Background

MRI and CT modalities are both current standard-of-care options for initial imaging in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). MR provides greater lesion conspicuity and spatial resolution, but few series have demonstrated multimodal MR may be performed efficiently.

Methods

In a prospective comprehensive stroke center registry, we analyzed all anterior circulation LVO thrombectomy patients between 2012–2017 who: (1) arrived directly by EMS from the field, and (2) had initial NIHSS ≥6. Center imaging policy was multimodal MRI (including DWI/GRE/MRA w/wo PWI) as the initial evaluation in all patients without contraindications, and multimodal CT (including CT with CTA, w/wo CTP) in the remainder.

Results

Among 106 EMS-arriving endovascular thrombectomy patients, initial imaging was MRI 62.3%, CT in 37.7%. MRI and CT patients were similar in age (72.5 vs 71.3), severity (NIHSS 16.4 v 18.2), and medical history, though MRI patients had longer onset-to-door times. Overall, door-to-needle (DTN) and door-to-puncture (DTP) times did not differ among MR and CT patients, and were faster for both modalities in 2015–2017 versus 2012–2014. In the 2015–2017 period, for MR-imaged patients, the median DTN 42m (IQR 34-55) surpassed standard (60m) and advanced (45m) national targets and the median DTP 86m (IQR 71-106) surpassed the standard national target (90m).

Conclusions

AIS-LVO patients can be evaluated by multimodal MR imaging with care speeds faster than national recommendations for door-to-needle and door-to-puncture times. With its more sensitive lesion identification and spatial resolution, MRI remains a highly viable primary imaging strategy in acute ischemic stroke patients, though further workflow efficiency improvements are desirable.

中文翻译：

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高效多模态MRI评价前循环大血管闭塞的血管内血栓切除术

背景

对于因大血管闭塞（AIS-LVO）导致的急性缺血性卒中患者，MRI和CT形式都是当前初始影像学的护理标准。MR可提供更大的病变显着性和空间分辨率，但很少有系列证据表明多模式MR可以有效执行。

方法

在一项前瞻性综合性卒中中心注册表中，我们分析了2012-2017年间所有前循环LVO血栓切除术患者，这些患者：（1）通过现场急诊由EMS直接到达；（2）初始NIHSS≥6。中心影像学策略是对所有无禁忌症的患者进行多模式MRI（包括DWI / GRE / MRA w / w Pw）作为初始评估，其余部分则采用多模式CT（包括具有CTA的w / w CTP CT）。

结果

在106例到达EMS的血管内血栓切除术患者中，MRI的初始显像率为62.3％，CT的为37.7％。MRI和CT患者的年龄（72.5 vs 71.3），严重程度（NIHSS 16.4 v 18.2）和病史相似，尽管MRI患者的上门时间更长。总体而言，MR和CT患者之间的门到针（DTN）和门到穿刺（DTP）时间没有差异，并且在2015-2017年与2012-2014年这两种方式的时间都更快。在2015年至2017年期间，对于MR图像患者，DTN的中位数超过了国家标准（60m）和高级（45m），达到了目标（60m）和高级（45m），DTP的中值超过了国家标准（86m（IQR 71-106））目标（90m）。

结论

AIS-LVO患者可以通过多模式MR成像进行评估，其护理速度比国家建议的门针时间和门针时间要快。MRI具有更敏感的病变识别和空间分辨率，尽管仍需要进一步提高工作流程效率，但MRI在急性缺血性中风患者中仍是高度可行的主要成像策略。