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The clinician caring for patients with neurologic symptoms is faced with myriad imaging options, including computed tomography (CT), CT angiography (CTA), perfusion CT (pCT), magnetic resonance imaging (MRI), MR angiography (MRA), functional MRI (fMRI), MR spectroscopy (MRS), MR neurography (MRN), diffusion and diffusion track imaging (DTI), susceptibility weighted MR imaging (SWI), and perfusion MRI (pMRI). In addition, an increasing number of interventional neuroradiologic techniques are available, including angiography catheter embolization, coiling, and stenting of vascular structures; and spine diagnostic and interventional techniques such as diskography, transforaminal and translaminar epidural and nerve root injections and blood patches. Recent developments such as multidetector CTA (MDCTA) and gadolinium-enhanced MRA, have narrowed the indications for conventional angiography, which is now reserved for patients in whom small-vessel detail is essential for diagnosis or for whom concurrent interventional therapy is planned (Table 368-1).

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Table 368-1 Guidelines for the Use of CT, Ultrasound, and MRI 
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In general, MRI is more sensitive than CT for the detection of lesions affecting the central nervous system (CNS), particularly those of the spinal cord, cranial nerves, and posterior fossa structures. Diffusion MR, a sequence sensitive to the microscopic motion of water, is the most sensitive technique for detecting acute ischemic stroke of the brain or spinal cord, and it is also useful in the detection of encephalitis, abscesses, and prion diseases. CT, however, is quickly acquired and is widely available, making it a pragmatic choice for the initial evaluation of patients with acute changes in mental status, suspected acute stroke, hemorrhage, and intracranial or spinal trauma. CT is also more sensitive than MRI for visualizing fine osseous detail and is indicated in the initial ...

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