Evidence map›Paper›PMID 26892282›Full record

ArticleStroke2016

Streamlined Hyperacute Magnetic Resonance Imaging Protocol Identifies Tissue-Type Plasminogen Activator-Eligible Stroke Patients When Clinical Impression Is Stroke Mimic.

Manu S Goyal, Brian G Hoff, Jennifer Williams, Naim Khoury, Rebecca Wiesehan, Laura Heitsch, Peter Panagos, Katie D Vo, Tammie Benzinger, Colin P Derdeyn and 2 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Stroke, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

16 citing papers in PubMed.

  1. Article
  2. Current state and advancements of imaging in acute ischemic stroke: a practical review.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025
    Review
  3. Article
  4. Article
  5. Observational
  6. Article
  7. Article
  8. Article
  9. Review
  10. Article
  11. Non-invasive monitoring of longitudinal changes in cerebral hemodynamics in acute ischemic stroke using BOLD signal delay.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2020
    Article
  12. Migraine as a Stroke Mimic and as a Stroke Chameleon.Current pain and headache reports · 2019
    Review
  13. Article
  14. Diagnostic Error in Stroke-Reasons and Proposed Solutions.Current atherosclerosis reports · 2018
    Review
  15. Stroke Chameleons and Stroke Mimics in the Emergency Department.Current neurology and neuroscience reports · 2017
    Review
  16. Stroke mimic diagnoses presenting to a hyperacute stroke unit.Clinical medicine (London, England) · 2016
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Manu S GoyalFrom the Mallinckrodt Institute of Radiology (M.S.G., K.D.V., T.B., C.P.D., J.-M.L.), Department of Neurology (R.W., C.P.D., J.-M.L., A.L.F.), Division of Emergency Medicine (L.H., P.P.), and Department of Neurological Surgery (C.P.D.), Washington University School of Medicine, St Louis, MO; Department of Operational Excellence (B.G.H.) and Department of Emergency Services (J.W.), Barnes-Jewish Hospital, St Louis, MO; Department of Neuroradiology, University of Montreal, Montreal, Quebec, Canada (N.K.); and Department of Biomedical Engineering, Washington University, St Louis, MO (J.-M.L.).
Brian G HoffFrom the Mallinckrodt Institute of Radiology (M.S.G., K.D.V., T.B., C.P.D., J.-M.L.), Department of Neurology (R.W., C.P.D., J.-M.L., A.L.F.), Division of Emergency Medicine (L.H., P.P.), and Department of Neurological Surgery (C.P.D.), Washington University School of Medicine, St Louis, MO; Department of Operational Excellence (B.G.H.) and Department of Emergency Services (J.W.), Barnes-Jewish Hospital, St Louis, MO; Department of Neuroradiology, University of Montreal, Montreal, Quebec, Canada (N.K.); and Department of Biomedical Engineering, Washington University, St Louis, MO (J.-M.L.).
Jennifer WilliamsFrom the Mallinckrodt Institute of Radiology (M.S.G., K.D.V., T.B., C.P.D., J.-M.L.), Department of Neurology (R.W., C.P.D., J.-M.L., A.L.F.), Division of Emergency Medicine (L.H., P.P.), and Department of Neurological Surgery (C.P.D.), Washington University School of Medicine, St Louis, MO; Department of Operational Excellence (B.G.H.) and Department of Emergency Services (J.W.), Barnes-Jewish Hospital, St Louis, MO; Department of Neuroradiology, University of Montreal, Montreal, Quebec, Canada (N.K.); and Department of Biomedical Engineering, Washington University, St Louis, MO (J.-M.L.).
Naim KhouryFrom the Mallinckrodt Institute of Radiology (M.S.G., K.D.V., T.B., C.P.D., J.-M.L.), Department of Neurology (R.W., C.P.D., J.-M.L., A.L.F.), Division of Emergency Medicine (L.H., P.P.), and Department of Neurological Surgery (C.P.D.), Washington University School of Medicine, St Louis, MO; Department of Operational Excellence (B.G.H.) and Department of Emergency Services (J.W.), Barnes-Jewish Hospital, St Louis, MO; Department of Neuroradiology, University of Montreal, Montreal, Quebec, Canada (N.K.); and Department of Biomedical Engineering, Washington University, St Louis, MO (J.-M.L.).
Rebecca WiesehanFrom the Mallinckrodt Institute of Radiology (M.S.G., K.D.V., T.B., C.P.D., J.-M.L.), Department of Neurology (R.W., C.P.D., J.-M.L., A.L.F.), Division of Emergency Medicine (L.H., P.P.), and Department of Neurological Surgery (C.P.D.), Washington University School of Medicine, St Louis, MO; Department of Operational Excellence (B.G.H.) and Department of Emergency Services (J.W.), Barnes-Jewish Hospital, St Louis, MO; Department of Neuroradiology, University of Montreal, Montreal, Quebec, Canada (N.K.); and Department of Biomedical Engineering, Washington University, St Louis, MO (J.-M.L.).
