Xue Yufeng, Haesebaert Julie, Derex Laurent, Viprey Marie, Termoz Anne, Della Vecchia Claire, Tassa Ouazna, Kerd Hela, Cakmak Serkan, Meyran Sylvie, Ducreux Bruno, Pidoux Christelle, Du Besset Marc, Bony Thomas, Gueugniaud Pierre-Yves, Douplat Marion, Potinet Veronique, Jacob Xavier, Sigal Alain, Tazarourte Karim, Lablanche Christophe, Melaine Regis, Nighoghossian Norbert, Schott Anne-Marie
Université de Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, Lyon, France.
Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France.
Cerebrovasc Dis. 2020;49(1):110-118. doi: 10.1159/000505960. Epub 2020 Feb 25.
In patients with suspected stroke, brain imaging is recommended in the acute phase for appropriate management and treatment. Both computed tomography (CT) and magnetic resonance imaging (MRI) are considered reasonable choices for initial brain imaging. When both techniques are available, choosing one or the other might be associated with specific factors related either to patients, stroke symptoms, and severity or management organization.
The study was performed within the STROKE 69 database, a population-based cohort of all adult patients with suspected stroke admitted in one of the emergency departments (ED), primary stroke center, or stroke center of the Rhône County, from November 2015 to December 2016. Patients were included if they were admitted within 24 h following either symptom onset or last known normal. To identify factors potentially associated with the choice of initial brain imaging, a multivariate logistic regression was performed.
Among the 3,244 patients with suspected stroke enrolled in the STROKE69 cohort, 3,107 (95.8%) underwent brain imaging within the first 24 h after admission. Among those 74.6% underwent CT as initial imaging while 25.4% had an MRI. In multivariate analyses, several factors were associated with a lower probability of having an MRI as initial brain imaging versus CT. These were either patient characteristics: older age (>80 years old, OR 0.39 [95% CI 0.28-0.54]), preexisting disability (OR 0.55 [95% CI 0.36-0.84]), use of anticoagulants (OR 0.52 [95% CI 0.33-0.81]), stroke characteristics: stroke of unknown onset (OR 0.42 [95% CI 0.31-0.58]) or factors associated with overall management: onset-to-door time (>6 h, OR 0.38 [95% CI 0.23-0.60]), initial admission to ED (OR 0.02 [95% CI 0.02-0.04]) or intensive care unit (OR 0.01 [95% CI 0.001-0.08]), personal transport (OR 0.66 [95% CI 0.45-0.96]), and admission during working hours (OR 0.65 [95% CI 0.51-0.84]).
Besides CT or MRI availability, a number of other parameters could influence the choice of first imaging in case of stroke suspicion. These are related to patient characteristics, type of stroke symptoms, and type of organization.
对于疑似中风患者，急性期推荐进行脑部成像以进行适当的管理和治疗。计算机断层扫描（CT）和磁共振成像（MRI）均被视为初始脑部成像的合理选择。当两种技术都可用时，选择其中一种可能与患者、中风症状、严重程度或管理组织等特定因素有关。
该研究在中风69数据库中进行，该数据库是一个基于人群的队列，纳入了2015年11月至2016年12月期间在罗纳县的急诊科、初级中风中心或中风中心之一就诊的所有疑似中风成年患者。如果患者在症状发作或最后一次已知正常状态后的24小时内入院，则纳入研究。为了确定可能与初始脑部成像选择相关的因素，进行了多因素逻辑回归分析。
在中风69队列中登记的3244例疑似中风患者中，3107例（95.8%）在入院后的头24小时内接受了脑部成像。其中74.6%的患者以CT作为初始成像，而25.4%的患者进行了MRI检查。在多因素分析中，与以MRI作为初始脑部成像而非CT的可能性较低相关的因素有：患者特征方面，年龄较大（>80岁，比值比0.39[95%置信区间0.28 - 0.54]）、存在残疾（比值比0.55[95%置信区间0.36 - 0.84]）、使用抗凝剂（比值比0.52[95%置信区间0.33 - 0.81]）；中风特征方面，发病时间不明的中风（比值比0.42[95%置信区间0.31 - 0.58]）；或与整体管理相关的因素，如发病到入院时间（>6小时，比值比0.38[95%置信区间0.23 - 0.60]）、最初在急诊科入院（比值比0.02[95%置信区间0.02 - 0.04]）或重症监护病房入院（比值比0.01[95%置信区间0.001 - 0.08]）、自行前往（比值比0.66[95%置信区间0.45 - 0.96]）以及工作时间入院（比值比0.65[95%置信区间0.51 - 0.84]）。
除了CT或MRI的可用性外，许多其他参数可能会影响中风疑似病例的首次成像选择。这些与患者特征、中风症状类型和组织类型有关。
