title: Pretreatment advanced imaging in patients with stroke treated with IV thrombolysis: evaluation of a multihospital data base.
abstract: OBJECTIVE
  CT angiography, CT perfusion, and MR imaging have all been advocated as potentially useful in treatment planning for patients with acute ischemic stroke. We evaluated a large multihospital data base to determine how the use of advanced imaging is evolving in patients treated with intravenous thrombolysis.
  
  
  METHODS
  Patients with acute ischemic stroke receiving IV thrombolytic therapy from 2008 to 2011 were identified by using the Premier Perspective data base. Mortality and discharge to long-term care rates were compared following multivariate logistic regression between patients who received head CT only versus those who received CTA without CT perfusion, CT perfusion, or MR imaging.
  
  
  RESULTS
  Of 12,429 included patients, 7305 (59%) were in the CT group, 2359 (19%) were in the CTA group, 848 (7%) were in the CTP group, and 1917 (15%) were in the MR group. From 2008 to 2011, the percentage of patients receiving head CT only decreased from 64% to 55%, while the percentage who received cerebral CT perfusion increased from 3% to 8%. The use of CT angiography and MR imaging marginally increased (1%-2%). Outcomes were similar between CT only and advanced imaging patients, except discharge to long-term care was slightly more frequent in the CTP group (OR = 1.17 [95% CI, 0.96-1.43]; P = .0412) and MR group (OR = 1.14 [95% CI, 1.01-1.28]; P = .0177) and mortality was lower in the MR group (OR = 0.64 [95% CI, 0.52-0.79]; P < .0001).
  
  
  CONCLUSIONS
  Use of advanced imaging is increasing in patients treated with IV thrombolysis. While there were differences in outcomes among imaging groups, the clinical effect of advanced imaging remains unclear.
authors.affiliation: From the Departments of Radiology (J.S.M., D.F.K., H.J.C.).
authors.forename: J S
authors.initials: JS
authors.lastname: McDonald
authors.forename: J
authors.initials: J
authors.lastname: Fan
authors.forename: D F
authors.initials: DF
authors.lastname: Kallmes
authors.forename: H J
authors.initials: HJ
authors.lastname: Cloft
mesh_terms: D000208:Acute Disease; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D002560:Cerebrovascular Circulation; D016208:Databases, Factual; D005343:Fibrinolytic Agents; D006801:Humans; D007262:Infusions, Intravenous; D008279:Magnetic Resonance Imaging; D059906:Neuroimaging / Q000379:methods*; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed
chemical_list: D005343:Fibrinolytic Agents