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<meta name="DC.Title" content="Pretreatment Advanced Imaging in Patients with Stroke Treated with IV Thrombolysis: Evaluation of a Multihospital Data Base" />
<meta name="DC.Identifier" content="10.3174/ajnr.A3797" />
<meta name="DC.Date" content="2014-03-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: CT angiography, CT perfusion, and MR imaging have all been advocated as potentially useful in treatment planning for patients with acute ischemic stroke. We evaluated a large multihospital data base to determine how the use of advanced imaging is evolving in patients treated with intravenous thrombolysis.

MATERIALS AND METHODS: Patients with acute ischemic stroke receiving IV thrombolytic therapy from 2008 to 2011 were identified by using the Premier Perspective data base. Mortality and discharge to long-term care rates were compared following multivariate logistic regression between patients who received head CT only versus those who received CTA without CT perfusion, CT perfusion, or MR imaging.

RESULTS: Of 12,429 included patients, 7305 (59%) were in the CT group, 2359 (19%) were in the CTA group, 848 (7%) were in the CTP group, and 1917 (15%) were in the MR group. From 2008 to 2011, the percentage of patients receiving head CT only decreased from 64% to 55%, while the percentage who received cerebral CT perfusion increased from 3% to 8%. The use of CT angiography and MR imaging marginally increased (1%–2%). Outcomes were similar between CT only and advanced imaging patients, except discharge to long-term care was slightly more frequent in the CTP group (OR = 1.17 [95% CI, 0.96–1.43]; P = .0412) and MR group (OR = 1.14 [95% CI, 1.01–1.28]; P = .0177) and mortality was lower in the MR group (OR = 0.64 [95% CI, 0.52–0.79]; P &lt; .0001).

CONCLUSIONS: Use of advanced imaging is increasing in patients treated with IV thrombolysis. While there were differences in outcomes among imaging groups, the clinical effect of advanced imaging remains unclear." />
<meta name="DC.Contributor" content="J.S. McDonald" />
<meta name="DC.Contributor" content="J. Fan" />
<meta name="DC.Contributor" content="D.F. Kallmes" />
<meta name="DC.Contributor" content="H.J. Cloft" />
<meta name="article:published_time" content="2014-03-01" />
<meta name="article:section" content="Brain" />
<meta name="citation_title" content="Pretreatment Advanced Imaging in Patients with Stroke Treated with IV Thrombolysis: Evaluation of a Multihospital Data Base" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;CT angiography, CT perfusion, and MR imaging have all been advocated as potentially useful in treatment planning for patients with acute ischemic stroke. We evaluated a large multihospital data base to determine how the use of advanced imaging is evolving in patients treated with intravenous thrombolysis.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Patients with acute ischemic stroke receiving IV thrombolytic therapy from 2008 to 2011 were identified by using the Premier Perspective data base. Mortality and discharge to long-term care rates were compared following multivariate logistic regression between patients who received head CT only versus those who received CTA without CT perfusion, CT perfusion, or MR imaging.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Of 12,429 included patients, 7305 (59%) were in the CT group, 2359 (19%) were in the CTA group, 848 (7%) were in the CTP group, and 1917 (15%) were in the MR group. From 2008 to 2011, the percentage of patients receiving head CT only decreased from 64% to 55%, while the percentage who received cerebral CT perfusion increased from 3% to 8%. The use of CT angiography and MR imaging marginally increased (1%–2%). Outcomes were similar between CT only and advanced imaging patients, except discharge to long-term care was slightly more frequent in the CTP group (OR = 1.17 [95% CI, 0.96–1.43]; &lt;i&gt;P&lt;/i&gt; = .0412) and MR group (OR = 1.14 [95% CI, 1.01–1.28]; &lt;i&gt;P&lt;/i&gt; = .0177) and mortality was lower in the MR group (OR = 0.64 [95% CI, 0.52–0.79]; &lt;i&gt;P&lt;/i&gt; &amp;lt; .0001).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Use of advanced imaging is increasing in patients treated with IV thrombolysis. While there were differences in outcomes among imaging groups, the clinical effect of advanced imaging remains unclear.&lt;/p&gt;" />
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<meta name="twitter:title" content="Pretreatment Advanced Imaging in Patients with Stroke Treated with IV Thrombolysis: Evaluation of a Multihospital Data Base" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: CT angiography, CT perfusion, and MR imaging have all been advocated as potentially useful in treatment planning for patients with acute ischemic stroke. We evaluated a large multihospital data base to determine how the use of advanced imaging is evolving in patients treated with intravenous thrombolysis.

