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A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
09:59

A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia

Published on: September 16, 2017

Time to stroke magnetic resonance imaging.

James F Burke1, Jeremy B Sussman, Lewis B Morgenstern

  • 1Department of Veterans Affairs, Veterans Affairs Center for Clinical Management and Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan 48109, USA. jamesbur@med.umich.edu

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|May 1, 2012
PubMed
Summary

Less than one-third of stroke patients receive magnetic resonance imaging (MRI) within 12 hours, despite guidelines recommending it. This timing is crucial for effective stroke diagnosis and treatment.

Keywords:
GuidelinesMonte Carlo simulationmagnetic resonance imaging

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Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • American Academy of Neurology (AAN) guidelines recommend magnetic resonance imaging (MRI) over computed tomography (CT) for stroke diagnosis within 12 hours of symptom onset.
  • Current clinical practice regarding the timeliness of stroke MRI is not well-characterized.

Purpose of the Study:

  • To estimate the proportion of stroke patients who undergo MRI within 12 hours of symptom onset.
  • To assess the impact of various time components on the overall timing of stroke MRI.

Main Methods:

  • Monte Carlo simulation was used to model total time from symptom onset to MRI.
  • Three key time components were modeled: time to presentation, time to emergency department (ED) MRI, and time to inpatient MRI.
  • Sensitivity analyses were performed to evaluate the influence of different parameters on MRI timing.

Main Results:

  • In 2009, an estimated 66% of stroke patients underwent MRI, with 14% receiving it in the ED.
  • Only 29% (95% CI 24-33%) of stroke MRIs were performed within 12 hours of symptom onset.
  • Sensitivity analyses indicated that even significant reductions in presentation time would only moderately increase the proportion of timely MRIs.

Conclusions:

  • Despite guidelines favoring early MRI for stroke, a substantial majority of stroke MRIs are not performed within the recommended 12-hour window.
  • Current clinical workflows may not adequately support timely MRI acquisition for stroke patients.
  • Further improvements in healthcare delivery are needed to align practice with guideline recommendations for stroke neuroimaging.