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.
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DOI：
10.1016/j.jstrokecerebrovasdis.2020.105093
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发表时间：
2020-09
影响因子：
2.5
通讯作者：
Leigh, Richard
中科院分区：
文献类型：
--
作者：
Adil, Malik M.;Luby, Marie;Lynch, John K.;Hsia, Amie W.;Kalaria, Chandni P.;Nadareishvili, Zurab;Latour, Lawrence L.;Leigh, Richard
在未知时间窗内出现的FLAIR阴性卒中患者的治疗已被证明是安全有效的。然而，由于需要超急性MRI筛查，实施可能具有挑战性。本研究的目的是审查临床试验以外的常规应用。如果<4.5 hours from symptom discovery but >患者进行了超急性MRI，则纳入2016年3月1日至2018年8月22日在距离最后已知正常值4.5小时的时间窗内就诊的患者。采用基于MR WITNESS试验的定量评估和基于WAKE-UP试验的定性评估对FLAIR图像进行分级。MR WITNESS试验使用FLAIR变化的定量评估，其中信号变化的分数增加必须<1.15，而WAKE-UP试验使用视觉评估，要求没有明显的FLAIR信号变化。在研究期间，136名中风患者在指定的时间窗内就诊并接受成像。其中，17例（12.5%）接受了IV tPA。3名患者在24小时MRI随访时出现出血; NIHSS均未增加≥4。在119例接受筛查但未接受治疗的患者中，18例（15%）符合FLAIR定量评估的条件，55例（46%）符合定性评估的条件。在所有患者未接受治疗的病例中，根据试验标准可识别排除。在研究期间，由于筛查和治疗不明发作卒中患者，IV tPA使用率增加了5.6%。在一个未知的时间窗内使用MRI筛查卒中患者在现实环境中是实用的，并增加了IV tPA的利用率。
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 hours from symptom discovery but >4.5 hours 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 <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-hour 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. Screening stroke patients in an unknown time window with MRI is practical in a real-world setting and increases IV tPA utilization.
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影响因子：
11.2
作者：
Schwamm, Lee H.;Wu, Ona;Warach, Steven
通讯作者：
Warach, Steven
影响因子：
2.9
作者：
Sablot, Denis;Ion, Ioana;Bonafe, Alain
通讯作者：
Bonafe, Alain
影响因子：
2.4
作者：
Nadareishvili, Zurab;Luby, Marie;Latour, Lawrence L.
通讯作者：
Latour, Lawrence L.
影响因子：
8.3
作者：
Fink, JN;Kumar, S;Schlaug, G
通讯作者：
Schlaug, G
影响因子：
158.5
作者：
Thomalla, G.;Simonsen, C. Z.;Gerloff, C.
通讯作者：
Gerloff, C.