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Background: MRI is more sensitive for the detection of ischemic stroke than CT, but is not routinely used in the Emergency Department (ED) due to limited availability, prolonged scan time, and higher cost.

Hypothesis: A 24/7 ED-based rapid MRI (8 minutes scan time) for the diagnosis of acute ischemic stroke will reduce direct costs, tPA administration to stroke mimics, and length of stay.

Methods: We included patients who were admitted to the ED under our Brain Attack stroke activation and had either a CT perfusion (CTP) (2013-2015) or, after it became available, a rapid MRI (2015-2018). The primary outcomes are total direct cost (reported as % of the mean cost for CTP due to data reporting restrictions), % of tPA administration given to stroke mimics, hospital length of stay in days.

Results: Our cohort includes 215 patients, aged 58.6±19.4 years and 45% male. Acute ischemic stroke was the discharge diagnosis in …