Evidence map›Paper›PMID 39903424›Full record

ArticleCJEM2025

The value of MRI in transient ischemic attack/minor stroke following a negative CT for predicting subsequent stroke.

Matthieu Robitaille, Marcel Émond, Mukul Sharma, Ariane Mackey, Pierre-Gilles Blanchard, Marie-Joe Nemnom, Marco L A Sivilotti, Ian G Stiell, Grant Stotts, Jacques Lee and 19 more

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in CJEM, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

29 authors.

Matthieu RobitailleDivision of Neurology, Laval University, Quebec City, QC, Canada.
Marcel ÉmondCHU de Québec, Hôpital de l'Enfant-Jésus, Quebec City, Québec, Canada.
Mukul SharmaDivision of Neurology, McMaster University, Hamilton, ON, Canada.
Ariane MackeyCHU de Québec, Hôpital de l'Enfant-Jésus, Quebec City, Québec, Canada.
Pierre-Gilles BlanchardCHU de Québec, Hôpital de l'Enfant-Jésus, Quebec City, Québec, Canada.
Marie-Joe NemnomOttawa Hospital Research Institute, Ottawa, ON, Canada.
Marco L A SivilottiDepartment of Emergency Medicine, Queen's University, Kingston, ON, Canada.
Ian G StiellDepartment of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
Grant StottsDivision of Neurology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Jacques LeeSchwartz\Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, ON, Canada.
Andrew WorsterDepartment of Medicine & Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada.
Judy MorrisHôpital du Sacré-Cœur de Montréal, Université de Montréal, Montreal, Québec, Canada.
Ka Wai CheungUniversity of British Columbia, Vancouver, BC, Canada.
Albert Y JinDivision of Neurology, Queen's University, Kingston, ON, Canada.
Demetrios J SahlasDivision of Neurology, McMaster University, Hamilton, ON, Canada.
Heather E MurrayDepartment of Emergency Medicine, Queen's University, Kingston, ON, Canada.
Steve VerreaultCHU de Québec, Hôpital de l'Enfant-Jésus, Quebec City, Québec, Canada.
Marie-Christine CamdenCHU de Québec, Hôpital de l'Enfant-Jésus, Quebec City, Québec, Canada.
Samuel YipDivision of Neurology, University of British Columbia, Vancouver, BC, Canada.
Philip TealDivision of Neurology, University of British Columbia, Vancouver, BC, Canada.
David J GladstoneHurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre & Division of Neurology, Department of Medicine, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
Mark I BoulosHurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre & Division of Neurology, Department of Medicine, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
Nicolas ChagnonDepartment of Emergency Medicine, Montfort Hospital and University of Ottawa, Ottawa, ON, Canada.
Elizabeth ShouldiceQueensway Carleton Hospital and University of Ottawa, Ottawa, ON, Canada.
Clare AtzemaDepartment of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Tarik SlaouiHôpital du Sacré-Cœur de Montréal, Université de Montréal, Montreal, Québec, Canada.
Jeanne TeitlebaumHôpital du Sacré-Cœur de Montréal, Université de Montréal, Montreal, Québec, Canada.
George A WellsOttawa Hospital Research Institute, Ottawa, ON, Canada.
Jeffrey J PerryDepartment of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. jperry@ohri.ca.ORCID 0000-0003-2134-9597

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDiffusion weighted magnetic resonance imaging's (MRI) role in predicting subsequent strokes beyond the validated Canadian TIA Score in in transient ischemic attack (TIA)/minor stroke patients with normal CT scans is unknown. In this study, we assessed the incidence of acute cerebral infarction on MRI in these patients, overall and stratified by the Canadian TIA Score levels and then we assessed subsequent stroke rates at 7, 30 and 90 days based on the presence of acute infarct on MRI.

methodsThis pre-planned substudy of the Canadian TIA risk score cohort was conducted across 13 Canadian emergency departments over an 11-year period. Eligible patients included adult TIA/minor stroke patients with negative CT scans who underwent MRI within 7 days.

resultsAmong 11,507 patients, 1048 with negative CT scans had early MRI, which revealed infarction in 330 (31.5%) patients. Acute infarction rates varied by Canadian TIA Score risk group: 130 (15.4%) in low-risk, 754 (30.4%) in medium-risk, and 162 (50.0%) in the high-risk group. At 90 days, the rates of stroke in patients with a positive MRI were 2 (10.0%), 168 (22.3%), and 40 (24.7%) in low-risk, medium-risk, and high-risk groups, respectively. In comparison, in patients with a negative MRI the rate was 1 (0.9%), 7 (1.3%), and 4 (4.9%).

conclusionsCombining the Canadian TIA Risk Score with follow-up MRI improves stroke risk assessment. MRI enhance the accuracy of diagnosis TIA, especially when CT is negative. The risk score helps prioritize MRI, benefiting medium-risk patients most, while high-risk patients need prompt management regardless of MRI results. Low-risk patients benefit from MRI for determining further investigations.

Indexed as

Diffusion Magnetic Resonance ImagingIschemic Attack, TransientMagnetic Resonance ImagingStrokeTomography, X-Ray ComputedAgedCanadaEmergency Service, HospitalFemaleHumansIncidenceMaleMiddle AgedPredictive Value of TestsRetrospective StudiesRisk AssessmentDiffusion magnetic resonance imagingIschemic attackStroke

Identifiers

PMID39903424

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.