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Diagnosis of acute ischaemic stroke with fluid-attenuated inversion recovery and diffusion-weighted sequences
C Oppenheim1, M Logak, D Dormont
1Department of Neuroradiology, Groupe Hospitalier Pitié-Salpêtrière, Paris VI University, France. catherine.oppenheim@psl.ap-hop-paris.fr
Abstract:
We evaluated the feasibility and use of diffusion-weighted and fluid-attenuated inversion-recovery pulse sequences performed as an emergency for patients with acute ischaemic stroke. A 5-min MRI session was designed as an emergency diagnostic procedure for patients admitted with suspected acute ischaemic stroke. We reviewed routine clinical implementation of the procedure, and its sensitivity and specificity for acute ischaemic stroke over the first 8 months. We imaged 91 patients (80 min to 48 h following the onset of stroke). Clinical deficit had resolved in less than 3 h in 15 patients, and the remaining 76 were classified as stroke (59) or stroke-like (17) after hospital discharge. Sensitivity of MRI for acute ischaemic stroke was 98%, specificity 100%. MRI provided an immediate and accurate picture of the number, site, size and age of ischaemic lesions in stroke and simplified diagnosis in stroke-like episodes. The feasibility and high diagnostic accuracy of emergency MRI in acute stroke strongly support its routine use in a stroke centre.
Insights
Emergency MRI using diffusion-weighted and fluid-attenuated inversion-recovery sequences is feasible for acute ischemic stroke. This rapid MRI approach offers high diagnostic accuracy, aiding prompt stroke diagnosis and management.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Acute ischemic stroke diagnosis requires rapid assessment.
- Diffusion-weighted imaging (DWI) and fluid-attenuated inversion-recovery (FLAIR) MRI are crucial for detecting ischemic changes.
- Emergency MRI protocols aim to expedite diagnosis in time-sensitive conditions.
Purpose of the Study:
- To evaluate the feasibility and diagnostic utility of a rapid, emergency MRI protocol for acute ischemic stroke.
- To assess the sensitivity and specificity of this emergency MRI approach in a clinical setting.
Main Methods:
- A 5-minute MRI session utilizing DWI and FLAIR sequences was implemented as an emergency diagnostic procedure.
- Routine clinical data from 91 patients suspected of acute ischemic stroke were reviewed over 8 months.
- MRI findings were correlated with clinical outcomes post-discharge.
Main Results:
- The emergency MRI protocol was successfully implemented in 91 patients within 48 hours of stroke onset.
- MRI demonstrated a sensitivity of 98% and specificity of 100% for diagnosing acute ischemic stroke.
- The imaging provided immediate and accurate characterization of ischemic lesions, aiding diagnosis in stroke and stroke-like episodes.
Conclusions:
- Emergency MRI with DWI and FLAIR sequences is a feasible and highly accurate diagnostic tool for acute ischemic stroke.
- This rapid MRI approach significantly aids in the diagnosis and management of acute stroke.
- Routine implementation of emergency MRI in stroke centers is strongly supported by these findings.