Comparative Analysis of CT and MRI in Emergency Assessment of Stroke: A Review
Objective: To compare the diagnostic accuracy of computed tomography (CT) and magnetic resonance imaging (MRI)in emergency assessment of stroke in brain imaging from the review of literature.
Method: Relevant databases (PubMed, google scholar etc.) were searched and literature were reviewed from 1995 to 2019. Literature from non-Scopus and unauthorized authorizations was excluded.
Result: It was observed that for MRI DWI (Diffusion-weighted imaging) is preferred and in CT, axial sections are opted. In earlier studies, it was seen that neither CT nor MRI came out to besuperior. This may be due to the previous technology used. Some studies also, suggested that Diffusion-weighted imaging is highly accurate in diagnosis of stroke and also superior to CT. Another study suggested that SWI is a new approach in visualizing the hemorrhage in acute stroke. On one hand, evidence revealed that MRI is as good as CT. While on the other hand, literature concluded that CT angiography is good for intracranial and extracranial vasculature. Some studies suggested that CT is more reliable and is readily available for stroke.
Conclusion: Present study concludes that both diagnostic imaging modalities i.e., CT and MRI have their advantages in diagnosis of ischemic and hemorrhagic stroke. Also chances of stroke increases with increase in age. Other factors influencing the stroke diagnosis and treatment are type of stroke, diagnostic imaging modality available, and cost-effectiveness of diagnostic exams performed.
Albers, G.W., et al. (2018). Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. The New England Journal of Medicine, 378(8), 708-718. https://doi.org/10.1056/NEJMoa1713973 DOI: https://doi.org/10.1056/NEJMoa1713973
Barber, P.A., Hill, M.D., Eliasziw, M., Demchuk, A. M., Pexman, J.H.W., Hudon, M. E., Tomanek, A., Frayne, R. & Buchan, A.M. (2005). Imaging of the brain in acute ischaemic stroke: comparison of computed tomography and magnetic resonance diffusion-weighted imaging. Journal of Neurology, Neurosurgery & Psychiatry, 76(11), 1528-1533. https://doi.org/10.1136/jnnp.2004.059261 DOI: https://doi.org/10.1136/jnnp.2004.059261
Biesbroek, J.M., Niesten, J.M., Dankbaar, J.W., Biessels, G.J., Velthuis, B.K., Reitsma, J.B., & Van Der Schaaf, I.C. (2013). Diagnostic accuracy of CT perfusion imaging for detecting acute ischemic stroke: a systematic review and meta-analysis. Cerebrovascular diseases, 35(6), 493-501. https://doi.org/10.1159/000350200 DOI: https://doi.org/10.1159/000350200
Bisdas, S., Donnerstag, F., Ahl, B., Bohrer, I., Weissenborn, K., & Becker, H. (2004). Comparison of perfusion computed tomography with diffusion-weighted magnetic resonance imaging in hyperacute ischemic stroke. Journal of computer assisted tomography, 28(6), 747-755. https://doi.org/10.1097/00004728-200411000-00004 DOI: https://doi.org/10.1097/00004728-200411000-00004
Brazzelli, M., Sandercock, P.A.G., Celani, M.G., Righetti, E., Chappell, F.M., Arestis, N., Wardlaw, J.M. & Deeks, J. J. (2010). MRI versus CT for detection of acute vascular lesions in patients presenting with stroke symptoms. Stroke, 41(5), e427-e428. https://doi.org/10.1161/STROKEAHA.109.568667 DOI: https://doi.org/10.1161/STROKEAHA.109.568667
Caceres, J.A., & Goldstein, J.N. (2012). Intracranial hemorrhage. Emergency medicine clinics of North America, 30(3), 771. https://doi.org/10.1016/j.emc.2012.06.003 DOI: https://doi.org/10.1016/j.emc.2012.06.003
Carpenter, C.R., Hussain, A.M., Ward, M.J. Zipfel, G.J., Fowler, S., Pines, J.M. & Sivilotti, M.L.A. (2016). Spontaneous Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis Describing the Diagnostic Accuracy of History, Physical Examination, Imaging, and Lumbar Puncture with an Exploration of Test Thresholds. Academic Emergency Medicine. 23(9), 963-1003. https://doi.org/10.1111/acem.12984 DOI: https://doi.org/10.1111/acem.12984
Chalela, J.A., Kidwell, C.S., Nentwich, L.M., Luby, M., Butman, J. A., Demchuk, A. M., Hill, M.D., Patronas, N., Latour, L. & Warach, S. (2007). Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. The Lancet, 369(9558), 293-298. https://doi.org/10.1016/S0140-6736(07)60151-2 DOI: https://doi.org/10.1016/S0140-6736(07)60151-2
