. Role of MRI in Diagnosis and Management of Stroke Cases; A Systematic Review. ARCHIVES OF PHARMACY PRACTICE 2022. [DOI: 10.51847/lxobuviry5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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