Table 1:

Clinical condition—Cerebrovascular disease: Ischemia

MRI, brain, with or without contrastCT, head, with or without contrastMRA, head and neck, with or without contrastCTA, head and neckArterio-graphy, neckArterio-graphy, head and neckUS, carotid, duplexUS, trans cranial, Doppler
Asymptomatic: positive physical exam (cervical bruit) and/or risk factors.5a5ak8i8j228h3
TIA: carotid territory or vertebrobaslar TIA, initial screening survey8abc8abcd8bc8bc3363
Less than 3 hours: new focal neurologic defect, fixed or worsening.8abc8abc8bc8bc5e5e22
Three to 24 hours: new focal neurologic defect, fixed or worsening.8bcf8bcg8bc8bc6e6e22
Greater than 24 hours: new focal neurologic defect, fixed or worsening.8bcf8bcg8bc8bc6e6e22

  • Note: —Appropriateness criteria scale from 1 to 9, 1 = least appropriate, 9 = most appropriate;

  • a , consider perfusion if stenosis found;

  • b , combined vascular and cerebral evaluation should be considered;

  • c , MR preferred if treatment not unreasonably delayed;

  • d , primarily to rule out hemorrhage;

  • e , if intra-arterial therapy is considered;

  • f , diffusion especially valuable;

  • g , for perfusion according to institutional protocols;

  • h , may need to confirm with second non-invasive study;

  • i , MRA of neck only, with or without contrast. MRA head = 3 but recommended if neck stenosis or occlusion found;

  • j , CTA of neck only. CTA head = 3 but recommended if neck stenosis or occlusion found;

  • k , CT head without contrast = 3