急诊MRI作为急性脑卒中的第一成像方式：对诊断表现和结果的影响。

IF 2.2 3区医学 Q3 CLINICAL NEUROLOGY

Cerebrovascular Diseases Pub Date : 2025-07-05 DOI:10.1159/000547095

Zijie Wang, Xueyun Liu, Yunhe Xia, Chuanqin Fang, Yanghua Tian, Qi Li

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引用次数: 0

摘要

从CT转向MRI作为急诊评估的初始诊断方法是否会在急性卒中护理中提供优势尚不清楚。我们试图在一个综合性卒中中心评估mri优先范式对诊断、工作流程和临床结果的影响。方法：在这项前瞻性观察队列的回顾性分析中，纳入了在（2022年7月至2023年3月）和实施MRI范式（2023年4月至2024年1月）之前（2022年7月至2023年3月）和急诊部诊断为急性缺血性卒中、脑出血（ICH）或短暂性脑缺血发作（TIA）的24小时内或最后一次已知的连续患者。我们比较了ct优先和mri优先范式之间的诊断性能、工作流程指标和3个月修改的Rankin量表（mRS）。结果：初步诊断为急性卒中或TIA的ct先行组和mri先行组共纳入478例和488例患者。MRI-first范式实施后卒中诊断一致性提高（95.7% [95% CI 93.9% ~ 97.5%] vs 91.2% [95% CI 88.7% ~ 93.7%]， P=0.003）。尽管溶栓率较低，从门到针的时间稍长，但采用溶栓治疗的模拟脑卒中病例较少。在所有最终诊断为急性卒中或TIA的患者中，mri优先范式与三个月时mRS的有利变化相关（调整后的共同优势比[cOR] 0.65, 95%可信区间[CI] 0.51-0.84）。在脑缺血患者中，mri优先模式与良好的结果特别相关（调整后的cOR 0.61, 95% CI 0.45-0.83）。mri优先模式与脑出血患者的功能结局无关。结论：MRI作为脑卒中急诊评估的第一影像学手段是可行的，且与脑缺血患者良好的临床预后相关。

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Emergency MRI as the First Imaging Modality in Acute Stroke: Effect on Diagnostic Performance and Outcomes.

Introduction: Whether shifting from CT to MRI as the initial diagnostic approach in emergency assessment may offer an advantage in acute stroke care remains unclear. We sought to evaluate the impact of the MRI-first paradigm on diagnosis, workflow, and clinical outcomes in a comprehensive stroke center.

Methods: In this retrospective analysis of a prospective observational cohort, consecutive patients admitted within 24 hours after onset or last known well and with diagnosis of acute ischemic stroke, intracerebral hemorrhage (ICH), or transient ischemic attack (TIA) at the emergency department before (July 2022 to March 2023) and after the implementation of an MRI paradigm (April 2023 to January 2024) were included. We compared the diagnostic performance, workflow metrics, and 3-month modified Rankin Scale (mRS) between CT-first and MRI-first paradigms.

Results: A total of 478 patients in the CT-first group and 488 patients in the MRI-first group with initial diagnosis of acute stroke or TIA were included. The concordance of stroke diagnosis was improved after implementation of MRI-first paradigm (95.7% [95% CI 93.9%-97.5%] vs 91.2% [95% CI 88.7%-93.7%], P=0.003). Despite a lower rate of thrombolysis and slightly prolonged door-to-needle time, fewer cases of stroke mimics were treated by thrombolysis. MRI-first paradigm was associated with favorable shift in mRS (adjusted common odds ratio [cOR] 0.65, 95% confidence interval [CI] 0.51-0.84) at three months among all patients with final diagnosis of any acute stroke or TIA. MRI-first paradigm was specifically related to favorable outcome (adjusted cOR 0.61, 95% CI 0.45-0.83) among patients with cerebral ischemia. MRI-first paradigm was not associated with functional outcomes among ICH patients.

Conclusion: Implementing MRI as the first imaging modality in emergency assessment of stroke is feasible and associated with favorable clinical outcomes for cerebral ischemia.

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来源期刊

Cerebrovascular Diseases 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

审稿时长

1 months

期刊介绍： A rapidly-growing field, stroke and cerebrovascular research is unique in that it involves a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. ''Cerebrovascular Diseases'' is an international forum which meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues, dealing with all aspects of stroke and cerebrovascular diseases. It contains original contributions, reviews of selected topics and clinical investigative studies, recent meeting reports and work-in-progress as well as discussions on controversial issues. All aspects related to clinical advances are considered, while purely experimental work appears if directly relevant to clinical issues.