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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Does the Primary Imaging Modality-Computed Tomography or Magnetic Resonance Imaging-Influence Stroke Physicians' Certainty on Whether or Not to Give Thrombolysis to Randomized Acute Stroke Patients?
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Does the Primary Imaging Modality-Computed Tomography or Magnetic Resonance Imaging-Influence Stroke Physicians' Certainty on Whether or Not to Give Thrombolysis to Randomized Acute Stroke Patients?

机译：初级成像模型计算的层析成像或磁共振成像 - 影响中风医生是否对随机急性中风患者的溶栓进行溶解性吗？

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Background: Door-to-needle time of 20 minutes to stroke patients with intravenous tissue plasminogen activator (iv-tPA) is feasible when computed tomography (CT) is used as first-line of brain imaging. Magnetic resonance imaging (MRI)-based assessment is more time-consuming but superior in detecting acute ischemia. The certainty with which stroke physicians prescribe or refrain from giving iv-tPA treatment to CT-versus MRI-examined patients has not previously been studied. The aim of the present study was to determine the effect of a primary imaging strategy of CT or MRI on clinicians' certainty to prescribe or refrain from giving iv-tPA to patients with suspected acute stroke. Method: Consecutive patients with suspected stroke were quasi-randomized to either CT- or MRI-based assessment before potential iv-tPA treatment. The influence of (1) the clinical findings and (2) the image findings, and (3) the certainty with which the stroke physician prescribed or refrained from giving iv-tPA treatment were assessed with visual analog scales (VAS). Predictors of treatment certainty were identified with a random-effect model. Results: Four-hundred forty-four consecutive patients were quasi-randomized. MRI influenced the final treatment decision more than CT (P = .002). Compared with CT-examined patients (mean VAS score 8.6, SD +/- 1.6) stroke physicians were significantly more certain when prescribing or refraining from giving iv-tPA to MRI-examined patients (mean VAS score 9.0, SD +/- 1.2) (P = .014). No differences in modified Rankin scale or mortality were detected at 3 months in CT-versus MRI-examined iv-tPA-treated patients. Conclusions: Stroke physicians were significantly more certain when prescribing iv-tPA to MRI-examined stroke patients, and MRI influences the final treatment decision significantly more compared with CT, although no difference in mortality and functional outcome at 3 months was detected between CT- and MRI-examined patients treated with iv-tPA.
机译：背景：当计算机断层扫描（CT）用作脑成像的一线脑成像时，静脉内组织纤溶酶原激活剂（IV-TPA）的脑卒中患者20分钟的门对针时间是可行的。基于磁共振成像（MRI）的评估更耗时，但在检测急性缺血方面优越。前面还没有研究中风医生规定或避免对CT-VERES MRI检查的患者进行治疗的情况。本研究的目的是确定CT或MRI的主要成像策略对临床医生的确定性，以规定或避免对疑似急性中风的患者提供IV-TPA。方法：在潜在的IV-TPA治疗之前，涉及疑似中风的患者是准随机的基于CT或MRI的评估。 （1）临床发现和（2）图像发现的影响和（3）用视觉模拟尺度（VAS）评估规定或不赋予IV-TPA治疗的中风医生的确定性。用随机效应模型鉴定治疗确定性的预测因素。结果：四百四十四次连续患者是准随机化。 MRI影响了最终治疗决策超过CT（p = .002）。与CT检测的患者相比（平均VAS得分8.6，SD +/- 1.6）中风医生在处方或避免给MRI检查的患者赋予IV-TPA时明显更加确定（平均VAS 9.0，SD +/- 1.2） （p = .014）。在CT型MRI检测的IV-TPA治疗患者中，在3个月内检测到改性的Rankin规模或死亡率没有差异。结论：在向MRI检测的中风患者处方，中风医生明显更加确定，与CT相比，MRI显着影响最终治疗决策，尽管在CT-和3个月内没有发生死亡率和功能结果的差异。用IV-TPA治疗的MRI检查患者。

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