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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2024; 34(03): 488-495
DOI: 10.1055/s-0044-1778726
Systematic Review

Comparative Diagnostic Accuracy of Computed Tomography Scan versus Magnetic Resonance Imaging in the Emergency Department for the Evaluation of Dizziness: A Systematic Review

Ishfaq Nabeel Ashiq
1   Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
,
Safeer Khan 
2   Department of Pharmaceutical Sciences, Institute of Chemical Sciences, Government College University, Lahore, Punjab, Pakistan
,
Adil Yousaf
3   Green Health Pharmaceutical Company, Riyadh, Kingdom of Saudi Arabia
› Author Affiliations Funding None.
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Abstract

Introduction Both computed tomography (CT) and magnetic resonance imaging (MRI) play significant roles in assessing patients with dizziness. However, understanding the comparative capabilities of these imaging methods in detecting pathological causes is crucial for determining the most suitable modality. This review aims to evaluate the diagnostic accuracy and clinical utility of MRI and CT scans in managing patients with acute dizziness in the emergency department.

Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a comprehensive search in various databases (PubMed, Google Scholar, Cochrane library, British Medical Journals, and ScienceDirect) from 2010 to 2023. We used the QUADAS-2 tool to assess bias risk, considering MRI as the reference standard and CT scan as the index test.

Results The final analysis included six studies, with 3,993 patients (48% male, 52% female; average age: 56.7 years). Three studies were of high quality, two of medium quality, and one of low quality. Central ischemia was the predominant diagnosis for dizziness. MRI demonstrated higher diagnostic efficacy for stroke compared with CT scans, while mixed results were observed for other multiple diseases when both MRI and CT scans were used.

Conclusion MRI outperforms CT scans in diagnosing dizziness-related strokes. However, for other causes of dizziness, there is no significant difference between these techniques. Nevertheless, it is crucial to acknowledge the limitations associated with MRI. Consequently, to address these concerns, the selection of an imaging technique should be tailored to the individual based on factors such as their clinical presentation, comorbidities, and socioeconomic circumstances.

Keywords

dizziness assessment - diagnostic accuracy - computed tomography (CT) scan - magnetic resonance imaging - emergency department


