Shareef Faryal, Tu Long, Neupane Anish, Siddique Zaid, Joshi Rudra, Melnick Edward, Wira Charles, Mahajan Amit
Department of Radiology and Biomedical Imaging, Yale University, 333 Cedar Street New Haven, New Haven, CT, 06510, USA.
Department of Radiology, Bridgeport Hospital/Yale University, Bridgeport, CT, USA.
Emerg Radiol. 2025 Jun 5. doi: 10.1007/s10140-025-02349-y.
MRI is the preferred imaging modality for patients with acute dizziness when a central etiology is possible. Abbreviated protocols may improve access in urgent settings. This study assesses the diagnostic yield and utility of an abbreviated MRI protocol for patients presenting with dizziness to the emergency department (ED).
This retrospective study included 613 adult patients presenting to the ED with dizziness from August 1, 2019 to August 31, 2023. The protocol included 3 mm coronal and axial DWI, axial FLAIR, and SWI sequences, with a duration of approximately 11 min. MRI findings were categorized as negative or positive for intracranial pathology; etiology and location were recorded. Charts were reviewed for concurrent CTA during the ED visit, and findings were assessed for correlation with MRI results.
Of the 613 patients, clinically significant intracranial pathology was identified in 52 cases (8%), including 42 (7%) acute infarcts. Of these infarcts, 19 (45%) were infratentorial, 16 (38%) supratentorial, and 7 (17%) involved both regions. The cerebellum was the most common infratentorial site (38%), followed by the brainstem (24%). Infarcts ranged from 1-84 mm, with 48% measuring less than 1 cm. TOAST classification revealed strokes as cardioembolic (36%), large vessel (26%), cryptogenic (19%), and lacunar (19%). Statistical analysis showed no significant relationship between vertigo and infarct characteristics (P > 0.05).
Abbreviated protocol MRI demonstrated a 8% diagnostic yield for detecting intracranial pathology and more often positive than concurrent CT/CTA in identifying acute findings. Supratentorial pathology can present with symptoms of dizziness as well. The abbreviated protocol offers a rapid, efficient diagnostic tool for urgent care settings and MRI identifies more acute findings than concurrent CT/CTA.
对于可能存在中枢病因的急性头晕患者，磁共振成像（MRI）是首选的影像学检查方式。简化方案可能会改善在紧急情况下的检查可及性。本研究评估了一种简化MRI方案对急诊科（ED）头晕患者的诊断率及效用。
这项回顾性研究纳入了2019年8月1日至2023年8月31日期间因头晕就诊于急诊科的613例成年患者。该方案包括3毫米的冠状位和轴位扩散加权成像（DWI）、轴位液体衰减反转恢复序列（FLAIR）和磁敏感加权成像（SWI）序列，时长约11分钟。MRI检查结果分为颅内病变阴性或阳性；记录病因及位置。查阅病历以了解急诊科就诊期间同时进行的CT血管造影（CTA）情况，并评估其结果与MRI结果的相关性。
在613例患者中，52例（8%）发现有具有临床意义的颅内病变，其中42例（7%）为急性梗死。在这些梗死中，幕下梗死19例（45%），幕上梗死16例（38%），累及两个区域的梗死7例（17%）。小脑是最常见的幕下梗死部位（38%），其次是脑干（24%）。梗死灶大小为1 - 84毫米，48%的梗死灶小于1厘米。急性卒中组织学亚型分类（TOAST）显示，心源性栓塞性卒中占36%，大血管性卒中占26%，隐源性卒中占19%，腔隙性卒中占19%。统计分析显示眩晕与梗死特征之间无显著相关性（P > 0.05）。
简化方案的MRI对检测颅内病变的诊断率为8%，在识别急性病变方面比同时进行的CT/CTA更常呈阳性结果。幕上病变也可表现为头晕症状。简化方案为紧急护理环境提供了一种快速、有效的诊断工具，且MRI比同时进行的CT/CTA能识别更多急性病变。
