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Background and purposeIn the diagnosis and management of suspected hyperacute stroke patients "time is brain". Considering this dictum; in our institute we devised a comprehensive MRI protocol with inclusion of ASL technique for penumbral imaging, such that it will be faster and still competent enough for accurately diagnosing patients with suspected hyperacute stroke. The sequences in "FAST MRI" stroke protocol take approximately 10-11 minutes, with ASL sequence attributing to 3.5 minutes. Purpose of this comprehensive yet "FAST MRI" stroke protocol was to assist clinicians in planning appropriate reperfusion treatment (I.V thrombolysis, endovascular or conservative) within the window period for better prognosis. MethodsPatients referred to our emergency department with suspected hyperacute stroke were imaged with "FAST MRI" stroke protocol (diffusion, FLAIR, SWAN, 3D ASL and TOF -MRA sequences). Follow up imaging (preferably with MRI) was also performed in these patients at 6 and 24 hours. Results76 patients were diagnosed with hyperacute stroke using this MRI protocol. Median age was 68.5 years, median time to MR imaging was 2 hours and median NIHSS was 6. Total 64 patients received reperfusion therapy, of which 48 were diagnosed with diffusion-perfusion abnormalities on ASL maps. Conclusion"FAST MRI" stroke protocol with inclusion of ASL technique enables stroke units to give prompt diagnosis in a reasonably short time interval, facilitate triage of patients into hyperacute/acute, ischemic/ hemorhhagic strokes or TIA (transient ischemic attack), guide necessary reperfusion treatment and thus increase treatment cohorts.

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