Publication History

Article published online:
27 January 2024

© 2024. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Tarnutzer AA, Berkowitz AL, Robinson KA, Hsieh YH, Newman-Toker DE. Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ 2011; 183 (09) E571-E592
    CrossrefPubMedGoogle Scholar
  • 2 Strupp M, Kremmyda O, Brandt T. Pharmacotherapy of vestibular disorders and nystagmus. Semin Neurol 2013; 33 (03) 286-296
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Newman-Toker DE, Hsieh YH, Camargo Jr CA, Pelletier AJ, Butchy GT, Edlow JA. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin Proc 2008; 83 (07) 765-775
    CrossrefPubMedGoogle Scholar
  • 4 Saber Tehrani AS, Coughlan D, Hsieh YH. et al. Rising annual costs of dizziness presentations to U.S. emergency departments. Acad Emerg Med 2013; 20 (07) 689-696
    CrossrefPubMedGoogle Scholar
  • 5 Kroenke K, Jackson JL. Outcome in general medical patients presenting with common symptoms: a prospective study with a 2-week and a 3-month follow-up. Fam Pract 1998; 15 (05) 398-403
    CrossrefPubMedGoogle Scholar
  • 6 Newman-Toker DE, Cannon LM, Stofferahn ME, Rothman RE, Hsieh YH, Zee DS. Imprecision in patient reports of dizziness symptom quality: a cross-sectional study conducted in an acute care setting. Mayo Clin Proc 2007; 82 (11) 1329-1340
    CrossrefPubMedGoogle Scholar
  • 7 Mohamed S, Khan I, Iliodromiti S, Gaggini M, Kontorinis G. Ménière's disease and underlying medical and mental conditions: towards factors contributing to the disease. ORL J Otorhinolaryngol Relat Spec 2016; 78 (03) 144-150
    CrossrefPubMedGoogle Scholar
  • 8 Lempert T. Recurrent spontaneous attacks of dizziness. Continuum (Minneap Minn) 2012; 18 (5 Neuro-otology): 1086-1101
    Google Scholar
  • 9 Navi BB, Kamel H, Shah MP. et al. The use of neuroimaging studies and neurological consultation to evaluate dizzy patients in the emergency department. Neurohospitalist 2013; 3 (01) 7-14
    CrossrefPubMedGoogle Scholar
  • 10 Cappello M, di Blasi U, di Piazza L. et al. Dizziness and vertigo in a department of emergency medicine. Eur J Emerg Med 1995; 2 (04) 201-211
    CrossrefPubMedGoogle Scholar
  • 11 Baloh RW. Vertigo. Lancet 1998; 352 (9143): 1841-1846
    CrossrefPubMedGoogle Scholar
  • 12 Gerlier C, Hoarau M, Fels A. et al. Differentiating central from peripheral causes of acute vertigo in an emergency setting with the HINTS, STANDING, and ABCD2 tests: a diagnostic cohort study. Acad Emerg Med 2021; 28 (12) 1368-1378
    CrossrefPubMedGoogle Scholar
  • 13 Spiegel R, Kirsch M, Rosin C. et al. Dizziness in the emergency department: an update on diagnosis. Swiss Med Wkly 2017; 147: w14565
    CrossrefPubMedGoogle Scholar
  • 14 Adams ME, Karaca-Mandic P, Marmor S. Use of neuroimaging for patients with dizziness who present to outpatient clinics vs emergency departments in the US. JAMA Otolaryngol Head Neck Surg 2022; 148 (05) 465-473
    CrossrefPubMedGoogle Scholar
  • 15 Kontorinis G. The imaging of the dizzy patient: computed tomography versus magnetic resonance imaging. Eur Radiol 2018; 28 (07) 2914-2915
    CrossrefPubMedGoogle Scholar
  • 16 Chalela JA, Kidwell CS, Nentwich LM. et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet 2007; 369 (9558): 293-298
    CrossrefPubMedGoogle Scholar
  • 17 Oppenheim C, Stanescu R, Dormont D. et al. False-negative diffusion-weighted MR findings in acute ischemic stroke. AJNR Am J Neuroradiol 2000; 21 (08) 1434-1440
    PubMedGoogle Scholar
  • 18 Kim JS, Cho KH, Lee H. Isolated labyrinthine infarction as a harbinger of anterior inferior cerebellar artery territory infarction with normal diffusion-weighted brain MRI. J Neurol Sci 2009; 278 (1–2): 82-84
    CrossrefPubMedGoogle Scholar
  • 19 Patkar D, Yevankar G, Parikh R. Radiology in vertigo and dizziness. Int J Otorhinolaryngol Clin 2012; 4 (02) 86-92
    CrossrefGoogle Scholar
  • 20 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151 (04) 264-269 , W64
    CrossrefPubMedGoogle Scholar
  • 21 Matchar DB. Chapter 1: introduction to the methods guide for medical test reviews. J Gen Intern Med 2012; 27 (Suppl 1, Suppl 1): S4-S10
    CrossrefPubMedGoogle Scholar
  • 22 Whiting PF, Rutjes AW, Westwood ME. et al; QUADAS-2 Group. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011; 155 (08) 529-536
    CrossrefPubMedGoogle Scholar
  • 23 Hamzah KH, Ayad O. Role of MRI versus CT scan in evaluation of patient with vertigo. Med J Babylon 2017; 14: 550-557
    Google Scholar
  • 24 Alawneh KZ, Raffee LA, Oqlat AA. et al. The utility of brain CT scan modality in the management of dizziness at the emergency department: a retrospective single-center study. Ann Med Surg (Lond) 2021; 64: 102220
    PubMedGoogle Scholar
  • 25 Hammoud K, Lanfranchi M, Li SX, Mehan WA. What is the diagnostic value of head MRI after negative head CT in ED patients presenting with symptoms atypical of stroke?. Emerg Radiol 2016; 23 (04) 339-344
    CrossrefPubMedGoogle Scholar
  • 26 Fakhran S, Alhilali L, Branstetter IV BF. Yield of CT angiography and contrast-enhanced MR imaging in patients with dizziness. AJNR Am J Neuroradiol 2013; 34 (05) 1077-1081
    CrossrefPubMedGoogle Scholar
  • 27 Ahsan SF, Syamal MN, Yaremchuk K, Peterson E, Seidman M. The costs and utility of imaging in evaluating dizzy patients in the emergency room. Laryngoscope 2013; 123 (09) 2250-2253
    CrossrefPubMedGoogle Scholar
  • 28 Hwang DY, Silva GS, Furie KL, Greer DM. Comparative sensitivity of computed tomography vs. magnetic resonance imaging for detecting acute posterior fossa infarct. J Emerg Med 2012; 42 (05) 559-565
    CrossrefPubMedGoogle Scholar
  • 29 Salmela MB, Mortazavi S, Jagadeesan BD. et al; Expert Panel on Neurologic Imaging. ACR appropriateness criteria® cerebrovascular disease. J Am Coll Radiol 2017; 14 (5S): S34-S61
    CrossrefPubMedGoogle Scholar
  • 30 Gottlieb M, Peksa GD, Carlson JN. Head impulse, nystagmus, and test of skew examination for diagnosing central causes of acute vestibular syndrome. Cochrane Database Syst Rev 2023; 11 (11) CD015089
    PubMedGoogle Scholar
  • 31 Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 2009; 40 (11) 3504-3510
    CrossrefPubMedGoogle Scholar
  • 32 Smith AG, Rowland Hill C. Imaging assessment of acute ischaemic stroke: a review of radiological methods. Br J Radiol 2018; 91 (1083): 20170573
    CrossrefPubMedGoogle Scholar