The American Academy of Neurology’s new guidelines on using MRI for stroke may represent best practice, but practical issues remain, interviews with several experts revealed.

In the July 13 issue of Neurology, the academy compared all the scientific data through 2008 on diffusion- weighted and perfusion-weighted imaging in acute ischemic stroke. A panel of experts in vascular neurology and radiology found DWI is established as useful and should be considered instead of noncontrast CT for the diagnosis of acute ischemic stroke within 12 hours of symptom onset.

“The routine practice in many hospital emergency departments is still to get a noncontrast CT to rule out stroke for all patients who present with a suspicion of acute ischemic stroke,” said Dr. Steven Warach, coauthor of the recommendations and section chief of stroke diagnostics and therapeutics at the National Institute of Neurological Disorders and Stroke. “Based on the scientific evidence, that routine practice is not justifiable and cannot be considered the highest quality of care.” No one argues MRI isn’t superior diagnostically to CT, but in the stroke world there’s a saying, “Time saved is brain saved.”

Continued on Diagnostic Imaging