Abstract T P47: Feasibility of Rapid Short Sequence Magnetic Resonance Imaging for Screening Stroke Mimics within the IV-tPA Treatment Window - A Pilot Study
Background & Purposes: Up to 30 percent of patients presenting with acute onset of neurological symptoms may suffer from stroke mimics (SMs). MRI is highly sensitive for detection of acute ischemia; however, its clinical utility in the acute stage is limited secondary to the complexity, availability, and time required for a comprehensive brain MRI. In this pilot study, we investigated the feasibility of rapid short sequence (RSS) MRI to screen possible SMs while keeping the door-to-needle (DTN) time below one hour.
Subjects & Methods: We developed clinical criteria to clinically suspect possible SMs and deployed RSS MRI in those patients presenting with acute stroke like-symptoms. Our RSS MRI protocol takes 5-6 minutes and includes DWI, ADC, and FLAIR sequences. The patients also received a non-contrast CT head at the time of ER presentation as standard of care. The new processes to our code stroke protocol included adding MRI technicians to the code stroke, the stroke nurse or physician filling out the MRI screening sheet and transporting the patient to the MRI suite. The stroke physicians were also available at the MRI console to read the MRI and the stroke team was on standby to initiate IV tPA infusion in the MR suite, if it was indicated.
Results: In a 9-month period, we evaluated 35 patients, who met our criteria for possible SMs, using RSS MRI (mean age 49, 78% women, median NIHSS 4). Three patients had diagnosis of an acute ischemic stroke on RSS MRI and received IV TPA while still in the MR suite. The DTN time ranged from 48 to 58 minutes. The median door-to-imaging time was 43 minutes (range 38-49). All of our patients with a RSS MRI negative for acute stroke had a final diagnosis other than stroke.
Conclusions: Our preliminary results show that RSS MRI can be rapidly obtained in selected patients without delaying the DTN time. This screening method avoids unnecessary IV-tPA administration to SMs.
Author Disclosures: N. Goyal: None. G. Tsivgoulis: None. S. Male: None. D. Bhaskaran: None. A. Alexandrov: None. R. Zand: None.
- © 2015 by American Heart Association, Inc.