MRI Images May Pinpoint Time of Stroke11/02/10
TUESDAY, Nov. 2 (HealthDay News) -- MRI images can serve as a
"surrogate clock" to pinpoint stroke onset in patients whose
symptoms began during sleep, increasing the number of patients
eligible for highly effective clot-busting therapy, according to a
Researchers found that MRI data could accurately determine if
patients had experienced stroke symptoms within a three-hour period
or less, which would allow the use of a clot-busting drug that
works best if administered within that window of time. Tissue
plasminogen activator, known as tPA, can dramatically reverse
stroke symptoms in those whose strokes are caused by blood clots
and blockages, which account for an estimated 85 percent of all
Strokes strike about 795,000 Americans each year, killing
137,000, according to the U.S. Centers for Disease Control and
Prevention. The condition is a leading cause of serious, long-term
disability in the United States.
"A tool that can estimate the age of stroke would be of great value in cases of unknown stroke onset time," said lead researcher Dr. Catherine Oppenheim, professor of radiology at Universite Paris Descartes in France. "This concerns as many as a quarter of all stroke patients who cannot be given tPA because they wake up with stroke symptoms or are unable to say when their stroke began."
Under current guidelines, patients who awaken with symptoms are
arbitrarily excluded from tPA therapy, Oppenheim said, because the
onset is considered to be the last time the patient was
symptom-free, which might have been the night before.
The clot-busting drug is recommended for use only within 4.5
hours of stroke onset because it carries a risk of brain
hemorrhage, a potentially fatal prospect, with the risk increasing
as more time passes.
The study, reported online Nov. 2 and in the December issue of
Radiology, reinforces results from similar research, Oppenheim said. Her team reviewed MRI images from 130 patients treated for clot-caused strokes at Sainte-Anne Hospital in Paris between May 2006 and October 2008.
Of those patients, whose average age was 64.7 years, 63
underwent MRI within three hours of stroke onset and 67 were imaged
between three and 12 hours afterwards. With the MRI data,
radiologists could predict with more than 90 percent accuracy which
patients had experienced stroke symptoms for longer than three
However, the study did not compare patients with unknown stroke
onset who received tPA to those who did not, Oppenheim said.
"Providing stroke neurologists with a reliable marker of stroke age will help to ensure that patients . . . are managed as urgently as those with known stroke onset time," she said. "These results will be useful for centers that offer 24-hour access to acute stroke patients. The main limitation is the limited access to MRI in emergency rooms worldwide."
Oppenheim said the next step would be clinical trials to
validate whether MRIs serve as a "surrogate clock" for stroke
Several doctors specializing in stroke care were encouraged by
Oppenheim's study, though they cautioned further research would be
necessary to determine if the results could be replicated.
"It's potentially helpful, and I don't know that it would take years to prove that," said Dr. Larry B. Goldstein, director of the Duke University Stroke Center in Durham, N.C.
Goldstein noted that about 40 percent of stroke patients who
arrive at his facility within two hours of symptom onset receive
tPA. If they don't, "the major reason . . . is that they get there
too late," he said.
Dr. Wally Ghurabi, emergency department director at Santa
Monica-UCLA Medical Center, said a group of ongoing studies there
include a similar focus on MRIs and stroke.
"Really pinpointing the time of onset is so crucial for us. This will definitely give us that edge," Ghurabi said. "I've seen it with my own eyes -- a 60-year-old male or female patient comes into the ER and they're not able to move on one side or speak. A couple of hours later [after therapy], they can walk and talk. What more could we as doctors want?"
Dr. David F. Kallmes, an interventional neuro-radiologist at the
Mayo Clinic in Rochester, Minn., was also optimistic about
The MRI is "trying to act as a surrogate clock," said Kallmes,
who edited Oppenheim's journal article. "Like any imaging
technique, it has a certain accuracy but it won't be perfect. It's
certainly an innovative approach for patients with stroke-like
In October 2008, the American Heart Association, the American
Stroke Association and the European Stroke Association revised
their guidelines to recommend that tPA be used up to 4.5 hours
after the onset of an ischemic (clot-caused) stroke, but the U.S.
Food and Drug Administration has not yet revised its approved
treatment window of 3 hours.
A study in
The Lancet Neurology also found that a slight increase in
deaths and bleeding in an extended treatment group over a
three-month follow-up period underlined the notion that treatment
within 3 hours -- although not required -- is still optimal.
Review the warning signs of stroke at the
American Stroke Association.
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