Hospital System Efficiently Uses MRI To Screen For Stroke and Shorten Treatment Window

Amie W. Hsia, MD Medical Director, Comprehensive Stroke Center MedStar Washington Hospital Center NIH Stroke Program at MWHC Associate Professor, Neurology Georgetown University Washington, DC 20010MedicalResearch.com Interview with:
Amie W. Hsia, MD
Medical Director, Comprehensive Stroke Center
MedStar Washington Hospital Center
NIH Stroke Program at MWHC
Associate Professor, Neurology
Georgetown University Washington, DC 20010

 

Medical Research: What is the background for this study? What are the main findings?

Dr. Hsia: Acute stroke is a common presenting problem in the emergency department. We know that “time is brain” and that for patients experiencing an ischemic or “blockage” type of stroke, the most common type, the sooner we can administer tPA, a clot-busting medication and the only FDA-approved medication to treat acute stroke, the better chance for a good outcome. Therefore, there is a goal national benchmark time of administering the drug to appropriate acute stroke patients within 60 minutes of their arrival to the emergency department. There are many steps that are necessary in the evaluation of an acute stroke patient in the emergency department before tPA can be given. This includes a brain scan to make sure a patient is not having the less common bleeding type of stroke. A CT or “CAT” scan is the typical type of brain scan that is performed in emergency departments across the country and the world to screen a patient before giving tPA. The primary purpose of the CT scan is to exclude bleeding; it is difficult to visualize an early stroke on CT. Though an MRI can give more complete information including showing the stroke as it is happening in these first few hours and though most hospitals have an MRI scanner, an MRI takes longer to perform and has not traditionally been used in an emergency setting.

At the two hospitals included in this study, MedStar Washington Hospital Center in D.C. and Suburban Hospital in Maryland, we are fortunate to serve as the sites for the NINDS intramural stroke clinical research program and use MRI routinely to screen acute stroke patients to learn more about stroke and develop new treatments for stroke. It is upon this foundation that we performed independent hospital-wide quality improvement initiatives engaging multidisciplinary committees with leadership from all the departments involved in the care of the acute stroke patient in that critical first 60 minutes. Inspired by our colleagues at Washington University in St. Louis led by Dr. Andria Ford who used similar methods in reducing treatment times with CT screening, we used lean manufacturing principles to streamline our processes that include MRI screening and dramatically reduced our treatment times from a baseline of 93 minutes down to 55 minutes while still maintaining safety. Through these efficiency improvements, we were able to achieve a 4-fold increase in the percentage of stroke patients treated with tPA within 60 minutes.
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Specialized MRI May Predict Early Cognitive Decline

Sven Haller, M.D. University of Geneva in Geneva, Switzerland.
MedicalResearch.com Interview with:

Sven Haller, M.D.
University of Geneva in Geneva, Switzerland.

Medical Research: What are the main findings of the study?

Dr. Haller: The main finding is that some elderly individuals with intact cognitive function at baseline already have visible alterations of the brain perfusion measured in Arterial Spin Labeling (ASL)  MRI, which is similar to patients with mild cognitive impairment (MCI). This elderly individual may initially maintain intact cognitive functions due to the activation of their cognitive reserve, yet eventually the cognitive reserve is exhausted and those individuals develop subtle cognitive decline at follow-up 18 months later.

Consequently, Arterial Spin Labeling MRI may predict the very earliest form of cognitive decline.

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MRI Findings as Surrogate Markers for Brain Microinfarcts

Kejal Kantarci, M.D. M.S. Professor of Radiology Division of Neuroradiology Mayo Clinic, Rochester, MN 55905 MedicalResearch.com Interview with:
Kejal Kantarci, M.D. M.S.
Professor of Radiology
Division of Neuroradiology
Mayo Clinic, Rochester, MN 55905

MedicalResearch: What are the main findings of the study?

Dr. Kantarci: Microinfarcts are one of the most common pathologies identified in the brains of older individuals and they impact cognition. However they are invisible lesions on MRI. We demonstrated that presence of microinfarcts in autopsied individuals are associated with the macroinfarcts identified on their MRI scans than they were alive. We also demonstrated that the presence of these invisible lesions are related to greater brain atrophy rates that are localized to watershed zones.
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Prostate Cancer Detection: Accuracy of Multiparametric MRI For Detection

Dr. Maarten de Rooij MD, PhD Candidate Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland 6525 GA, The NetherlaMedicalResearch.com Interview with:
Dr. Maarten de Rooij MD, PhD Candidate
Department of Radiology
Radboud University Nijmegen Medical Centre
Nijmegen, Gelderland 6525 GA, The Netherlands

 

MedicalResearch.com: What are the main findings of the study?

