Department of Veterans Affairs, VA Center for Clinical Management and Research, Ann Arbor VA Healthcare System, MI, USA.
Ann Neurol. 2012 Feb;71(2):179-85. doi: 10.1002/ana.22698.
Neuroimaging is an essential component of the acute stroke evaluation. Magnetic resonance imaging (MRI) is more accurate than computed tomography (CT) for the diagnosis of stroke, but is more costly and time-consuming. We sought to describe changes in MRI utilization from 1999 to 2008.
We performed a serial cross-sectional study with time trends of neuroimaging in patients with a primary International Classification of Diseases, 9th Edition, Clinical Modification discharge diagnosis of stroke admitted through the emergency department in the State Inpatient Databases from 10 states. MRI utilization was measured by Healthcare Cost and Utilization Project criteria. Data were included for states from 1999 to 2008 where MRI utilization could be identified.
A total of 624,842 patients were hospitalized for stroke in the period of interest. MRI utilization increased in all states. Overall, MRI absolute utilization increased 38%, and relative utilization increased 235% (28% of strokes in 1999 to 66% in 2008). Over the same interval, CT utilization changed little (92% in 1999 to 95% in 2008). MRI use varied widely by state. In 2008, MRI utilization ranged from a low of 55% of strokes in Oregon to a high of 79% in Arizona. Diagnostic imaging was the fastest growing component of total hospital costs (213% increase from 1999 to 2007).
MRI utilization during stroke hospitalization increased substantially, with wide geographic variation. Rather than replacing CT, MRI is supplementing it. Consequently, neuroimaging has been the fastest growing component of hospitalization cost in stroke. Recent neuroimaging practices in stroke are not standardized and may represent an opportunity to improve the efficiency of stroke care.
神经影像学是急性脑卒中评估的重要组成部分。磁共振成像（MRI）比计算机断层扫描（CT）更准确地诊断脑卒中，但成本更高，耗时更长。我们旨在描述 1999 年至 2008 年期间 MRI 应用的变化。
我们对 10 个州的急诊住院患者进行了一项具有时间趋势的连续横断面研究，这些患者的主要国际疾病分类第 9 版临床修正诊断为脑卒中。根据医疗保健成本和利用项目标准衡量 MRI 的应用情况。我们纳入了能够识别 MRI 应用的州在 1999 年至 2008 年的数据。
在研究期间，共有 624842 名患者因脑卒中住院。所有州的 MRI 应用都有所增加。总体而言，MRI 的绝对应用增加了 38%，相对应用增加了 235%（1999 年为 28%，2008 年为 66%）。在此期间，CT 应用变化不大（1999 年为 92%，2008 年为 95%）。MRI 的应用因州而异。2008 年，MRI 的应用范围从俄勒冈州的脑卒中的 55%到亚利桑那州的 79%。诊断成像成为医院总费用增长最快的部分（1999 年至 2007 年增长 213%）。
脑卒中住院期间 MRI 的应用显著增加，且存在广泛的地域差异。MRI 并没有取代 CT，而是对其进行了补充。因此，神经影像学是脑卒中住院费用增长最快的部分。目前脑卒中的神经影像学实践尚未标准化，这可能是提高脑卒中治疗效率的机会。
