Identification of imaging selection patterns in acute ischemic stroke patients and the influence on treatment and clinical trial enrollment decision making

Marie Luby; Steven J Warach; Gregory W Albers; Jean-Claude Baron; Christophe Cognard; Antoni Dávalos; Geoffrey A Donnan; Jochen B Fiebach; Jens Fiehler; Werner Hacke; Maarten G Lansberg; David S Liebeskind; Heinrich P Mattle; Catherine Oppenheim; Peter D Schellinger; Joanna M Wardlaw; Max Wintermark

doi:10.1177/1747493015616634

Identification of imaging selection patterns in acute ischemic stroke patients and the influence on treatment and clinical trial enrollment decision making

Int J Stroke. 2016 Feb;11(2):180-90. doi: 10.1177/1747493015616634.

Authors

Marie Luby¹, Steven J Warach², Gregory W Albers³, Jean-Claude Baron⁴, Christophe Cognard⁵, Antoni Dávalos⁶, Geoffrey A Donnan⁷, Jochen B Fiebach⁸, Jens Fiehler⁹, Werner Hacke¹⁰, Maarten G Lansberg³, David S Liebeskind¹¹, Heinrich P Mattle¹², Catherine Oppenheim¹³, Peter D Schellinger¹⁴, Joanna M Wardlaw¹⁵, Max Wintermark¹⁶

Affiliations

¹ National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA Department of Neurology and Neurotherapeutics, Seton/UT Southwestern Clinical Research Institute of Austin, UT Southwestern Medical Center, Austin, TX, USA lubym@ninds.nih.gov.
² Dell Medical School, University of Texas Austin, Austin, TX, USA.
³ Stanford University School of Medicine, Stanford, CA, USA.
⁴ INSERM U894, Centre Hospitalier Sainte-Anne, Sorbonne Paris Cité, Paris, France Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
⁵ Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
⁶ Hospital Universitari Germans Trias I Pujol, Badalona, Spain.
⁷ The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia.
⁸ Academic Neuroradiology, Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
⁹ University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁰ Department of Neurology, University of Heidelberg, Heidelberg, Germany.
¹¹ UCLA Stroke Center, Los Angeles, CA, USA.
¹² Inselspital, University of Bern, Bern, Switzerland.
¹³ Université Paris-Descartes, Sorbonne Paris Cité, Hôpital Sainte-Anne, INSERM U 894, Paris, France.
¹⁴ Johannes Wesling Medical Center Minden, Minden, Germany.
¹⁵ Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
¹⁶ Stanford University School of Medicine, Stanford, CA, USA Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.

Abstract

Background and purpose: For the STroke Imaging Research (STIR) and VISTA-Imaging Investigators The purpose of this study was to collect precise information on the typical imaging decisions given specific clinical acute stroke scenarios. Stroke centers worldwide were surveyed regarding typical imaging used to work up representative acute stroke patients, make treatment decisions, and willingness to enroll in clinical trials.

Methods: STroke Imaging Research and Virtual International Stroke Trials Archive-Imaging circulated an online survey of clinical case vignettes through its website, the websites of national professional societies from multiple countries as well as through email distribution lists from STroke Imaging Research and participating societies. Survey responders were asked to select the typical imaging work-up for each clinical vignette presented. Actual images were not presented to the survey responders. Instead, the survey then displayed several types of imaging findings offered by the imaging strategy, and the responders selected the appropriate therapy and whether to enroll into a clinical trial considering time from onset, clinical presentation, and imaging findings. A follow-up survey focusing on 6 h from onset was conducted after the release of the positive endovascular trials.

Results: We received 548 responses from 35 countries including 282 individual centers; 78% of the centers originating from Australia, Brazil, France, Germany, Spain, United Kingdom, and United States. The specific onset windows presented influenced the type of imaging work-up selected more than the clinical scenario. Magnetic Resonance Imaging usage (27-28%) was substantial, in particular for wake-up stroke. Following the release of the positive trials, selection of perfusion imaging significantly increased for imaging strategy.

Conclusions: Usage of vascular or perfusion imaging by Computed Tomography or Magnetic Resonance Imaging beyond just parenchymal imaging was the primary work-up (62-87%) across all clinical vignettes and time windows. Perfusion imaging with Computed Tomography or Magnetic Resonance Imaging was associated with increased probability of enrollment into clinical trials for 0-3 h. Following the release of the positive endovascular trials, selection of endovascular only treatment for 6 h increased across all clinical vignettes.

Keywords: Computed Tomography scan; Magnetic Resonance Imaging; clinical trial; ischemic stroke; stroke; thrombolysis.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Humans
Neuroimaging / statistics & numerical data*
Patient Selection*
Stroke / diagnosis*
Stroke / therapy
Surveys and Questionnaires

Grants and funding

Z99 NS999999/Intramural NIH HHS/United States