A 78 Seconds Complete Brain MRI Examination in Ischemic Stroke: A Prospective Cohort Study
Related Experiment Video
Updated: Oct 3, 2025
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
Siri Af Burén1,2, Annika Kits3,4, Lucas Lönn1
1Department of Radiology, Capio Saint Göran Hospital, Stockholm, Sweden.
Background:
Fast 78-second multicontrast echo-planar MRI (EPIMix) has shown good diagnostic performance for detecting infarctions at a comprehensive stroke center, but its diagnostic performance has not been evaluated in a prospective study at a primary stroke center.
Purpose:
To prospectively determine whether EPIMix was noninferior in detecting ischemic lesions compared to routine clinical MRI.
Study Type:
Prospective cohort study.
Population:
A total of 118 patients with acute MRI and symptoms of ischemic stroke.
Field Strength And Sequence:
A 3 T. EPIMix (echo-planar based: T1-FLAIR, T2-weighted, T2-FLAIR, T2*, DWI) and routine clinical MRI sequences (T1-weighted fast spin echo, T2-weighted PROPELLER, T2-weighted-FLAIR fast spin echo, T2* gradient echo echo-planar, and DWI spin echo echo-planar).
Assessment:
Three radiologists, blinded for clinical information, assessed signs of ischemic lesions (DWI↑, ADC↓, and T2/T2-FLAIR↑) on EPIMix and routine clinical MRI, with disagreements solved in consensus with a fourth reader to establish the reference standard.
Statistical Tests:
Diagnostic performance including sensitivity and specificity against the reference standard was evaluated. EPIMix sensitivity was tested for noninferiority compared to the reference standard using Nam's restricted maximum likelihood estimation (RMLE) Score. A P-value < 0.05 was considered statistically significant.
Results:
Of 118 patients (mean age 62 ± 16 years, 58% males), 25% (n = 30) had MRI signs of acute infarcts. EPIMix was noninferior with 97% (95% CI 83-100) sensitivity for reader 1, 100% (95% CI 88-100) sensitivity for reader 2, and 90% (95% CI 88-98) sensitivity for reader 3 vs. 93% (95% CI 78-99) sensitivity for readers 1 and 2 and 90% (95% CI 74-98) for reader 3 on routine clinical MRI. Specificity was 99% (95% CI 94-100) for reader 1, 100% (95% CI 96-100) for reader 2, and 98% (95% CI 92-100) for reader 3 on EPIMix vs. 100% (95% CI 96-100) for all readers on routine clinical MRI.
Conclusion:
EPIMix was noninferior to routine clinical MRI for the diagnosis of acute ischemic stroke.
Evidence Level:
2 TECHNICAL EFFICACY: Stage 2.
Insights
Fast 78-second multicontrast echo-planar MRI (EPIMix) demonstrated noninferior diagnostic performance for acute ischemic stroke detection compared to routine MRI. This study confirms EPIMix
Area of Science:
- Neuroradiology
- Medical Imaging
- Stroke Diagnosis
Background:
- Fast 78-second multicontrast echo-planar MRI (EPIMix) shows promise for infarction detection in stroke centers.
- Previous evaluations were not prospective and lacked data from primary stroke centers.
Purpose of the Study:
- To prospectively assess if EPIMix is noninferior to routine MRI in detecting ischemic lesions.
- To evaluate the diagnostic performance of EPIMix in a primary stroke center setting.
Main Methods:
- Prospective cohort study involving 118 patients with acute ischemic stroke symptoms.
- Comparison of EPIMix (T1-FLAIR, T2-weighted, T2-FLAIR, T2*, DWI) with routine MRI sequences.
- Radiologist assessment of ischemic lesions, with consensus for reference standard determination.
Main Results:
- EPIMix achieved high sensitivity (90-100%) and specificity (98-100%) across three readers.
- The diagnostic performance of EPIMix was found to be noninferior to routine clinical MRI.
- 25% of patients showed signs of acute infarcts on MRI.
Conclusions:
- EPIMix is a noninferior imaging technique for diagnosing acute ischemic stroke.
- The findings support the use of EPIMix in primary stroke centers.
- EPIMix offers a fast and effective alternative for stroke diagnosis.
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