J Clin Outcomes Manage
Head CT findings compared with MRI done within 48 hours of emergency department presentation
Moser FG, Izadi K, Saidian L, Binesh N, Maya M, Pressman BD
Abstract Objective: To evaluate noncontrast computed tomography (CT) and the concordance with subsequent brain magnetic resonance imaging (MRI) within the first 48 hours after presentation to the emergency department (ED). Methods: The medical records of 502 patients who underwent a head CT in the ED followed by an inpatient MRI of the head within 48 hours of the head CT were reviewed. Major differences between MRI and CT findings were classified according to the admitting diagnosis (ie, infarct, bleed, mass, potential meningitis, or demyelinating process). Results: Of the 502 patients studied, 71 (14.1%) had major differences between the CT and MRI studies. These included 19.9% of patients presenting with stroke-related symptoms, 7.5% of patients presenting with headache, and 11.4% of patients presenting with confusion. The majority of the differences (74.6%) that were found were classified as missed acute infarcts on initial CT exam. Conclusion: A follow-up MRI done within 48 hours of unenhanced CT examination of the brain done in the ED is unlikely to lead to findings that would impact management.
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