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Comparative Study
. 2025 Apr 5:21:207-215.
doi: 10.2147/VHRM.S503362. eCollection 2025.

The Necessity of Using MRI as an Imaging Modality in Acute Code Stroke in Indonesia

Rakhmad Hidayat #  1   2   3 , Marc Fisher #  4 , Siti Pujiwati Permata Rima #  2 , Elvan Wiyarta #  1   3 , Gemia Clarisa Fathi #  1   3 , Alyssa Putri Mustika #  1   2 , Aruni Cahya Irfannadhira #  1   3 , David Pangeran #  1   2 , Taufik Mesiano #  1   2 , Mohammad Kurniawan #  1   2 , Al Rasyid #  1   2 , Salim Harris #  1   2
Affiliations
Comparative Study

The Necessity of Using MRI as an Imaging Modality in Acute Code Stroke in Indonesia

Rakhmad Hidayat et al. Vasc Health Risk Manag. .

Abstract

Purpose: To evaluate the performance and outcomes of the 6-minute magnetic resonance imaging (MRI) protocol in diagnosing stroke within Indonesian healthcare setting compared to computed tomography (CT).

Patients and methods: This retrospective single-center study was conducted at the Universitas Indonesia Hospital in Depok, Indonesia from September 2021 to September 2023. Patients who were diagnosed with acute stroke underwent a clinical evaluation and a 6-minute MRI protocol. The primary objective was to assess the efficiency of the 6-minute MRI protocol in promptly and accurately evaluating acute stroke patients, including determining average MRI time, thrombolysis eligibility, and post-thrombolysis outcomes compared to CT imaging. Exclusions comprised those requiring resuscitation, lack of stroke code activation, or having incomplete documentation.

Results: This study involved 182 stroke patients, 136 of which underwent MRI and 46 had CT scans. Thrombolysis eligibility was similar between the groups (48.9% for MRI vs 47.8% for CT-Scan), but a higher proportion of eligible MRI patients received thrombolysis (70.1% vs 54.5%, p = 0.037). MRI also achieved shorter door-to-imaging times, especially from February to June 2022. Among those treated for ischemic stroke via MRI, 70.3% showed improvement compared to 55% for CT (p=0.016). Door-to-MRI times varied across periods, averaging 88.2 minutes before national healthcare insurance collaboration, 29.1 minutes during transition, and 47.8 minutes afterward.

Conclusion: This study emphasizes the crucial role of the 6-minute MRI protocol for accurately diagnosing stroke types, severity, and determining thrombolysis eligibility. Positive outcomes in thrombolysis patients using this protocol highlight its effectiveness. However, prolonged time-to-MRI indicates the need for further improvement. Optimizing time management and workflow efficiency are critical for improving treatment efficacy and safety.

Keywords: CT-scan; MRI; code stroke; developing country; thrombolysis.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flowchart of Patients Undergoing 6-Minute MRI.
See this image and copyright information in PMC

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