title: Identification of imaging selection patterns in acute ischemic stroke patients and the influence on treatment and clinical trial enrollment decision making.
abstract: OBJECTIVE
  For the STroke Imaging Research (STIR) and VISTA-Imaging Investigators The purpose of this study was to collect precise information on the typical imaging decisions given specific clinical acute stroke scenarios. Stroke centers worldwide were surveyed regarding typical imaging used to work up representative acute stroke patients, make treatment decisions, and willingness to enroll in clinical trials.
  
  
  METHODS
  STroke Imaging Research and Virtual International Stroke Trials Archive-Imaging circulated an online survey of clinical case vignettes through its website, the websites of national professional societies from multiple countries as well as through email distribution lists from STroke Imaging Research and participating societies. Survey responders were asked to select the typical imaging work-up for each clinical vignette presented. Actual images were not presented to the survey responders. Instead, the survey then displayed several types of imaging findings offered by the imaging strategy, and the responders selected the appropriate therapy and whether to enroll into a clinical trial considering time from onset, clinical presentation, and imaging findings. A follow-up survey focusing on 6 h from onset was conducted after the release of the positive endovascular trials.
  
  
  RESULTS
  We received 548 responses from 35 countries including 282 individual centers; 78% of the centers originating from Australia, Brazil, France, Germany, Spain, United Kingdom, and United States. The specific onset windows presented influenced the type of imaging work-up selected more than the clinical scenario. Magnetic Resonance Imaging usage (27-28%) was substantial, in particular for wake-up stroke. Following the release of the positive trials, selection of perfusion imaging significantly increased for imaging strategy.
  
  
  CONCLUSIONS
  Usage of vascular or perfusion imaging by Computed Tomography or Magnetic Resonance Imaging beyond just parenchymal imaging was the primary work-up (62-87%) across all clinical vignettes and time windows. Perfusion imaging with Computed Tomography or Magnetic Resonance Imaging was associated with increased probability of enrollment into clinical trials for 0-3 h. Following the release of the positive endovascular trials, selection of endovascular only treatment for 6 h increased across all clinical vignettes.
authors.affiliation: National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA Department of Neurology and Neurotherapeutics, Seton/UT Southwestern Clinical Research Institute of Austin, UT Southwestern Medical Center, Austin, TX, USA lubym@ninds.nih.gov.
authors.forename: Marie
authors.initials: M
authors.lastname: Luby
authors.affiliation: Dell Medical School, University of Texas Austin, Austin, TX, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Warach
authors.affiliation: Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Albers
authors.affiliation: INSERM U894, Centre Hospitalier Sainte-Anne, Sorbonne Paris Cité, Paris, France Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Baron
authors.affiliation: Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Cognard
authors.affiliation: Hospital Universitari Germans Trias I Pujol, Badalona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Dávalos
authors.affiliation: The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Donnan
authors.affiliation: Academic Neuroradiology, Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Jochen B
authors.initials: JB
authors.lastname: Fiebach
authors.affiliation: University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Fiehler
authors.affiliation: Department of Neurology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Hacke
authors.affiliation: Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Maarten G
authors.initials: MG
authors.lastname: Lansberg
authors.affiliation: UCLA Stroke Center, Los Angeles, CA, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.affiliation: Inselspital, University of Bern, Bern, Switzerland.
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.affiliation: Université Paris-Descartes, Sorbonne Paris Cité, Hôpital Sainte-Anne, INSERM U 894, Paris, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Oppenheim
authors.affiliation: Johannes Wesling Medical Center Minden, Minden, Germany.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Schellinger
authors.affiliation: Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Wardlaw
authors.affiliation: Stanford University School of Medicine, Stanford, CA, USA Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
authors.forename: Max
authors.initials: M
authors.lastname: Wintermark
mesh_terms: D006801:Humans; D059906:Neuroimaging / Q000706:statistics & numerical data*; D018579:Patient Selection; D020521:Stroke / Q000175:diagnosis* / Q000628:therapy; D011795:Surveys and Questionnaires
keywords: Computed Tomography scan; Magnetic Resonance Imaging; clinical trial; ischemic stroke; stroke; thrombolysis