Laura HeitschFrom the Mallinckrodt Institute of Radiology (M.S.G., K.D.V., T.B., C.P.D., J.-M.L.), Department of Neurology (R.W., C.P.D., J.-M.L., A.L.F.), Division of Emergency Medicine (L.H., P.P.), and Department of Neurological Surgery (C.P.D.), Washington University School of Medicine, St Louis, MO; Department of Operational Excellence (B.G.H.) and Department of Emergency Services (J.W.), Barnes-Jewish Hospital, St Louis, MO; Department of Neuroradiology, University of Montreal, Montreal, Quebec, Canada (N.K.); and Department of Biomedical Engineering, Washington University, St Louis, MO (J.-M.L.).
Peter PanagosFrom the Mallinckrodt Institute of Radiology (M.S.G., K.D.V., T.B., C.P.D., J.-M.L.), Department of Neurology (R.W., C.P.D., J.-M.L., A.L.F.), Division of Emergency Medicine (L.H., P.P.), and Department of Neurological Surgery (C.P.D.), Washington University School of Medicine, St Louis, MO; Department of Operational Excellence (B.G.H.) and Department of Emergency Services (J.W.), Barnes-Jewish Hospital, St Louis, MO; Department of Neuroradiology, University of Montreal, Montreal, Quebec, Canada (N.K.); and Department of Biomedical Engineering, Washington University, St Louis, MO (J.-M.L.).
Katie D VoFrom the Mallinckrodt Institute of Radiology (M.S.G., K.D.V., T.B., C.P.D., J.-M.L.), Department of Neurology (R.W., C.P.D., J.-M.L., A.L.F.), Division of Emergency Medicine (L.H., P.P.), and Department of Neurological Surgery (C.P.D.), Washington University School of Medicine, St Louis, MO; Department of Operational Excellence (B.G.H.) and Department of Emergency Services (J.W.), Barnes-Jewish Hospital, St Louis, MO; Department of Neuroradiology, University of Montreal, Montreal, Quebec, Canada (N.K.); and Department of Biomedical Engineering, Washington University, St Louis, MO (J.-M.L.).
Tammie BenzingerFrom the Mallinckrodt Institute of Radiology (M.S.G., K.D.V., T.B., C.P.D., J.-M.L.), Department of Neurology (R.W., C.P.D., J.-M.L., A.L.F.), Division of Emergency Medicine (L.H., P.P.), and Department of Neurological Surgery (C.P.D.), Washington University School of Medicine, St Louis, MO; Department of Operational Excellence (B.G.H.) and Department of Emergency Services (J.W.), Barnes-Jewish Hospital, St Louis, MO; Department of Neuroradiology, University of Montreal, Montreal, Quebec, Canada (N.K.); and Department of Biomedical Engineering, Washington University, St Louis, MO (J.-M.L.).
Colin P DerdeynFrom the Mallinckrodt Institute of Radiology (M.S.G., K.D.V., T.B., C.P.D., J.-M.L.), Department of Neurology (R.W., C.P.D., J.-M.L., A.L.F.), Division of Emergency Medicine (L.H., P.P.), and Department of Neurological Surgery (C.P.D.), Washington University School of Medicine, St Louis, MO; Department of Operational Excellence (B.G.H.) and Department of Emergency Services (J.W.), Barnes-Jewish Hospital, St Louis, MO; Department of Neuroradiology, University of Montreal, Montreal, Quebec, Canada (N.K.); and Department of Biomedical Engineering, Washington University, St Louis, MO (J.-M.L.).
Jin-Moo LeeFrom the Mallinckrodt Institute of Radiology (M.S.G., K.D.V., T.B., C.P.D., J.-M.L.), Department of Neurology (R.W., C.P.D., J.-M.L., A.L.F.), Division of Emergency Medicine (L.H., P.P.), and Department of Neurological Surgery (C.P.D.), Washington University School of Medicine, St Louis, MO; Department of Operational Excellence (B.G.H.) and Department of Emergency Services (J.W.), Barnes-Jewish Hospital, St Louis, MO; Department of Neuroradiology, University of Montreal, Montreal, Quebec, Canada (N.K.); and Department of Biomedical Engineering, Washington University, St Louis, MO (J.-M.L.).
Andria L FordFrom the Mallinckrodt Institute of Radiology (M.S.G., K.D.V., T.B., C.P.D., J.-M.L.), Department of Neurology (R.W., C.P.D., J.-M.L., A.L.F.), Division of Emergency Medicine (L.H., P.P.), and Department of Neurological Surgery (C.P.D.), Washington University School of Medicine, St Louis, MO; Department of Operational Excellence (B.G.H.) and Department of Emergency Services (J.W.), Barnes-Jewish Hospital, St Louis, MO; Department of Neuroradiology, University of Montreal, Montreal, Quebec, Canada (N.K.); and Department of Biomedical Engineering, Washington University, St Louis, MO (J.-M.L.). forda@neuro.wustl.edu.

