6 ms·
You don't typically need an MRI in an ER setting except for the problem stated, differentiating between various reasons for a stroke. A CT can do the rest and i
by l33tman 6y ago
You don't typically need an MRI in an ER setting except for the problem stated, differentiating between various reasons for a stroke. A CT can do the rest and is way cheaper and simpler to setup and operate.
There are other reasons an MR could be better though, for example no ionizing radiation, so you could argue you could send more patients through it than you would with an ER CT (you would only send patients you have a higher confidence of them requiring it to avoid spamming radiation).
- thomasfedb 6y agoEven for a stroke, the standard ED protocol is a CT in the majority of cases.
- ska 6y agoThat has a lot to do with the difficultly and cost of siting an MRI close enough and keeping it open for for emergency protocols.
- lostlogin 6y agoIt also relates to the patient though. Stroke patients are often not very compliant and a morality that is slow and requires a still patient is ill suited to a lot of the work an ED sees.
- ska 6y agoTrue enough, but MRI is not inherently too slow for this use. If the economics otherwise made sense, an acceptably fast throughput stroke protocol MR is quite doable.
- lostlogin 6y agoIt is. The requirements of the MR environment make it a lot more difficult than CT though. For example a tubed patient is harder to manage in MR than CT, and while this is done regularly it isn't as easily done as CT.
- ska 6y agoTrue, but the improved contrast would probably make it a no-brainer if the other issues were taken care of .
- lostlogin 6y agoPun intended? The contrast is so good. You are probably aware, but there are 5 minute protocols (Siemens call their one a “go brain”) that are pretty reasonable, and probably not far off a gold standard routine protocol 10 years ago.
- Engineering-MD 6y agoThat just excludes haemorrhagic stroke rather than confirms most ischaemic strokes. It allows for antiplatlets to be safely given. MRI is still needed to diagnose all but severe or very late strokes as far as I’m aware (although this is not my field. Happy to be proven wrong)
- jmhmd 6y agoCT is often done both as a non-contrast study (to exclude hemorrhage or large established stroke) and also as a CTA and sometimes with perfusion. This data at most stroke centers is all that is needed acutely to decide whether and how to treat, and MRI is often not done until days later to evaluate final extent of the stroke.