A new era for stroke patients

Editor – The commentary by Smyth on the recent Royal College of Physicians stroke conference advocates computed tomography (CT) as first line imaging for acute stroke, rather than magnetic resonance imaging (MRI) (Clin Med December 2009 pp 557–9). We agree CT imaging is adequate for assessing patients for thrombolysis, but MRI of stroke is superior to CT.¹ With the use of limited sequences, rapid imaging is possible with greater accuracy than CT in the district general hospital setting and can be performed in the majority of acute stroke patients.^2,3 MRI also allows a more accurate determination of the vascular distribution of the event and the pattern of infarction can also provide clues to the cause of the event.^4,5 Multimodal MRI does not appear to carry the risk of multimodal CT scanning.⁶ In our view, MRI is the optimal first line investigation for stroke and should be more widely used.