Division of Neurology, Kobe Red Cross Hospital and Hyogo Emergency Medical Center, Chuo Ward, Kobe, Japan.
Eur Neurol. 2010;64(4):241-5. doi: 10.1159/000319918. Epub 2010 Sep 7.
In Japan, MRI-based thrombolysis after CT screening is the most common imaging strategy prior to intravenous thrombolysis (IVT) with tissue plasminogen activator (tPA) within 3 h after ischemic stroke. A choice of MRI with MR angiography (MRA) provides a higher diagnostic accuracy, but may delay an initiation of thrombolysis.
In our neuro-unit, brain CT is the first screening image for suspected stroke. We retrospectively examined a delay to thrombolysis, imaging modality, diagnostic accuracy, and clinical outcomes at 3 months by the modified Rankin Scale in patients receiving IVT within 3 h.
Among 67 patients receiving IVT with tPA, brain imaging prior to IVT was solely CT in 10 (15%) patients and CT + MRI/MRA in 57 (85%) patients. Final diagnosis of brain ischemia was 100%. Patients receiving CT + MRI had significantly shorter pre-hospital delay (mean 54 vs. 83 min; p = 0.012), but longer door-to-needle time (mean 90 vs. 57 min; p = 0.019) than those receiving CT only. Finally, time from onset to thrombolysis was not different between the two groups and clinical outcomes were also comparable. The earlier patients arrived, the longer door-to-needle times were (p < 0.001).
The imaging strategy of initial CT screening with optional MRI/MRA scans prior to IVT was feasible. However, it resulted in an additional 30 min in-hospital delay of tPA administration, which may affect clinical outcomes.
在日本，CT 筛查后行 MRI 溶栓治疗联合 3 小时内静脉注射组织型纤溶酶原激活剂（tPA）是最常见的影像学策略。选择 MRI 联合磁共振血管造影（MRA）可以提高诊断准确率，但可能会延迟溶栓治疗的开始时间。
在我们的神经科，脑 CT 是疑似脑卒中患者的首筛影像。我们回顾性分析了在发病 3 小时内接受 tPA 静脉溶栓治疗的患者的溶栓延迟时间、影像方式、诊断准确率和 3 个月时改良 Rankin 量表评分的临床结局。
在 67 例接受 tPA 静脉溶栓治疗的患者中，10 例（15%）患者仅行脑 CT 检查，57 例（85%）患者行 CT+MRI/MRA 检查。最终诊断为脑缺血的患者比例为 100%。接受 CT+MRI 的患者的院前延迟时间明显更短（平均 54 分钟比 83 分钟；p = 0.012），但门到针时间更长（平均 90 分钟比 57 分钟；p = 0.019）。两组患者从发病到溶栓的时间无差异，临床结局也相似。患者到达时间越早，门到针时间越长（p < 0.001）。
在静脉溶栓治疗前进行初始 CT 筛查，再选择性行 MRI/MRA 检查的影像学策略是可行的。然而，这导致 tPA 给药的院内延迟增加了 30 分钟，可能会影响临床结局。
