Feasibility and logistics of MRI before thrombolytic treatment.
OBJECTIVE
The study analyzes feasibility and time-delays in Magnetic resonance imaging (MRI) based thrombolysis and estimate the impact of MRI on individual tissue plasminogen activator (rtPA) treatment.


METHODS
Feasibility of MRI and time logistics were prospectively recorded in patients referred with presumed acute stroke over a 2 year time period. Door-to-needle-times (DNT) were compared with those of patients treated with rtPA after conventional CT during the same time period, and to published open label studies.


RESULTS
We received 174 patients with presumed stroke. MRI was feasible in 141 of 161 (88%) of those requiring acute imaging. MRI supported the decision to treat 11 patients with mild symptoms or seizures, and not to treat four patients with extensive infarctions. Median 'door-to-needle time' (DNT) in MR scanned patients (70 min), did not differ significantly from DNT after conventional CT (n = 17, DNT = 66 min, P = 0.27) or the Safe Implementation of Thrombolysis in Stroke (SITS-MOST) registry (DNT = 68 min).


CONCLUSIONS
Magnetic resonance imaging can be performed in the majority of acute stroke patients without delaying treatment. MRI may affect decision making in a large proportion of patients.
Sølling
C
C
Department of Neuroradiology, Center of Functionally Integrative Neuroscience, Aarhus University Hospital, Arhus C, Denmark. christin@pet.auh.dk
Ashkanian
M
M
Hjort
N
N
Gyldensted
C
C
Andersen
G
G
Østergaard
L
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator