title: Feasibility of using magnetic resonance imaging as a screening tool for acute stroke thrombolysis.
abstract: BACKGROUND
  Feasibility of performing MRI first for suspected hyperacute stroke patients in real-world practice has not been fully examined. Moreover, most past studies of reducing door-to-needle time (DNT) in intravenous thrombolysis were conducted using CT. The aim of this study was to evaluate the feasibility of an MRI-first policy and examine the effects of a quality improvement (QI) process for reducing DNT using MRI.
  
  
  METHODS
  From January 2014 to August 2015, consecutive acute stroke patients who were treated with thrombolysis were prospectively enrolled into the present study. In principle, multimodal 1.5T-MRI was performed first for patients with suspected acute stroke. A step-by-step QI process for decreasing DNT, including prenotification by the emergency medical service, limiting the MRI sequence, and introduction of a rapid examination tool, was also implemented during this period. Time metrics for thrombolysis were compared between specific time periods.
  
  
  RESULTS
  A total of 73 patients (27 women; median age 74years) were included in the present study. More than 80% of the patients were screened with MRI. More patients were managed with the MRI-first policy in the late phase (p=0.018). DNT (83min in the early phase, 68min in the middle phase, and 54min in the late phase, p<0.001) was significantly reduced across phases. The percentage of patients with DNT<60min increased significantly across time periods (p<0.001).
  
  
  CONCLUSIONS
  An MRI-first policy was feasible, and DNT was substantially reduced with a QI process. This process may be applicable to other hospitals.
authors.affiliation: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan. Electronic address: ysakamoto02@gmail.com.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Sakamoto
authors.affiliation: Nursing Department, Nippon Medical School, Tokyo, Japan.
authors.forename: Midori
authors.initials: M
authors.lastname: Tanabe
authors.affiliation: Nursing Department, Nippon Medical School, Tokyo, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Masuda
authors.affiliation: Nursing Department, Nippon Medical School, Tokyo, Japan.
authors.forename: Hitomi
authors.initials: H
authors.lastname: Ozaki
authors.affiliation: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Okubo
authors.affiliation: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Suda
authors.affiliation: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Arata
authors.initials: A
authors.lastname: Abe
authors.affiliation: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Aoki
authors.affiliation: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Kanako
authors.initials: K
authors.lastname: Muraga
authors.affiliation: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Kanamaru
authors.affiliation: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Katano
authors.affiliation: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy; D004632:Emergency Medical Services / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D058996:Quality Improvement; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors; D061665:Time-to-Treatment; D014057:Tomography, X-Ray Computed
keywords: Acute ischemic stroke; Door-to-needle time; Magnetic resonance imaging; Thrombolysis