Faculty Collaboration Database

Magnetic resonance imaging results can affect therapy decisions in hyperacute stroke care. Acta Radiol 2008 Jun;49(5):550-7

Date

06/24/2008

Pubmed ID

18568542

DOI

10.1080/02841850801958320

Scopus ID

2-s2.0-46149098883 (requires institutional sign-in at Scopus site)   30 Citations

Abstract

BACKGROUND: Despite some limitations, a perfusion/diffusion mismatch can provide a working estimate of the ischemic penumbra in hyperacute stroke and has successfully been used to triage patients.

PURPOSE: To evaluate whether the addition of magnetic resonance imaging (MRI) to clinical and non-contrast computed tomography (CT) data alters diagnosis and choice of therapy.

MATERIAL AND METHODS: We retrospectively analyzed clinical records, and CT and MRI data fully available in 97 of 117 patients. Upon clinical examination and CT, a diagnosis and treatment path was scored and compared to treatment path after addition of MRI data. The MRI protocol included T2-weighted images, diffusion-weighted images (DWI), and perfusion-weighted images (PWI), and MR angiography (MRA).

RESULTS: MRI data were acquired in less than 15 min. In 20 of 97 patients (21%), the diagnosis changed after MRI. In 25 of 97 patients (26%), the presumptive treatment plan was changed after MRI evaluation. Thirteen patients had their treatment changed from thrombolytic to nonthrombolytic therapy. Three patients were changed from nonthrombolytic to intraarterial (IA) thrombolysis. In one patient, treatment was changed from intravenous (IV) to IA thrombolysis, and in five patients it was changed from IA to IV thrombolysis. In two patients, systemic heparin was added to antiplatelet therapy.

CONCLUSION: The expansion of the acute stroke protocol to include MRI altered the therapy plan in 26% of our patients. The utility of MRI, shown here to improve patient stratification into best-treatment options, demonstrates the value of using MRI to optimize care in hyperacute stroke patients.

Author List

Heidenreich JO, Hsu D, Wang G, Jesberger JA, Tarr RW, Zaidat OO, Sunshine JL

MESH terms used to index this publication - Major topics in bold

Acute Disease
Adult
Aged
Aged, 80 and over
Brain
Contrast Media
Diffusion Magnetic Resonance Imaging
Echo-Planar Imaging
Female
Gadolinium DTPA
Humans
Image Enhancement
Imaging, Three-Dimensional
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Male
Middle Aged
Predictive Value of Tests
Retrospective Studies
Stroke
Thrombolytic Therapy
Tomography, X-Ray Computed