Department of Diagnostic Imaging, Kaiser Permanente Moanalua Medical Center, Honolulu, HI.
Perm J. 2021 May;25. doi: 10.7812/TPP/20.214.
In our health maintenance organization, we have seen a trend among our referring physicians to order simultaneous brain magnetic resonance imaging (MRI), head magnetic resonance angiography (MRA), and neck MRA in the evaluation of patients for acute stroke. However, there are little data to demonstrate any improvement in patient care resulting from ordering this triple study. The objective of this study was to analyze the utility of the triple MRI/MRA study for patients who experience stroke-like symptoms.
We reviewed all triple-study cases between January 1, 2013 and December 31, 2016. We recorded whether or not an acute stroke occurred, the presence or absence of a major stenosis in the intracranial and/or neck arteries, subsequent percutaneous endovascular or open surgical intervention within 90 days, and any follow-up computed tomography angiography or carotid ultrasound studies within 30 days.
During the studied period, 591 triple studies were ordered, and 162 patients (27.4%) were found to have moderate or severe stenosis. Of the patients who had an acute stroke, 100 (48.3%) also had a major stenosis. Of 591 patients, only 15 (2.5%) underwent percutaneous endovascular or open surgical intervention within 90 days. Of these, 4 patients had an intervention in less than a week; in all of the cases, the triple study did not need to be ordered simultaneously to achieve the same clinical outcome.
Brain MRI, head MRA, and neck MRA studies should not be ordered simultaneously as a generalized response to patients presenting with acute stroke-like symptoms.
在我们的健康维护组织中，我们发现我们的转诊医生有一种趋势，即在评估急性中风患者时同时开单进行脑部磁共振成像（MRI）、头部磁共振血管造影（MRA）和颈部 MRA。然而，几乎没有数据表明这种三联检查可以改善患者的护理效果。本研究的目的是分析三联 MRI/MRA 检查在出现类似中风症状的患者中的应用价值。
我们回顾了 2013 年 1 月 1 日至 2016 年 12 月 31 日期间所有三联检查病例。我们记录是否发生急性中风、颅内和/或颈部动脉是否存在严重狭窄、90 天内是否进行经皮腔内血管成形术或开放手术介入治疗，以及 30 天内是否进行任何随访 CT 血管造影或颈动脉超声检查。
在研究期间，共开单 591 次三联检查，发现 162 例（27.4%）患者存在中度或重度狭窄。在发生急性中风的患者中，100 例（48.3%）患者存在严重狭窄。在 591 例患者中，仅 15 例（2.5%）在 90 天内进行了经皮腔内血管成形术或开放手术介入治疗。在这 15 例患者中，有 4 例在不到一周内进行了干预；在所有情况下，同时进行三联检查并不是实现相同临床效果的必要条件。
对于出现急性类似中风症状的患者，不应作为常规反应同时进行脑部 MRI、头部 MRA 和颈部 MRA 检查。
