Monday, June 23, 2014

Stroke MRI in 6-Minutes or Your Money Back

Despite the advances of modern medicine, the non-contrast CT of the brain is a crude tool.  It is especially poor in the setting of acute stroke – infrequently providing helpful diagnostic information, while serving primarily to rule out intracranial hemorrhage.

These authors, however, offer us a glimpse of the MRI of the future – a useful diagnostic test without long delays of image acquisition time.  These authors report on a single-center, convenience sample of patients with acute neurologic deficits who were able to undergo MRI.  They use a 3.0T MRI to acquire DWI, FLAIR, GRE, perfusion, and MRA sequences using a 6-minute protocol on 62 patients, and two radiologists rated image quality as moderate or good 94% or greater for each modality.

The authors also provide two sample cases, one of which being an acutely altered, profoundly disabled patient within the 3-hour window for tPA.  The 6-minute MRI, however, showed heterogeneous perfusion abnormalities more suggestive of seizure, rather than stroke.  After treatment with anti-eplipetics, the patient made a full neurologic recovery.

This series is small enough it’s clearly just a technology pilot.  Additional study regarding diagnostic accuracy and feasbility in the acute setting is necessary, but it would certainly be a vast improvement over the current state of the art.  Considering the present rush to judgement for tPA and the likelihood of overtreatment of stroke mimics, a diagnostic modality that adds to clinical assessment is sorely needed.a

“Six-Minute Magnetic Resonance Imaging Protocol for Evaluation of Acute Ischemic Stroke: Pushing the Boundaries”
http://www.ncbi.nlm.nih.gov/pubmed/24916906

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