A push for change: a review of the sue of advanced neuroimaging in the urgent evaluation of acute stroke, and the impact on clinical guidelines

Abstract

In 1996, the United States Food and Drug Administration officially approved the use of intravenous recombinant tissue-type plasminogen activator for treatment of acute ischemic stroke, with the requirement that a baseline computed tomography (CT) scan be performed to rule out acute intracerebral or subarachnoid hemorrhage. Today, the American Heart Association (AHA) Stroke Council acknowledges magnetic resonance imaging (MRI) as more sensitive to the detection of ischemia, and yet, guidelines released by the group suggest that either CT or MRI may serve as the primary, hyperacute imaging modality. The AHA recommends that for most cases, non-contrast-enhanced CT scans provide sufficient information for medical management decisions. A systematic review of published literature was conducted to compare current capabilities of CT and MRI in an effort to determine which imaging modality should be used in the setting of acute ischemic stroke. Current research indicates that MRI is comparable to CT in the detection of acute hemorrhage, but superior in the detection of acute ischemia. In addition, MRI has demonstrated the ability to not only identify suitable patients for treatment, but also identify patients whose treatment would be unnecessary and potentially dangerous. Therefore, the hope is that clinical guidelines, like those released by the AHA Stroke Council, will be modified to promote MRI as the primary imaging modality. A modification to the major clinical guidelines will initiate a change in the approach of acute stroke evaluation across all clinical stroke centers.