MATERIALS AND METHODS: Patients with acute ischemic stroke receiving IV thrombolytic therapy from 2008 to 2011 were identified by using the Premier Perspective data base. Mortality and discharge to long-term care rates were compared following multivariate logistic regression between patients who received head CT only versus those who received CTA without CT perfusion, CT perfusion, or MR imaging.

RESULTS: Of 12,429 included patients, 7305 (59%) were in the CT group, 2359 (19%) were in the CTA group, 848 (7%) were in the CTP group, and 1917 (15%) were in the MR group. From 2008 to 2011, the percentage of patients receiving head CT only decreased from 64% to 55%, while the percentage who received cerebral CT perfusion increased from 3% to 8%. The use of CT angiography and MR imaging marginally increased (1%–2%). Outcomes were similar between CT only and advanced imaging patients, except discharge to long-term care was slightly more frequent in the CTP group (OR = 1.17 [95% CI, 0.96–1.43]; P = .0412) and MR group (OR = 1.14 [95% CI, 1.01–1.28]; P = .0177) and mortality was lower in the MR group (OR = 0.64 [95% CI, 0.52–0.79]; P &lt; .0001).

CONCLUSIONS: Use of advanced imaging is increasing in patients treated with IV thrombolysis. While there were differences in outcomes among imaging groups, the clinical effect of advanced imaging remains unclear." />
<meta name="og-title" property="og:title" content="Pretreatment Advanced Imaging in Patients with Stroke Treated with IV Thrombolysis: Evaluation of a Multihospital Data Base" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/35/3/478" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: CT angiography, CT perfusion, and MR imaging have all been advocated as potentially useful in treatment planning for patients with acute ischemic stroke. We evaluated a large multihospital data base to determine how the use of advanced imaging is evolving in patients treated with intravenous thrombolysis.

MATERIALS AND METHODS: Patients with acute ischemic stroke receiving IV thrombolytic therapy from 2008 to 2011 were identified by using the Premier Perspective data base. Mortality and discharge to long-term care rates were compared following multivariate logistic regression between patients who received head CT only versus those who received CTA without CT perfusion, CT perfusion, or MR imaging.

RESULTS: Of 12,429 included patients, 7305 (59%) were in the CT group, 2359 (19%) were in the CTA group, 848 (7%) were in the CTP group, and 1917 (15%) were in the MR group. From 2008 to 2011, the percentage of patients receiving head CT only decreased from 64% to 55%, while the percentage who received cerebral CT perfusion increased from 3% to 8%. The use of CT angiography and MR imaging marginally increased (1%–2%). Outcomes were similar between CT only and advanced imaging patients, except discharge to long-term care was slightly more frequent in the CTP group (OR = 1.17 [95% CI, 0.96–1.43]; P = .0412) and MR group (OR = 1.14 [95% CI, 1.01–1.28]; P = .0177) and mortality was lower in the MR group (OR = 0.64 [95% CI, 0.52–0.79]; P &lt; .0001).

