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一种可携式电脑断层(CT)扫描器可以显著降低急诊(ED)病患诊断缺血性中风的时间；麻塞诸塞州的研究者在第94届北美放射科学会科学研讨会暨年会中报告指出，它可增加86%的急性中风病患接受栓塞治疗。
主要研究者David Weinreb医师向与会听众表示，可携式CT影像减少时间上的需求，在北岸医学中心-Salem医院进行之408名ED病患的研究中，从医师提出要求到进行CT的时间，可以从将近30分钟缩短到不到16分钟。
Weinreb医师目前是康乃狄克纽哈芬圣拉斐尔医院的放射科住院医师，他比较了还没有可携式CT扫描时127名急性中风病患的结果，与有可携式CT扫描器之后，281名类似症状病患的结果。
Weinreb医师表示，在我们的小社区医院中，需要CT的病患必须转到医院的另一栋楼，这得花上将近11分钟，这个时间加上中风发作的时间、抵达急诊的时间、抵达急诊之后到医师指示进行CT的时间，这些时间会让病患延迟使用组织型血纤维蛋白溶解酶原活化剂(tPA)进行血栓治疗的黄金时间。
Weinreb医师指出，大部份中风病患抵达急诊的时间，是在以tPA治疗黄金时间的3至4小时；在这个研究中，症状发生到呼救119的平均时间为2.68小时。在有可携式装备之前，从抵达急诊到获得CT的时间为34.55分钟(±2.2分钟)。之后，减少为15.88分钟(±2.4分钟)。急诊室完成相关检查及神经专科医师会诊时间为1.62小时。
Weinreb医师向Medscape Radiology表示，若有可携式CT，我们可减少11分钟运送病患前往CT室的时间，这减少了医师要求CT与进行CT的时间达54% (P< .001)，增加了86%病患接受tPA的机会 —几乎是原来的两倍。
Weinreb医师表示，使用传统的CT时，每170名中风病患只有一人有机会使用tPA。用可携式装置，每91名急性中风病患就有1人有机会。从0.59%增加到1.1%。
Weinreb医师的团队使用NeuroLogica公司制造的可携式CT扫描器。他指出，它足以进行成人的脑部CT与小孩的全身CT。
华盛顿大学医学中心放射与泌尿科教授Colin Derdeyn医师在Medscape Radiology访问对于Weinreb医师的发表的看法时表示，可携式CT对小医院将很有用，但是大多数大型医学中心在急诊已有传统的CT扫描器。运送病患去接受CT并不是个大问题。
Derdeyn医师指出，另一点很重要的是，Weinreb医师与制造可携式CT扫描器的NeuroLogica有利益冲突。
Derdeyn医师表示，我们平均急诊室完成相关检查及神经专科医师会诊时间为45分钟，我们每年约以tPA治疗40名病患。在北岸医学中心-Salem医院，每个月只有1或2名病患接受tPA。
Derdeyn医师建议，如果你每周只有用一次CT扫描器或使用次数更少，你可能不会记得如何使用它才会有最佳结果；也就是说，如果你还没办法好好使用传统CT，使用可携式装置可能是不错的选择。
Weinreb医师与NeuroLogica公司有财务关系。他表示，该组设备约3,000元美金。Derdeyn医师宣称没有相关资金上的往来。
RSNA 2008: 第94届北美放射科学会科学研讨会暨年会：科学组SSJ07-02。发表于2008年12月2日。
RSNA 2008: Portable Head CT Speeds Diagnosis, Treatment of Ischemic Stroke
By Martha Kerr
Medscape Medical News
A portable computed tomography (CT) scanner can significantly reduce the time to diagnosis of ischemic stroke for a patient presenting to the emergency department (ED). It resulted in "an 86% increase in the predicted percent of acute stroke patients treatable with thrombolytic therapy," Massachusetts radiologists reported here at the 94th Scientific Assembly and Annual Meeting of the Radiological Society of North America.
Portable CT imaging reduced the time from the physician's request for CT to when the scan was performed from approximately 30 minutes to less than 16 minutes in a study of 408 patients presenting to the ED of North Shore Medical Center–Salem Hospital, in Massachusetts, principal investigator David Weinreb, MD, told meeting attendees.
Dr. Weinreb, who is currently a resident physician in the Department of Radiology at the Hospital of St. Raphael, in New Haven, Connecticut, compared outcomes of 127 patients presenting with signs of acute stroke prior to the use of the portable CT scanner with the outcomes of 281 patients presenting with similar symptoms after a portable CT scanner was available.
"In our small community hospital, a patient requiring CT had to be transported to another building in our hospital complex," Dr. Weinreb said. "This would take approximately 11 minutes." That, plus the time from stroke symptom onset, arrival at the ED, and time between ED arrival and the physician ordering a CT could put the patient beyond the treatment window for thrombolytic therapy with tissue-type plasminogen activator (tPA).
Most stroke patients arrive at the ED beyond the 3- to 4-hour treatment window for tPA," Dr. Weinreb pointed out. In his study, the average time between symptom onset and calling 911 was 2.68?hours. The time from ED arrival to getting a head CT was 34.55?minutes (±2.2 minutes) before the use of the portable unit. Afterward, it was 15.88?minutes (±2.4 minutes). Door-to-needle time was 1.62 hours.
"We were able to eliminate the 11-minute transport to the CT room with the portable CT," Dr. Weinreb said. This resulted in a reduction of 54% in time between the physician's request for CT to the time when the scan was performed (P?< .001). "There was an 86% increase in patients eligible for tPA — almost a doubling of eligibility," he told Medscape Radiology.
"One out of every 170 stroke patients were eligible for tPA with conventional CT. One out of 91 acute stroke patients were eligible with the portable unit. This is an increase of 0.59% to 1.1%." Dr. Weinreb said.
Dr. Weinreb's group used a portable CT scanner made by NeuroLogica, Inc, of Danbury, Connecticut. "It is large enough to perform a head CT in adults or a whole-body CT in a small child," he noted.
"A portable CT might be useful for a small hospital, but most large academic centers will have a CT scanner in the ED already," Colin Derdeyn, MD, professor of radiology and urology at Washington University Medical Center, in St. Louis, Missouri, commented during an interview with Medscape Radiology after Dr. Weinreb's presentation. "Transporting the patient to the CT is not that much of an issue."
"It's also important to note that Dr. Weinreb has a conflict of interest with NeuroLogica, which manufactures the portable CT scanner," Dr. Derdeyn pointed out.
"Our average door-to-needle time is 45 minutes and we treat about 40 patients a year [with tPA]," Dr. Derdeyn said. At North Shore Medical Center–Salem Hospital, only 1 or 2 patients a month receive tPA.
"If you only use [the CT scanner] once a week or less, you may not remember how to use it well enough to get the best results," Dr. Derdeyn commented. "That said, if you don't have ready access to conventional CT, it could be useful to have a portable unit."
Dr. Weinreb has a financial arrangement with NeuroLogica, Inc. He said the unit costs about $3000. Dr. Derdeyn has disclosed no relevant financial relationships.
RSNA 2008: 94th Scientific Assembly and Annual Meeting of the Radiological Society of North America: Scientific Session SSJ07-02: Presented December 2, 2008.