AAN Guidelines Suggest Using MRI for Ischemic Stroke Diagnosis

New guidelines from the American Academy of Neurology recommend using diffusion MRI over noncontrast CT for the diagnosis of acute ischemic stroke within 12 hours of symptom onset.

The guidelines, which are published in Neurology, dictate that diffusion-weighted imaging (DWI) should be performed for the most accurate diagnosis of acute ischemic stroke; however, the sensitivity of DWI for the diagnosis of ischemic stroke “is not perfect.”

Written by P.D. Schellinger, MD, PhD, of the National Institutes of Neurological Disorders and Stroke, and colleagues, the guidelines do not delve into the use of diffusion MRI for cerebral hemorrhage.

Other recommendations include the following:

• There is insufficient evidence to support or refute the value of PWI in diagnosing acute ischemic stroke.
• Baseline DWI volume should be considered useful in predicting baseline clinical stroke severity and final lesion volume in anterior-circulation stroke syndromes.
• Baseline DWI volume may be considered not useful in predicting baseline NIHSS score in posterior-circulation stroke syndromes.
• Baseline DWI volume may be considered useful in predicting clinical outcome as measured by the NIHSS and Barthel Index.
• Baseline PWI volume may be considered useful in predicting baseline clinical stroke severity.