MR angiography overused in assessing vertigo.
This retrospective study found that primary care physicians order the majority of magnetic resonance angiographies (MRAs) for evaluation of isolated vertigo, often with a lack of clear documentation of patient symptoms.
"The decision for MRA evaluation for isolated vertigo should be reserved for subspecialists and those specializing in balance disorders, such as neurologists and otolaryngologists," wrote Dr. Baumgartner of the Madigan Army Medical Center, Tacoma, Wash.
He and his colleagues reviewed the records of 46 patients aged 17 years and older who underwent posterior fossa MRA between 2000 and 2003. Of those, 19 had documented management changes based on the MRA results, such as further diagnostic testing, therapeutic intervention, or referral to a specialist. No identifiable, documented management changes based on the MRA test were found in the other 27 patients.
"Although MRA has never been clinically shown to be an effective screening tool for patients with isolated vertigo of unknown etiology, it appears reasonable in patients with significant, cerebrovascular disease risk factors, [with] central neurologic exam findings, or for whom a high clinical suspicion of vertebral basilar insufficiency exists," Dr. Baumgartner wrote.
Careful consideration of history, risk factors, and physical findings are essential, he added. Without this, physicians may discover unrelated vertebral basilar system abnormalities which may or may not be clinically relevant.
BY ELAINE ZABLOCKI
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|Title Annotation:||Magnetic resonance|
|Publication:||Internal Medicine News|
|Article Type:||Brief article|
|Date:||Mar 1, 2006|
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