Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
Ann Neurol. 2022 Aug;92(2):184-194. doi: 10.1002/ana.26413. Epub 2022 Jun 10.
To examine rates of intravenous thrombolysis (IVT), mechanical thrombectomy (MT), door-to-needle (DTN) time, door-to-puncture (DTP) time, and functional outcome between patients with admission magnetic resonance imaging (MRI) versus computed tomography (CT).
An observational cohort study of consecutive patients using a target trial design within the nationwide Swiss-Stroke-Registry from January 2014 to August 2020 was carried out. Exclusion criteria included MRI contraindications, transferred patients, and unstable or frail patients. Multilevel mixed-effects logistic regression with multiple imputation was used to calculate adjusted odds ratios with 95% confidence intervals for IVT, MT, DTN, DTP, and good functional outcome (mRS 0-2) at 90 days.
Of the 11,049 patients included (mean [SD] age, 71 [15] years; 4,811 [44%] women; 69% ischemic stroke, 16% transient ischemic attack, 8% stroke mimics, 6% intracranial hemorrhage), 3,741 (34%) received MRI and 7,308 (66%) CT. Patients undergoing MRI had lower National Institutes of Health Stroke Scale (median [interquartile range] 2 [0-6] vs 4 [1-11]), and presented later after symptom onset (150 vs 123 min, p < 0.001). Admission MRI was associated with: lower adjusted odds of IVT (aOR 0.83, 0.73-0.96), but not with MT (aOR 1.11, 0.93-1.34); longer adjusted DTN (+22 min [13-30]), but not with longer DTP times; and higher adjusted odds of favorable outcome (aOR 1.54, 1.30-1.81).
We found an association of MRI with lower rates of IVT and a significant delay in DTN, but not in DTP and rates of MT. Given the delays in workflow metrics, prospective trials are required to show that tissue-based benefits of baseline MRI compensate for the temporal benefits of CT. ANN NEUROL 2022;92:184-194.
研究有入院磁共振成像（MRI）与计算机断层扫描（CT）的患者之间静脉溶栓（IVT）、机械取栓（MT）、门到针（DTN）时间、门到穿刺（DTP）时间和功能结局的比率。
这是一项在 2014 年 1 月至 2020 年 8 月期间在全国瑞士卒中登记处内使用目标试验设计进行的连续患者观察队列研究。排除标准包括 MRI 禁忌症、转院患者和不稳定或体弱患者。使用多级混合效应逻辑回归和多重插补法计算调整后的比值比（OR），并计算 95%置信区间（CI），用于 90 天时 IVT、MT、DTN、DTP 和良好功能结局（mRS 0-2）。
纳入 11049 例患者（平均[SD]年龄 71[15]岁；4811 例[44%]为女性；69%为缺血性卒中，16%为短暂性脑缺血发作，8%为卒中模拟，6%为颅内出血），其中 3741 例（34%）行 MRI 检查，7308 例（66%）行 CT 检查。行 MRI 检查的患者 NIHSS 评分较低（中位数[四分位数间距]2[0-6]比 4[1-11]，p<0.001），起病后就诊时间较晚（150 分钟比 123 分钟，p<0.001）。入院 MRI 与：IVT 的调整后 OR 降低（0.83，0.73-0.96），但与 MT 无关（aOR 1.11，0.93-1.34）；调整后的 DTN 时间延长（+22 分钟[13-30]），但 DTP 时间无明显延长；以及良好结局的调整后 OR 升高（aOR 1.54，1.30-1.81）。
我们发现 MRI 与 IVT 率较低和 DTN 时间显著延迟相关，而与 DTP 时间和 MT 率无关。鉴于工作流程指标的延迟，需要前瞻性试验来证明基线 MRI 的组织获益是否可以弥补 CT 的时间获益。ANN NEUROL 2022；92:184-194.
