Cerebral Ischemia (TIA and Stroke) - The 2018 guidelines for early management of patients with acute ischemic stroke both recommended and considered equal (in patients selected for mechanical thrombectomy) CT, diffusion weighted MRI or MRI perfusion.15 This guideline was promulgated by the American Heart Association/American Stroke Association and endorsed by the Society for Academic Emergency Medicine, among other professional organizations.
In a joint statement published by the American Society of Neuroradiology, the American College of Radiology, and the Society of Neurointerventional Surgery, MRI was reported to be equivalent to a non-contrast brain CT. MRI was also found to have superior accuracy in detecting microhemorrhages.16
Spine MRI
Spine and spinal cord emergencies must be promptly and correctly diagnosed to avoid or minimize functional loss. Knowledge of the most appropriate imaging modalities is essential to facilitate diagnosis and treatment for patients presenting with spine-related emergencies.
Low back pain prompts many ED visits and is a major cause of disability in the United States.
MRI is unwarranted for those patients with acute (< 6 weeks duration) low back pain in whom serious pathology, such as cauda equina, malignancy, epidural hematoma, or infection is not suspected. Manage most low back pain patients conservatively and without imaging.17