CONCLUSIONS: Use of advanced imaging is increasing in patients treated with IV thrombolysis. While there were differences in outcomes among imaging groups, the clinical effect of advanced imaging remains unclear." />
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">J.S. McDonald</span>, <span class="highwire-citation-author" data-delta="1">J. Fan</span>, <span class="highwire-citation-author" data-delta="2">D.F. Kallmes</span> and <span class="highwire-citation-author" data-delta="3">H.J. Cloft</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">March 2014,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">35 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">478-481; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A3797 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-12905--6559203380" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">J.S. McDonald </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (J.S.M., D.F.K., H.J.C.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.S.%2BMcDonald%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=McDonald%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJ.S.%2BMcDonald%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">J. Fan </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Health Sciences Research (J.F.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BFan%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Fan%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJ.%2BFan%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">D.F. Kallmes </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (J.S.M., D.F.K., H.J.C.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Neurosurgery (D.F.K., H.J.C.), Mayo Clinic, Rochester, Minnesota.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.F.%2BKallmes%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kallmes%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AD.F.%2BKallmes%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">H.J. Cloft </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (J.S.M., D.F.K., H.J.C.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Neurosurgery (D.F.K., H.J.C.), Mayo Clinic, Rochester, Minnesota.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=H.J.%2BCloft%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Cloft%20H&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AH.J.%2BCloft%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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<div class="cit ref-cit ref-journal" id="cit-35.3.478.23" data-doi="10.1002/ana.22500"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Dani</span>  <span class="cit-name-given-names">KA</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Thomas</span>  <span class="cit-name-given-names">RG</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Chappell</span>  <span class="cit-name-given-names">FM</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Computed tomography and magnetic resonance perfusion imaging in ischemic stroke: definitions and thresholds</span>. <abbr class="cit-jnl-abbrev">Ann Neurol</abbr> <span class="cit-pub-date">2011</span>;<span class="cit-vol">70</span>:<span class="cit-fpage">384</span>–<span class="cit-lpage">401</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1002/ana.22500&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=21796665&amp;link_type=MED&amp;atom=%2Fajnr%2F35%2F3%2F478.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">24.</span><a class="rev-xref-ref" href="#xref-ref-24-1" title="View reference 24. in text" id="ref-24">↵</a>

<div class="cit ref-cit ref-journal" id="cit-35.3.478.24"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Zussman</span>  <span class="cit-name-given-names">BM</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Boghosian</span>  <span class="cit-name-given-names">G</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Gorniak</span>  <span class="cit-name-given-names">RJ</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">The relative effect of vendor variability in CT perfusion results: a method comparison study</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2011</span>;<span class="cit-vol">197</span>:<span class="cit-fpage">468</span>–<span class="cit-lpage">73</span></cite></div><div class="cit-extra"></div></div></li><li><span class="ref-label">25.</span><a class="rev-xref-ref" href="#xref-ref-25-1" title="View reference 25. in text" id="ref-25">↵</a>

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<div class="cit ref-cit ref-journal" id="cit-35.3.478.27" data-doi="10.1161/01.STR.8.4.512"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Katzman</span>  <span class="cit-name-given-names">R</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Clasen</span>  <span class="cit-name-given-names">R</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Klatzo</span>  <span class="cit-name-given-names">I</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Report of joint committee for stroke resources. IV. Brain edema in stroke</span>. <abbr class="cit-jnl-abbrev">Stroke</abbr> <span class="cit-pub-date">1977</span>;<span class="cit-vol">8</span>:<span class="cit-fpage">512</span>–<span class="cit-lpage">40</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6OToic3Ryb2tlYWhhIjtzOjU6InJlc2lkIjtzOjc6IjgvNC81MTIiO3M6NDoiYXRvbSI7czoxOToiL2FqbnIvMzUvMy80NzguYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">28.</span><a class="rev-xref-ref" href="#xref-ref-28-1" title="View reference 28. in text" id="ref-28">↵</a>

<div class="cit ref-cit ref-web" id="cit-35.3.478.28"><div class="cit-metadata"><cite><span class="cit-comment"><a href="http://www.jointcommission.org/certification/primary_stroke_centers.aspx">http://www.jointcommission.org/certification/primary_stroke_centers.aspx</a></span>. <span class="cit-access-date">Accessed October 31, 2013</span>.</cite></div><div class="cit-extra"></div></div></li></ol></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 35</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 3 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Mar 2014 </div></div>
      
      
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      <div class="highwire-cite-title">Pretreatment Advanced Imaging in Patients with Stroke Treated with IV Thrombolysis: Evaluation of a Multihospital Data Base</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">J.S.</span> <span class="nlm-surname">McDonald</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Fan</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">D.F.</span> <span class="nlm-surname">Kallmes</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">H.J.</span> <span class="nlm-surname">Cloft</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Mar 2014, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">35 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">478-481; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3797 </span></div>
  
  
  
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