The moment a person is rushed with stroke-like symptoms to MedStar Washington Hospital Center, a chain-reaction process starts. The goal: To move the patient toward getting the clot-busting drug tPA as quickly as possible, preferably within 60 minutes.
But it’s one of the stops along the way in that process — magnetic resonance imaging, or the MRI — which has mixed reviews in the stroke community but also helped recently earn the hospital The Joint Commission designation as a Certified Comprehensive Stroke Center.
Most hospitals use CT scans as their default first-line test to diagnose stroke, said Dr. Amie Hsia, medical director of the Stroke Center at the hospital center. They are faster to perform, but provide less information than an MRI, Hsia said. The hospital has used MRIs as the default standard of care for suspected strokes for the last couple of years, Hsia said.
“We’re able to get more detailed information about what is really going on,” Hsia said. The sharper image helps providers determine who's really suffering a stroke, where it's occurring in the brain and how severe it is.
“But the push in the stroke community is to make sure we’re treating patients with tPA as quickly as possible," Hsia said. "So some argue we don’t need to have a much detailed information.” Among the additional support for CT scans, much of the debate in stroke imaging has centered around access-related limitations of MRI. As well, some studies have found certain strokes can be better detected by CT scans.
While multiple hospitals in the area are designated by the Joint Commission as primary stroke centers, MedStar is the only hospital in Greater Washington and one of just 74 hospitals around the country with the comprehensive designation. To achieve the recognition, MedStar Washington Hospital Center underwent an on-site review in May when Joint Commission surveyors reviewed compliance with all comprehensive stroke center standards and requirements.
It serves as a stamp of approval from the Joint Commission that the hospital can handle some of the most complex stroke cases, Hsia said.
A representative from the Joint Commission said only hospitals which use MRI imaging for stroke diagnosis can be designated "Comprehensive Stroke Centers." That is because these centers handle the most complex stroke cases and scientific literature shows MRI's provide the most accurate imaging of the brain.
Johns Hopkins University Hospital also has the Comprehensive Stroke Center designation. In May, Johns Hopkins published a study in the journal Stroke supporting the use of the MRI, saying it developed a technique that can predict with 95 percent accuracy which stroke victims will benefit from clot-busters and which will suffer potentially dangerous side effects.
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