Dr. de Rooij : Prostate cancer is the most common cancer in men and the second leading cause of cancer related death. The current diagnosis is based on ‘random or blind’ systematic transrectal ultrasound guided prostate biopsies in men with an elevated PSA. This can lead to over-diagnosis and over-treatment of prostate cancer, but can also miss important tumors. The role of multiparametric MRI (mpMRI) to improve the diagnosis of prostate cancer is evolving. In this meta-analysis we determined the diagnostic accuracy of mpMRI for the detection of prostate cancer. Our analysis included 7 studies using mpMRI which showed high overall specificity (0.88; 95% CI 0.82-0.92), with variable but high negative predictive values (0.65 – 0.95) and sensitivities (0.74; 95% CI 0.66-0.81).
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ADHD: Using MRI to Measure Brain Iron

Dr. Vitria Adisetiyo, Ph.D. Postdoctoral Research Fellow Medical University of South Carolina Center for Biomedical Imaging Charleston, SC 29425MedicalResearch.com Interview with:
Dr. Vitria Adisetiyo, Ph.D.
Postdoctoral Research Fellow
Medical University of South Carolina
Center for Biomedical Imaging Charleston, SC 29425


MedicalResearch.com: What are the main findings of the study?

Dr. Adisetiyo:  Using a non-invasive MRI method called magnetic field correlation imaging, we detected significantly reduced striatal and thalamic brain iron in medication-naive children and adolescents with ADHD compared to age-, gender- and IQ-matched typically developing controls. ADHD patients who had a history of psychostimulant medication treatment (e.g. Ritalin, Aderrall) had brain iron levels comparable to controls, suggesting brain iron may normalize with psychostimulants. Blood iron measures did not differ between patients and controls.

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MRIs of the Knee: How big a role is doctor’s financial stake?

Matthew P. Lungren, MD Duke University Medical CenterMedicalResearch.com Interview with:
Matthew P. Lungren, MD
Duke University Medical Center

MedicalResearch.com: What are the main findings of the study?

Dr. Lungren: In the single center study, knee MRIs are more likely to be normal when the referring doctor has a financial stake in the imaging center or the equipment used; these data suggest that some of these examinations may be unnecessary.
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Stroke Risk: Increased Risk with Intraplaque Carotid Artery Hemorrhage

Tobias Saam, MD Institute of Clinical Radiology Ludwig-Maximilians-Univ Hosp Munich, GermanyMedicalResearch.com Interview with:
Tobias Saam, MD
Institute of Clinical Radiology
Ludwig-Maximilians-Univ Hosp
Munich, Germany

MedicalResearch.com: What are the main findings of the study?

Dr. Saam: The results of our meta-analysis suggest that despite a large degree of detected heterogeneity of the published studies, the presence of intraplaque hemorrhage by MRI in patients with carotid artery disease is associated with an approximately 5.6-fold higher risk for cerebrovascular events, such as TIA or stroke, as compared to subjects without intraplaque hemorrhage.
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Diabetes: Whole-Body MRI to Predict Cardiac and Cerebrovascualar Events

Fabian Bamberg, MD, MPH Department of Clinical Radiology Ludwig Maximilians University, Klinikum Grosshadern Marchioninistrasse 15, 81377 Munich, GermanyMedicalResearch.com Interview with:

Fabian Bamberg, MD, MPH
Department of Clinical Radiology
Ludwig Maximilians University, Klinikum Grosshadern
Marchioninistrasse 15, 81377 Munich, Germany

 MedicalResearch.com: What are the main findings of the study? 

Dr. Bamberg: Our study shows that there is a substantial and heterogenous degree of subclinical cardiovascular disease burden in patients with diabetes undergoing whole-body MRI. These whole-body MRI findings have significant prognostic relevance. For instance, our results show that patients without any pathologic findings experience no adverse cardiovascular event over a period of six years while the risk for a heart attack or stroke increases with the degree of disease burden.
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Breast Cancer: Survival Outcomes Predicted by Chemotherapy Response on MRI

Nariya Cho, MD Departments of Radiology Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.MedicalResearch.com Interview with:
Nariya Cho, MD

Departments of Radiology
Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.

 


MedicalResearch.com: What are the main findings of the study?

Dr. Cho: Smaller reduction in tumor volume and a smaller reduction in washout component on dynamic contrast agent–enhanced MR imaging assessed by computer-aided evaluation after neoadjuvant chemotherapy were independent parameters of worse recurrence-free survival and overall survival in breast cancer patients who received neoadjuvant chemotherapy.

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PET/MRI : A Feasible Modality for Cardiac Imaging

Hybrid PET/MR Imaging of the Heart: Feasibility and Initial Results
Felix Nensa, MD
Department of Diagnostic and Interventional Radiology and Neuroradiology
University Hospital Essen, University of Duisburg-Essen,
Hufelandstrasse 55, 45147 Essen, Germany;

MedicalResearch.com: What are the main findings of the study?

Dr. Nensa: Cardiac positron emission tomography (PET)/magnetic resonance imaging (MRI) with fluorine 18 fluorodeoxyglucose (FDG) turned out to be feasible with an integrated whole-body 3-Tesla PET/MRI system. Despite the presence of a PET detector in the magnetic field of the MR imaging unit, high-quality cardiac MR images were acquired. PET images originating from a PET/CT and the PET/MR scanner showed very good visual agreement and no statistical significant difference of the mean was found in standardized uptake values, however, variance was considerable. In patients with myocardial infarction, PET and MR images were in good concordance regarding both, cine imaging and late gadolinium-enhanced imaging.

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