Routine use of FLAIR-negative MRI in the treatment of unknown onset stroke

Routine use of FLAIR-negative MRI in the treatment of unknown onset stroke

Treatment of FLAIR-negative stroke in patients presenting in an unknown time window has been shown to be safe and effective. However, implementation can be challenging due to the need for hyper-acute MRI screening. The purpose of this study was to review the routine application of this practice outs...

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Veröffentlicht in:Journal of stroke and cerebrovascular diseases 2020-09, Vol.29 (9), p.105093-105093, Article 105093
Hauptverfasser: Adil, Malik M., Luby, Marie, Lynch, John K., Hsia, Amie W., Kalaria, Chandni P., Nadareishvili, Zurab, Latour, Lawrence L., Leigh, Richard
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FLAIR negative
MRI
Thrombolysis
Unknown onset
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container_end_page 105093
container_issue 9
container_start_page 105093
container_title Journal of stroke and cerebrovascular diseases
container_volume 29
creator Adil, Malik M.
Luby, Marie
Lynch, John K.
Hsia, Amie W.
Kalaria, Chandni P.
Nadareishvili, Zurab
Latour, Lawrence L.
Leigh, Richard
description Treatment of FLAIR-negative stroke in patients presenting in an unknown time window has been shown to be safe and effective. However, implementation can be challenging due to the need for hyper-acute MRI screening. The purpose of this study was to review the routine application of this practice outside of a clinical trial. Patients presenting from 3/1/16 to 8/22/18 in a time window 4.5 h from last known normal were included if they had a hyper-acute MRI performed. Quantitative assessment based on the MR WITNESS trial and qualitative assessment based on the WAKE-UP trial were used to grade the FLAIR images. The MR WITNESS trial used a quantitative assessment of FLAIR change where the fractional increase in signal change had to be
doi_str_mv 10.1016/j.jstrokecerebrovasdis.2020.105093
format Article
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However, implementation can be challenging due to the need for hyper-acute MRI screening. The purpose of this study was to review the routine application of this practice outside of a clinical trial. Patients presenting from 3/1/16 to 8/22/18 in a time window &lt;4.5 h from symptom discovery but &gt;4.5 h from last known normal were included if they had a hyper-acute MRI performed. Quantitative assessment based on the MR WITNESS trial and qualitative assessment based on the WAKE-UP trial were used to grade the FLAIR images. The MR WITNESS trial used a quantitative assessment of FLAIR change where the fractional increase in signal change had to be &lt;1.15, whereas the WAKE-UP trial used a visual assessment requiring the absence of marked FLAIR signal changes. During the study period, 136 stroke patients presented and were imaged in the specified time window. Of these, 17 (12.5%) received IV tPA. Three patients had hemorrhage on 24-h MRI follow up; none had an increase in NIHSS ≥4. Of the 119 patients who were screened but not treated, 18 (15%) were eligible based on FLAIR quantitative assessment and 55 (46%) were eligible based on qualitative assessment. In all cases where patients were not treated, there was an identifiable exclusion based on trial criteria. During the study period, IV tPA utilization was increased by 5.6% due to screening and treating patients with unknown onset stroke. 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subjects FLAIR negative
MRI
Thrombolysis
Unknown onset
title Routine use of FLAIR-negative MRI in the treatment of unknown onset stroke
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