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Utility of repeat brain imaging in stroke
L B Schneider1, R B Libman, R Kanner
1Department of Neurology, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, NY 11042, USA.
Purpose:
To determine the utility of repeat brain imaging in patients with stroke.
Methods:
We reviewed the medical records of 98 consecutive patients in whom stroke was diagnosed between January 1 and December 31, 1991. We noted the number of brain scans performed, the indications cited, and whether repeat imaging changed the therapeutic decisions or final diagnosis.
Results:
Ninety-eight patients underwent 221 procedures, with 123 repeat imaging studies (98 CT scans and 25 MR images). Sixteen patients had only one scan; 51 had two, and 31 had three or more. Indications for repeat imaging were explicitly documented in 62 (50%) of 123 repeated scans and inferred in another 41 (33%). In 20 (16%), no definite indication could be determined. Indications included lack of acute abnormal imaging findings on the initial scan (n = 48, 39%); compliance with stroke research protocol (n = 11, 9%). In none of the 82 patients did the repeated scan change the diagnosis; therapy was changed in only two (2%) of 82 patients (aspirin was discontinued).
Conclusions:
Repeat imaging in patients rarely results in changes in the initial diagnosis or the therapeutic plan; indications for repeat imaging are frequently not clearly stated; in certain groups of patients with stroke, repeat imaging may not be useful.