Funding

Washington University Institute of Clinical and Translational SciencesUL1TR000448 · NCATS · WASHINGTON UNIVERSITY · PI EVANOFF, BRADLEY A · 2012 to 2016
$41.4M
LCenter for Clinical and Translational Science and TrainingUL1TR001425 · NCATS · UNIVERSITY OF CINCINNATI · PI HEUBI, JAMES E., KISSELA, BRETT M · 2015 to 2024
$37.5M
Washington University SPOTRIAS Center - Stroke Trials Registry / Web InterfaceP50NS055977 · NINDS · WASHINGTON UNIVERSITY · PI GOLDBERG, MARK PAUL · 2008 to 2012
$10.1M
Genetic Architecture of Acute Human Brain IschemiaR01NS085419 · NINDS · WASHINGTON UNIVERSITY · PI CRUCHAGA, CARLOS, LEE, JIN-MOO · 2014 to 2018
$2.8M
DEFINING THE ISCHEMIC PENUMBRA WITH MAGNETIC RESONANCE OXYGEN METABOLISMK23NS069807 · NINDS · WASHINGTON UNIVERSITY · PI FORD, ANDRIA LEE · 2011 to 2015
$872k
NCATS NIH HHS UL1 TR000448NCATS NIH HHS UL1 TR001425NINDS NIH HHS K23 NS069807NINDS NIH HHS P50 NS055977NINDS NIH HHS R01 NS085419
6 · The paper itself

Abstract

background and purposeStroke mimics (SM) challenge the initial assessment of patients presenting with possible acute ischemic stroke (AIS). When SM is considered likely, intravenous tissue-type plasminogen activator (tPA) may be withheld, risking an opportunity to treat AIS. Although computed tomography is routinely used for tPA decision making, magnetic resonance imaging (MRI) may diagnose AIS when SM is favored but not certain. We hypothesized that a hyperacute MRI (hMRI) protocol would identify tPA-eligible AIS patients among those initially favored to have SM.

methodsA streamlined hMRI protocol was designed based on barriers to rapid patient transport, MRI acquisition, and post-MRI tPA delivery. Neurologists were trained to order hMRI when SM was favored and tPA was being withheld. The use of hMRI for tPA decision making, door-to-needle times, and outcomes were compared before hMRI implementation (pre-hMRI: August 1, 2011 to July 31, 2013) and after (post-hMRI, August 1, 2013, to January 15, 2015).

resultsPost hMRI, 57 patients with suspected SM underwent hMRI (median MRI-order-to-start time, 29 minutes), of whom, 11 (19%) were diagnosed with AIS and 7 (12%) received tPA. Pre-hMRI, no tPA-treated patients were screened with hMRI. Post hMRI, 7 of 106 (6.6%) tPA-treated patients underwent hMRI to aid in decision making because of suspected SM (0% versus 6.6%; P=0.001). To ensure standard care was maintained after implementing the hMRI protocol, pre- versus post-hMRI tPA-treated cohorts were compared and did not differ: door-to-needle time (39 versus 37 minutes; P=0.63), symptomatic hemorrhage rate (4.5% versus 1.9%; P=0.32), and favorable discharge location (85% versus 89%; P=0.37).

conclusionsA streamlined hMRI protocol permitted tPA administration to a small, but significant, subset of AIS patients initially considered to have SM.

Indexed as

Administration, IntravenousAdultAgedBrain IschemiaClinical Decision-MakingDiagnosis, DifferentialFemaleFibrinolytic AgentsHumansMagnetic Resonance ImagingMaleMiddle AgedStrokeTissue Plasminogen ActivatorTreatment OutcomeFibrinolytic AgentsTissue Plasminogen Activatormagnetic resonance imagingstroketherapythrombolytictissue-type plasminogen activator

Identifiers

PMID26892282
PMCPMC4811697

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.