Diagnostic yield of MRI in adult patients with dizziness or vertigo at the emergency department: a systematic review and meta-analysis.

Abstract

Dizziness and vertigo are common in the emergency department, often requiring an MRI to detect central causes. However, utilization varies widely. This systematic review and meta-analysis quantify the diagnostic yield and utilization rate of MRI in adult emergency department patients and assess the impact of clinical setting, patient selection, and imaging protocols. A systematic search of MEDLINE, EMBASE, and Cochrane Library (until June 9, 2025) identified studies evaluating MRI in adult emergency department patients with dizziness or vertigo. Study quality was assessed using QUADAS-2. Pooled proportions were calculated via random-effects meta-analysis, with subgroup analyses for patient selection, exclusion of peripheral vertigo, and MRI protocols. Seventeen studies, including 42,994 patients, were analyzed. The mean age across studies ranged from 47.3 to 65.1 years, with an overall male proportion of 39.8% (17,121 men). The pooled MRI diagnostic yield was 13.1% (95% CI: 8.3-20.2), and MRI utilization was 23.2% (95% CI: 14.0-33.9). Isolated dizziness had a lower yield (5.7% vs 17.8%; p < 0.01). Excluding peripheral vertigo increased MRI use (30.1% vs 21.0%; p = 0.043) but did not improve yield (14.4% vs 11.4%; p = 0.32). DWI-only protocols had lower yield (4.3% vs 13.6%; p = 0.03) but higher utilization (71.5% vs 23.2%; p < 0.01). MRI was used in 23.2% of emergency department patients, with a 13.1% diagnostic yield. DWI-only protocols improve access but miss key findings. Optimizing imaging strategies can enhance diagnostic accuracy and efficiency. Question What is the diagnostic yield of MRI in adult emergency patients with dizziness or vertigo, and how do selection criteria and imaging protocols affect outcomes? Findings MRI diagnostic yield was 13.1% (utilization: 23.2%). DWI-only protocols were used more often (71.5%) but showed lower yield (4.3%). Yield for isolated dizziness was 5.7%. Clinical relevance While MRI is efficient for detecting central causes of dizziness, its yield is low in cases of isolated dizziness without neurological signs. Comprehensive clinical judgment and optimized protocols are essential to prevent unnecessary imaging in the emergency setting.