CT vs MRI for Extended Stroke Onset Imaging – Which Is Faster?

Written by Clay Smith

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Multimodal CT-based imaging led to faster treatment time than MRI for stroke patients with >4.5 hours or unknown time of onset.

Why does this matter?
In patients with extended or unknown time of stroke onset, imaging can help us decide on treatment. Which imaging approach leads to a shorter time to treatment, CT or MRI?

Is CT or MRI quicker? Is this a real question?
This was a single center, retrospective registry study of extended or unknown stroke onset patients who received tPA: 100 stroke patients had multimodal CT (noncontrast+CTA+CT perfusion; scan time 1 minute 54 seconds), and 84 patients had multimodal MRI (scan time 16 minutes 38 seconds). Patient characteristics were similar between the CT and MRI cohorts. However, the CT group had shorter time to presentation, and the MRI group had more wake-up strokes. The CT group was treated about 30 minutes faster (median 45 minutes) than the MRI group (median 75 minutes). There was no difference in 90-day neurological outcome between the groups. The editorialist’s take home was, “treatment with an IV thrombolytic in patients selected by perfusion imaging (CT or MRI), with no time limit, is feasible in a pragmatic real-world setting, with safety and efficacy outcomes comparable to previous randomized trials.”

Multimodal CT or MRI for IV thrombolysis in ischemic stroke with unknown time of onset. Neurology. 2020 Dec 1;95(22):e2954-e2964. doi: 10.1212/WNL.0000000000011059. Epub 2020 Oct 21.

What are your thoughts?

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