Neftaly: Trends in Neuroimaging Use Among Admitted Patients
1. Broad Historical Growth in Inpatient Imaging
- From 2002 to 2007, academic medical centers experienced a 28% rise in inpatient CT scans per patient discharge and a 20% rise in MRI use, after adjusting for case mix index. PubMed
- Before that, the sheer volume of CT usage grew dramatically—from about 3 million in 1980 to 62 million in 2007—underscoring CT’s rising dominance in hospital diagnostics. Wikipedia
2. Decline in Head CT Use Over Time
- In the U.S., inpatient head CT scans dropped sharply between 1997 and 2002, followed by stabilization from 2002 to 2014. Overall, head CT usage fell significantly. PubMed
- The reduction appears to reflect more cautious imaging practices, improved electronic governance (like audit checks), and evolving payment models discouraging unnecessary radiation exposure. PubMed
3. Rise in Advanced Stroke Imaging
- In U.S. Medicare stroke patients (2012–2019), there were dramatic increases:
- These advanced modalities were strongly linked to elevated use of treatment options like thrombectomy (EVT) and thrombolysis (IVT); CTA, MRI, and MRA correlated with lower mortality, whereas higher CTP use associated with higher post-discharge mortality. PubMedPMC
4. Neuroimaging in Admitted Stroke/TIA Patients
- Among hospitalized stroke/TIA patients (2015–2019), imaging usage was:
- CT scans: ~99%
- MRI: 40.5%
- CTA: 61.8%
- CTP: 50.3%
- Trends during this period:
- CT use increased by ~1.6% per year
- CTA rose by 13.8% per year
- CTP increased by 12.5% per year (borderline significant)
- MRI use declined slightly (–4.4%), though not significantly. PMC
5. ED Neuroimaging Trends (2007–2017)
- Emergency Department-based neuroimaging surged:
- Overall utilization rose by 72%
- Head CT increased 69%
- Head MRI increased 67%
- Head CTA skyrocketed by 1100%
- Neck CTA grew 1300%
- MRA usage rose modestly (36–52%)
- Carotid Doppler ultrasonography decreased by 8% PubMed
6. Disparities and Access Inequalities
- Utilization varied based on patient demographics:
- Urban patients had higher growth in CTA and CTP use than rural counterparts, thereby widening the urban–rural gap. PMCPubMed
- Older patients (≥80 years) had lower rates of CTA, MRI, and MRA. Women received fewer CTAs compared to men. PubMed
- Black patients had lower use of CTA and CTP but higher MRI and MRA usage. Lower-income areas saw elevated CTP use but reduced MRA access. PMCPubMed
7. Local Context: Imaging in Psychiatric Admissions
- At the Charlotte Maxeke Johannesburg Academic Hospital psychiatric unit (2014–2015):
- 20.5% of psychiatric inpatients underwent neuroimaging.
- Among them, 93% had CT, while only 2.3% had MRI, and 4.7% had both. PMC
8. Turning Insights Into Practice
Summary of Trends
| Trend | Summary |
|---|---|
| Inpatient CT/MRI (2002–2007) | Increased significantly in academic centers. |
| Head CT (1997–2014) | Decreased markedly, then stabilized. |
| Stroke Imaging (2012–2019) | CTA & CTP surged; MRI modest rise; MRA declined. |
| Stroke Admissions (2015–2019) | CT nearly universal; CTA and CTP use growing; MRI slightly decreasing. |
| ED Imaging (2007–2017) | Sharp increase, especially CTA/CTP; CT and MRI also rose. |
| Disparities | Age, gender, race, geography, and income influence utilization. |
| Psychiatric Inpatients | Low MRI use compared to CT, even when indicated. |
Implications for Hospital Practice
- Selective use over volume: Institutions need robust clinical decision support to curb unnecessary CTs while ensuring access to advanced imaging when needed.
- Address inequities: Monitor data to ensure fair imaging access across demographics and geographies.
- Optimize stroke pathways: Ensure infrastructure supports timely CTA and CTP—critical for acute stroke interventions.
- Expand MRI where undervalued: Particularly in settings like psychiatry where MRI can change diagnosis but remains underutilized.
- Plan capacity and workforce: As demand for advanced imaging grows, hospitals must invest in scanners, staff training, and protocol efficiency.
- Audit regularly: Track trends, follow-up outcomes, and influence of imaging on clinical decisions to refine strategy.
9. Conclusion
Neuroimaging use among admitted patients has evolved significantly over time—from a historic rise in CT/MRI use to a more nuanced adoption of advanced modalities like CTA and CTP, especially in stroke care. Simultaneously, the decreasing trend of simple head CTs, the persistent disparities, and modality-specific access patterns underscore the importance of balancing clinical need, resources, and equity in modern hospital settings.