LAUSR

The use of medical imaging in the US has been steadily increasing over the last 2 decades. 1 For patients with suspected ischemic stroke, almost all have received computed tomography (CT) imaging of the brain at initial evaluation to exclude hemorrhage. Most patients subsequently undergo MRI within several days of symptoms. Current American Heart Association/American Stroke Association guidelines state that it is reasonable to obtain additional magnetic resonance imaging (MRI) after initial head imaging in cases in which initial imaging did not demonstrate infarction. 2 Commonly cited reasons for the use of routine MRI in these patients include assisting in classification of etiologic subtype, estimating the extent of tissue injury, assisting in distinguishing mimics and chameleons from ischemia, providing imaging biomarkers for prognostication, and estimating early stroke recurrence risk. 3,4 Whether these purported benefits translate into improved clinical outcomes for patients is not clear.