The Importance of MRI for the Indication of Systemic Thrombolysis – Analysis of the First 30 Patients


Authors: D. Šaňák 1;  A. Bártková 1;  D. Horák 2;  I. Vlachová 1;  J. Bučil 2;  R. Herzig 1;  S. Buřval 2;  B. Křupka 1;  P. Hubáček 3;  J. Zapletalová 4;  M. Král 1;  M. Köcher 2;  M. Heřman 2;  P. Kaňovský 1
Authors‘ workplace: Iktové centrum, Neurologická klinika LF UP a FN Olomouc 1;  Radiologická klinika LF UP a FN Olomouc 2;  Oddělení urgentního příjmu, FN Olomouc 3;  Ústav lékařské biofyziky, biometrie a statistiky LF UP Olomouc 4
Published in: Cesk Slov Neurol N 2007; 70/103(2): 143-151
Category: Original Paper

Overview

Aim:
Magnetic resonance (MR) makes accurate the diagnosis of acute cerebral infarction as well as the indication of patients for thrombolytic therapy. The research aimed at demonstrating the benefits of applying MR in the indications of intravenous thrombolysis (IVT) using the analysis of our own set of patients examined with standardized MR protocol and treated with IVT. The authors have assessed their own experience with the use of routine MR.

Set and Methods:
A set consists of 30 patients with acute cerebral infarction treated by means of IVT. The initial size of infarct (VDWI-I) was quantified on the diffusion-weighed sequences. A neurological deficit was determined according to NIH Stroke Scale (N IHSS) at admission after 24 and 72 hours, and then on the 7th day after the ictus development. Resulting clinical state 90 days later was evaluated according to modified Rankin´s scale (mRS). The obtained results were compared to the data of large randomized multicentric studies. The mean2 test and Students´s t-test were used for assessing the statistical significance of results.

Results:
The mean VDWI-I was 21.2 ml, and initial NIHSS 12 ± 5 points. The regression of neurological deficit after 24 hours occurred in significantly higher number of patients (90%) if compared with the studies of NINDS (p < 0.0001) and ECASS I (p = 0.004). Excellent 90-days´ clinicalt result (mRS 0 – 1) was present in significantly higher number of patients (60%) if compared with the studies of NINDS (p = 0.0014), ECASS I (p = 0.001) and II (p = 0.023). In these patients the mean VDWI-I was 13.2ml, and the artery occlusion occurred in 17%.

Conclusion:
The use of MR makes accurate the identification of patients who have a greater probability of good clinical outcome after IVT. These are patients with a small, initial extent of infarction without the extracranial cervical artery occlusion.

Key words:
magnetic resonance, diffusion-weighed display, cerebral ischemia, intravenous thrombolysis


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