Published Online
on August 4, 2005

A more recent version of this article appeared on September 1, 2005

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Submitted on March 31, 2005
Revised on June 20, 2005
Accepted on June 27, 2005

MRI Screening Before Standard Tissue Plasminogen Activator Therapy Is Feasible and Safe

Dong-Wha Kang MD, PhD; Julio A. Chalela MD; William Dunn MD; Steven Warach MD, PhD^*; NIH-Suburban Stroke Center Investigators

From the Stroke Branch (D.-W.K., J.A.C., W.D., S.W.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md; and Department of Neurology (D.-W.K.), Asan Medical Center, University of Ulsan, Seoul, South Korea.

^* To whom correspondence should be addressed. E-mail: WarachS{at}ninds.nih.gov.

Background and Purpose--MRI screening for thrombolytic therapy may improve patient selection. Alternatively, it may excessively delay treatment and thereby lead to worse outcomes. We hypothesized that times to treatment and outcomes in a stroke center with immediate MRI access and interpretation would not differ from those of the typical clinical practice.

Methods--We compared the results of 120 consecutive patients treated with intravenous tissue plasminogen activator (tPA) within 3 hours of onset at our center with those of the 2 largest multicenter registries of tPA use.^5,6 In addition to standard criteria, MRI specific eligibility criteria were applied in 97 patients. MRI was not performed in 23 patients because of contraindications to MRI or late patient arrival (>2.5 hours). Outcomes were the modified Rankin Scale (mRS) obtained at 3 months.

Results--Times to treatment (median door-to-needle time 81.5 minutes; median onset-to-needle time 135 minutes) and outcomes (mRS 0 to 1, 40.8%; mRS 0 to 2, 47.5%) were not inferior to those of the typical clinical practice. Door-to-needle time was shorter in computed tomography (CT) screening (67.5±22.5 minutes; n=23) than in MRI screening (86.8±21.5 minutes; n=97; P<0.001). However, outcomes were not different between MRI screening (mRS 0 to 1, 42.3%; mRS 0 to 2, 49.5%) and CT screening (mRS 0 to 1, 34.8%; mRS 0 to 2, 39.1%). Neither times to treatment nor MRI screening was predictive of outcomes.

Conclusion--These data demonstrate that MRI screening before tPA therapy is feasible and not associated with unacceptable times to treatment or outcomes.

Key words: stroke, acute • magnetic resonance imaging • thrombolysis

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