This review focuses on the current landscape and future direction for low-field magnetic resonance imaging in the prehospital setting, with a discussion of current and upcoming devices, and potential barriers to ambulance integration and how these may be overcome.
Abstract
Stroke is a leading cause of morbidity and mortality globally. Prehospital stroke care is a rapidly growing field to improve stroke outcomes. Methods to assess patients in the prehospital setting include clinical scales and portable neuroimaging that are usually restricted to mobile stroke unit computed tomography scanners, which are not widely available. Lightweight low-field magnetic resonance imaging devices at the <0.1T range offer an opportunity for portable lightweight imaging for the prehospital setting, with the advantage of greater tissue assessment to diagnose stroke. This review focuses on the current landscape and future direction for low-field magnetic resonance imaging in the prehospital setting, with a discussion of current and upcoming devices, and potential barriers to ambulance integration and how these may be overcome. Low-field magnetic resonance imaging provides an exciting opportunity for portable and safe imaging for the prehospital setting for the early diagnosis of stroke and the initiation of triage and treatment. These devices have the potential to be much more widely available and accessible than the current prehospital assessment model of mobile stroke units and provide additional detail for treatment decisions compared with non-imaging-supported telehealth prehospital assessments.
Low-field and portable MRI show promising diagnostic potential for AIS and TIA, particularly when conventional MRI is unavailable, delayed, or impractical, but current evidence is limited by small, predominantly single-center studies with substantial risk of bias.
Rachana R. Borkar, Sai Dhanush Reddy Jeggari, Kamal Kandel et al.· Brain Science· 0 citations
Low-field magnetic resonance imaging (LF-MRI) has recently emerged as a novel approach to extend MRI capability into critical care environments and offers a unique opportunity to support repeated imaging during periods when neurological examination is unreliable or limited.
Lina Zheng, Z. Law, X. Nie et al.· Stroke· 0 citations
The current clinical evidence base is reviewed, including the role of LF-MRI in supporting stroke-type classification and tissue confirmation, in wake-up and unknown-onset stroke for tissue-based triage, and in post-therapeutic settings to enable serial assessment after thrombolysis or thrombectomy.
A. Sorby-Adams, N. Pintér, Keith W. Muir et al.· Stroke· 0 citations
Effects of stroke therapies area highly time dependent but onset-to-treatment times for recanalizing treatment are mostly beyond optimal time windows. Mobile stroke units shorten time to treatment and improve functional outcome. However, costs and logistical demands preclude their widespread use. There is a pressing need for alternative prehospital diagnostic tools that enable early, on-site treatment and facilitate targeted transport in patients needing interventional therapies. This systematic review aimed at examining the current landscape of noncomputed tomography-based technologies for prehospital stroke diagnosis. We conducted a literature search of original research papers on predetermined technologies and through systematic scouting on PubMed and included papers in English found through MEDLINE and Embase, published until October 2025. Relevant papers not identified by the systematic search but known to the authors were included and indicated as such. The final review included 105 publications evaluating innovations in microwave, transcranial eddy current damping, volumetric impedance phase shift spectroscopy, ultrasound, magnetic resonance imaging, electroencephalography, near-infrared spectroscopy, blood biomarkers, telemedicine, and artificial intelligence. Each technology's potentials, limitations, and clinical feasibility for enhancing prehospital diagnosis and therapeutic and monitoring utility were assessed. No single technology provides capabilities similar to noncomputed tomography in terms of detection and differentiation of ischemic and hemorrhagic stroke. A combination of ultrasound and near-infrared spectroscopy may complement each other in hemorrhage detection. Electroencephalography shows most promise in identifying large vessel occlusion. Telemedicine can be used for reliable prehospital stroke assessment. Future research should target both the improvement of individual technologies as well as combining different modalities.
Maximilian Kaffes, Maxwell S. Damian, Stephen M. Davis et al.· Journal of the American Hear...· 0 citations
This review critically appraise how CT and MRI are integrated hierarchically across these scenarios, and how emerging fast MRI and quantitative biomarkers may reshape future selection paradigms.
Kai Xu, J. Lyu, Xin Lou· Journal of Magnetic Resonanc...· 0 citations
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