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Updated: May 1, 2026
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A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
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Incorporating diffusion-weighted magnetic resonance imaging into an observation unit transient ischemic attack
J Adam Oostema1, Mark Delano2, Archit Bhatt3
1Department of Emergency Medicine, Spectrum Health, Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
The Neurohospitalist
|April 8, 2014
Summary
Implementing a transient ischemic attack (TIA) clinical pathway with routine MRI showed high compliance and diagnostic yield. However, patient outcomes were similar to protocols without routine MRI, suggesting further cost-benefit analysis is needed.
Area of Science:
- Neurology
- Emergency Medicine
- Radiology
Background:
- National guidelines recommend early, aggressive transient ischemic attack (TIA) evaluations.
- Diffusion-weighted magnetic resonance imaging (MRI) is recommended for brain imaging in TIA cases.
Purpose of the Study:
- To evaluate clinician compliance with a TIA clinical pathway incorporating routine MRI.
- To assess the diagnostic yield of MRI in TIA evaluations.
- To determine patient-centered clinical outcomes after implementing an emergency department observation unit (EDOU) pathway for TIA.
Main Methods:
- A prospective observational study of 116 patients with TIA admitted from the emergency department (ED).
- Low-risk TIA patients were routed to an EDOU for diagnostic testing, including MRI.
- High-risk patients were admitted directly; outcomes were tracked at 7 and 30 days.
Main Results:
- 92 patients (79.3%) were transferred to the EDOU, with 69 (59.5%) discharged without hospitalization.
- Pathway compliance was high at 91.2%.
- MRI detected acute infarct in 15.7% of patients; 4.3% experienced stroke or recurrent TIA within 30 days.
Conclusions:
- The TIA clinical pathway effectively promoted guideline-compliant diagnostic testing with routine MRI.
- Patient outcomes were comparable to protocols not using routine MRI.
- Further research is required to ascertain the benefits and costs of routine MRI in TIA evaluations.
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