Feasibility and practicality of MR imaging of stroke in the management of hyperacute cerebral ischemia

BACKGROUND AND PURPOSE: Neuroimaging techniques such as diffusion- and perf usion-weighted MR imaging have been proposed as tools for advanced diagnosi s in hyperacute ischemic stroke. There is, however, substantial doubt regar ding the feasibility and practicality of applying MR imaging for the diagno sis of stroke on a routine basis, especially with respect to possible delay for specific treatment such as thrombolysis. In this study, we tested whet her MR imaging of stroke is safe, fast, and accurate, and whether the gain in additional information can be used in the daily routine without a loss o f time and a risk of suboptimal treatment for the patient with stroke. METHODS: Between September 1997 and August 1999, 64 patients with acute isc hemic stroke were recruited for MR imaging (ie, diffusion-weighted imaging, perfusion-weighted imaging, MR angiography, T2-weighted imaging) after a b aseline CT was performed. We evaluated practicality and feasibility of MR i maging of stroke by analyzing the intervals between symptom onset, arrival, CT, and MR imaging. RESULTS: Sixty-four patients (mean age, 60.9 years) underwent routine CT an d MR imaging within 12 hours after stroke onset (n = 25, less than or equal to3 hr; n = 26, 3-6 hr; n = 13, 6-12 hr). Median times to arrival, start o f CT, MR imaging, and between CT and MR imaging were 1.625 hours, 2 hours, 3.875 hours, and 1 hour, respectively. Intervals between symptom onset and MR imaging (P < .005), arrival and MR imaging (P < .002), and CT and MR ima ging (P = .0007) differed significantly between the early phase of the stud y and after November 1998, whereas the intervals between symptom onset and arrival, symptom onset and CT, and arrival and CT did not. Hemorrhage could be excluded in all; a perfusion/diffusion match or mismatch could be shown in 63 of 64 patients. CONCLUSION: Practice and experience with MR imaging in a stroke team signif icantly reduce the time and effort required to perform this technique and t hus make 24-hour availability for MR imaging of stroke practical. Assessmen t of patients with hyperacute stroke is rapid and comprehensive. Image qual ity can be substantially improved by head immobilization and by mild sedati on, if necessary.