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This was a single-center, retrospective study of 205 consecutive patients who were referred for vessel wall MR imaging to clarify the etiology of an ischemic stroke or TIA. An expert panel classified stroke etiology before and after incorporating vessel wall MR imaging results using a modified Trial of Org 10172 in Acute Stroke Treatment system. Vessel wall MR imaging altered the etiologic classification in 55% (112/205) of patients. The proportion of patients classified as having intracranial arteriopathy not otherwise specified decreased from 31% to 4% (64/205 versus 9/205) and the proportion classified as having intracranial atherosclerotic disease increased from 23% to 57%. When vessel wall MR imaging is performed to clarify the etiology of a stroke or TIA, it frequently alters the etiologic classification, which is the basis for therapeutic decision-making.

Of 3769 included radiologists ever subspecialty certified, 84.1% are currently subspecialty certified. Of 1777/3769 radiologists ever subspecialty-certified and with lifetime primary certificates, only 66.6% are currently subspecialty certified. Of 3341 included most-practice neuroradiologists (>50% clinical work effort in neuroradiology based on work relative value unit–weighted national Medicare claims), 73.0% were ever subspecialty certified; of these, 89.1% are currently subspecialty certified. More than one-quarter of most-practice neuroradiologists never obtained neuroradiology subspecialty certification. Even when initially obtained, that certification is commonly not maintained, particularly by lifetime primary certificate diplomates and those in nonacademic and smaller practices.