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. 2014 Mar;35(3):478-81.
doi: 10.3174/ajnr.A3797. Epub 2013 Dec 5.

Pretreatment advanced imaging in patients with stroke treated with IV thrombolysis: evaluation of a multihospital data base

J S McDonald  1 , J Fan, D F Kallmes, H J Cloft
Affiliations

Pretreatment advanced imaging in patients with stroke treated with IV thrombolysis: evaluation of a multihospital data base

J S McDonald et al. AJNR Am J Neuroradiol. 2014 Mar.

Abstract

Background and purpose: CT angiography, CT perfusion, and MR imaging have all been advocated as potentially useful in treatment planning for patients with acute ischemic stroke. We evaluated a large multihospital data base to determine how the use of advanced imaging is evolving in patients treated with intravenous thrombolysis.

Materials and methods: Patients with acute ischemic stroke receiving IV thrombolytic therapy from 2008 to 2011 were identified by using the Premier Perspective data base. Mortality and discharge to long-term care rates were compared following multivariate logistic regression between patients who received head CT only versus those who received CTA without CT perfusion, CT perfusion, or MR imaging.

Results: Of 12,429 included patients, 7305 (59%) were in the CT group, 2359 (19%) were in the CTA group, 848 (7%) were in the CTP group, and 1917 (15%) were in the MR group. From 2008 to 2011, the percentage of patients receiving head CT only decreased from 64% to 55%, while the percentage who received cerebral CT perfusion increased from 3% to 8%. The use of CT angiography and MR imaging marginally increased (1%-2%). Outcomes were similar between CT only and advanced imaging patients, except discharge to long-term care was slightly more frequent in the CTP group (OR = 1.17 [95% CI, 0.96-1.43]; P = .0412) and MR group (OR = 1.14 [95% CI, 1.01-1.28]; P = .0177) and mortality was lower in the MR group (OR = 0.64 [95% CI, 0.52-0.79]; P < .0001).

Conclusions: Use of advanced imaging is increasing in patients treated with IV thrombolysis. While there were differences in outcomes among imaging groups, the clinical effect of advanced imaging remains unclear.

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Figures

Fig 1.
Fig 1.
Trends in the use of head CT and advanced imaging in patients treated with IV thrombolysis from 2008 to 2011. Patients who received only head CT (blue line), head CT with CT angiography (red line), head CT with CT perfusion (green line), or head CT with MR imaging (purple line) are shown.
See this image and copyright information in PMC

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