Diagnostic yield of an abbreviated MRI protocol in the evaluation of dizziness in the emergency department, a single institutional experience.

Purpose: 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).

Method: 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.

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).

Conclusion: 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.