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The impact of MRI on stroke management and outcomes: a systematic review

Authors

  • James F Burke MD,

    Clinical Lecturer, Corresponding author
    1. Department of Veterans Affairs, VA Center for Clinical Management and Research, Ann Arbor VA Healthcare System, Ann Arbor, Michigan, USA
    2. Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor, Michigan, USA
    3. Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
    • Correspondence

      Dr James F Burke

      Robert Wood Johnson Clinical Scholars Program

      University of Michigan Medical School

      6312 Medical Science Building 1

      Ann Arbor, MI 48109

      USA

      E-mail: jamesbur@med.umich.edu

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  • Douglas J Gelb MD PhD,

    Professor
    1. Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
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  • Douglas J Quint MD,

    Professor
    1. Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
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  • Lewis B Morgenstern MD,

    Professor
    1. Department of Neurology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
    2. Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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  • Kevin A Kerber MD

    Assistant Professor
    1. Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
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  • Disclosures: All authors have seen and agree with the contents of the manuscript. This manuscript is not under review at any other publication. The authors do not have any relevant financial disclosures.

Abstract

Rationale, aims and objectives

Magnetic resonance imaging (MRI) is widely used in stroke evaluation and is superior to computed tomography for the detection of acute ischaemia. We sought to evaluate the evidence that conventional MRI influences doctor management or patient outcomes in routine care.

Methods

We systematically searched PubMED, EMBASE and proceedings of the International Stroke Conference. Studies were included if they included patients presenting with possible stroke syndromes and they reported MRI results and resulting changes in management or outcome. Multiple reviewers determined inclusion/exclusion for each study, abstracted study characteristics and assessed study quality.

Results

Of 1813 articles screened, nine studies met inclusion criteria. None were randomized controlled trials, cohort studies or case-control studies. We found little evidence that MRI affects outcomes – one single-centre case series presented three patients. The remaining articles were studies of diagnostic tests or vignette-based studies that described changes in doctor management attributed to MRI.

In the studies that suggested MRI influenced management, it did so in two ways. First, MRI distinguished stroke from mimics (e.g. brain tumours), thus enabling more appropriate selection of therapies. Second, even when MRI confirmed a suspected stroke diagnosis, it sometimes provided information (on stroke mechanism, localization, timing or pathophysiology) that influenced management.

Conclusions

The impact of MRI on management and outcomes in stroke patients has been inadequately studied. Further research is needed to understand how MRI may productively affect stroke management and outcomes.

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