European Radiology: For stroke patients, CT alone is not enough!

Ischemic stroke is the cause patient one cause of severe disability and is the world heart blood vessels mainly due to disease deaths
.

The economic burden of ischemic stroke is very high, with the cost of stroke in the United States estimated at $65.

Ischemic stroke is one of the leading causes of severe disability in stroke patients and the leading cause of cardiovascular death worldwide .

In most emergency departments, cephalometric CT scans are the primary imaging modality for neurological patients suspected of having intracranial lesions

Recently, a study published in the journal European Radiology explored the cost-effectiveness of a supplementary short-scan regimen of cranial MRI scans after negative plain CT scans in neurological emergency patients with mild and nonspecific clinical symptoms .
It provides a process reference for accurate judgment and timely treatment of emergency patients' conditions .
 

The evaluation strategies of "no additional imaging" and "additional short- scan protocol MRI" were performed in this study using the Markov model of decision analysis .
It was assumed that 40% of patients without short- scan protocol MRI would miss a minor stroke at the initial assessment .
Dedicated post- stroke care was assumed for patients with detected minor stroke , with immediate secondary prevention measures .
Availability and quality of life measures were estimated in quality-adjusted life years (QALYs) .
Input parameters were obtained from the literature .
The Markov model simulated a follow-up period of up to 30 years .
Willingness to pay is set at $100,000 per QALY .
Cost-effectiveness was calculated and deterministic and probabilistic sensitivity analyses were performed .
 Quality of Life

An additional short- scan protocol, MRI, was the dominant strategy, with a total cost of $26,304 (CT only: $27,109)
.

The cumulative calculated effectiveness in the CT-only group was 14.
25QALYs (short MRI group: 14.
31QALYs)

An additional short- scan protocol, MRI, was the dominant strategy, with a total cost of $26,304 (CT only: $27,109)

Figure A representative CT image of a patient with a concealed minor stroke who presented with transient left-sided mild hemiplegia .

Unenhanced CT (a) did not show any signs of ischemic stroke .
Diffusion-weighted imaging (b, b1000) and corresponding apparent diffusion coefficient map (ADC map, c) show , from the short-scan MRI protocol, an ischemic lesion (arrow) in the hindlimb of the right internal capsule .
 

Figure A representative CT image of a patient with a concealed minor stroke who presented with transient left-sided mild hemiplegia .
Unenhanced CT (a) did not show any signs of ischemic stroke .
Diffusion-weighted imaging (b, b1000) and corresponding apparent diffusion coefficient map (ADC map, c) show , from the short-scan MRI protocol, an ischemic lesion (arrow) in the hindlimb of the right internal capsule .
Figure A representative CT image of a patient with a concealed minor stroke who presented with transient left-sided mild hemiplegia .
Unenhanced CT (a) did not show any signs of ischemic stroke .
Diffusion-weighted imaging (b, b1000) and corresponding apparent diffusion coefficient map (ADC map, c) show , from the short-scan MRI protocol, an ischemic lesion (arrow) in the hindlimb of the right internal capsule .
 

This performance demonstrates that , for specific neurological patients with mild and nonspecific symptoms , the addition of a short- scan protocol emergency brain MRI after a negative unenhanced head CT is a cost-effective procedure that can lead to better outcomes.

low cost and high quality level , for the diagnosis and treatment of stroke patients in clinical standardization process management provide a reference .

This performance demonstrates that , for specific neurological patients with mild and nonspecific symptoms , the addition of a short- scan protocol emergency brain MRI after a negative unenhanced head CT is a cost-effective procedure that can lead to better outcomes.
low cost and high quality level , for the diagnosis and treatment of stroke patients in clinical standardization process management provides a reference management .

Original source :

Daniel Puhr-Westerheide , Matthias F Froelich , Olga Solyanik , et al .

Cost-effectiveness of short-protocol emergency brain MRI after negative non-contrast CT for minor stroke detection .
DOI : 10.

Daniel Puhr-Westerheide Matthias F Froelich Olga Solyanik , et al Cost-effectiveness of short-protocol emergency brain MRI after negative non-contrast CT for minor stroke detection 10.
1007/s00330-021-08222-z 10.
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