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The primary imaging study used to evaluate a transient ischemic attack (TIA) is the carotid Doppler ultrasonography. This non-invasive test helps assess blood flow in the carotid arteries, which supply blood to the brain. It can identify significant stenosis (narrowing) or occlusion in these vessels, which are common causes of TIAs. By visualizing the carotid arteries, healthcare providers can determine whether the blood supply to the brain is compromised, allowing for appropriate management and prevention strategies.

Other imaging studies may serve complementary roles but are not the initial choice for TIA evaluation. For instance, while MRI of the brain is excellent for detecting acute brain ischemia and assessing detailed brain structures, it is typically not the first step in the evaluation of TIAs. Similarly, CT scans without contrast can help rule out hemorrhagic strokes but are less effective in identifying transient ischemic events since they may not show any acute findings. Angiograms are more invasive and typically reserved for cases where detailed vascular imaging is needed after initial assessments suggest significant vascular pathology. Thus, carotid Doppler is the most appropriate and commonly utilized initial imaging study for TIA evaluation.