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P177 Background: Acute MRI imaging including  diffusion, perfusion, angiography, and FLAIR provides useful  information in the diagnosis of stroke. It has been proposed that the  stroke MRI exam may improve patient selection and outcome for tPA  therapy. An alternate view holds that MRI may excessively delay times  to treatment and lead to worse outcomes. To look for any evidence of  adverse effects of MRI screening, we examined our initial experience  using MRI as a screening exam for tPA therapy.Methods: The  critical care pathway for stroke at our hospital mandates both CT and  MRI for all patients under consideration for IV tPA therapy within 3  hours of onset. Delays are minimized by 24 hour in-house MRI  technologists and immediate availability of both the MRI and CT  scanners when a stroke code is called. Scans are monitored by a stroke  neurologist and/or radiologist to minimize delays in image  interpretation. MRI exclusion criteria for tPA are: (1) presence of  subacute lesions not suspected from history or CT (2) normal DWI, PWI  and MRA of good technical quality (3) any evidence of hemorrhage.Results: Twelve patients were treated with tPA; 4 were  excluded based on MRIResults: 2 had subacute lesions, 1 had  evidence of chronic hemorrhage, 1 had a normal MRI (final diagnosis:  Guillain-Barre Syndrome). Four of the treated patients had no MRI  because of contraindications (n=3) or scanner unavailability (n=1). One  patient was treated based on MRI results only; CT was unavailable.  Median door-to-needle time (MDTNT) for the 8 MRI screened patients was  83 minutes; median time-to-treatment (MTTT) was 134 minutes. Four of  these 8 patients achieved a modified Rankin Score of 0 or 1 (mRS12) on  follow-up. One had a symptomatic hemorrhage and died (time-to-treatment  was 116 minutes).Conclusion: In this small series, door to  needle times and outcomes are well within benchmark values (STARS  Study: MDTNT - 96 minutes, MTTT - 164 minutes, mRS12 at outcome - 43%;  G. Albers, et al, JAMA. 2000;283:1145). There is no evidence to date  that MRI screening for iv tPA leads to excessive delays or worse  outcomes. A larger series is necessary to demonstrate the safety and  efficacy of MRI screening for IV thrombolysis.

Routine screening for IV tPA therapy less than 3 hours with MRI: initial clinical experience