Chen, C., Bivard, A., Lin, L., Levi, C. R., Spratt, N. J., & Parsons, M. W. (2019). Thresholds for infarction vary between gray matter and white matter in acute ischemic stroke: a CT perfusion study. Journal of Cerebral Blood Flow & Metabolism, 39(3), 536-546. https://doi.org/10.1177/0271678X17744453 DOI: https://doi.org/10.1177/0271678X17744453
Coutts, S.B., Modi, J., Patel, S.K., Demchuk, A.M., Goyal, M., & Hill, M. D. (2012). CT/CT angiography and MRI findings predict recurrent stroke after transient ischemic attack and minor stroke: results of the prospective CATCH study. Stroke, 43(4), 1013-1017. https://doi.org/10.1161/STROKEAHA.111.637421 DOI: https://doi.org/10.1161/STROKEAHA.111.637421
Desal, H.A., Auffray-Calvier, E., Guillon, B., Toulgoat, F., Madoz, A., Kersaint-Gilly, A.D. & Pasco-Papon, A. (2004). Emergency imaging of cerebrovascular accidents. Journal of Neuroradiology, 31(4), 327-333. https://doi.org/10.1016/S0150-9861(04)97011-3 DOI: https://doi.org/10.1016/S0150-9861(04)97011-3
Fiebach, J., Jansen, O., Schellinger, P., Knauth, M., Hartmann, M., Heiland, S., Ryssel, H., Pohlers, O., Hacke, W. & Sartor, K. (2001). Comparison of CT with diffusion-weighted MRI in patients with hyperacute stroke. Neuroradiology, 43(8), 628-632. https://doi.org/10.1007/s002340100542 DOI: https://doi.org/10.1007/s002340100542
Fiebach, J.B., Schellinger, P.D., Jansen, O., Meyer, M., Wilde, P., Bender, J., Schramm, P., Juttler, E., Oehler, J., Hartmann, M., Hahnel, S., Knauth, M., Hacke, W., & Sartor, K. (2002). CT and diffusion-weighted MR imaging in randomized order: diffusion-weighted imaging results in higher accuracy and lower interrater variability in the diagnosis of hyperacute ischemic stroke. Stroke, 33(9), 2206-2210. https://doi.org/10.1161/01.STR.0000026864.20339.CB DOI: https://doi.org/10.1161/01.STR.0000026864.20339.CB
Ferguson, K.J., Cvoro, V., MacLullich, A.M.J., Shenkin, S. D., Sandercock, P.A.G., Sakka, E., & Wardlaw, J.M. (2018). Visual rating scales of white matter hyperintensities and atrophy: comparison of computed tomography and magnetic resonance imaging. Journal of Stroke and Cerebrovascular Diseases, 27(7), 1815-1821. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.02.028 DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.02.028
GBD 2015 Disease and Injury Incidence and Prevalence Collaborators (2016). Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. The lancet, 388(10053), 1545-1602. https://doi.org/10.1016/S0140-6736(16)31678-6 DOI: https://doi.org/10.1016/S0140-6736(16)31678-6
Hacke, W., et al. (2009). Intravenous desmoteplase in patients with acute ischaemic stroke selected by MRI perfusion-diffusion weighted imaging or perfusion CT (DIAS-2): a prospective, randomised, double-blind, placebo-controlled study. The Lancet Neurology, 8(2), 141-150. https://doi.org/10.1016/S1474-4422(08)70267-9 DOI: https://doi.org/10.1016/S1474-4422(08)70267-9
Kidwell, C.S., et al. (2004). Comparison of MRI and CT for detection of acute intracerebral hemorrhage. Jama, 292(15), 1823-1830. https://doi.org/10.1001/jama.292.15.1823 DOI: https://doi.org/10.1001/jama.292.15.1823
Kidwell, C. S., & Hsia, A. W. (2006). Imaging of the brain and cerebral vasculature in patients with suspected stroke: advantages and disadvantages of CT and MRI. Current neurology and neuroscience reports, 6(1), 9-16. https://doi.org/10.1007/s11910-996-0003-1 DOI: https://doi.org/10.1007/s11910-996-0003-1
Lansberg, M.G., Albers, G.W., Beaulieu, C. & Marks, M.P. (2000). Comparison of diffusion-weighted MRI and CT in acute stroke. Neurology, 54(8), 1557-1561. https://doi.org/10.1212/WNL.54.8.1557 DOI: https://doi.org/10.1212/WNL.54.8.1557
Lövblad, K.O., & Baird, A.E. (2010). Computed tomography in acute ischemic stroke. Neuroradiology, 52(3), 175-187. https://doi.org/10.1007/s00234-009-0633-5 DOI: https://doi.org/10.1007/s00234-009-0633-5
Narayan, D., Kaul, S., Ravishankar, K., Suryaprabha, T., Bandaru, V.C.S.S., Mridula, K.R., Jabeen, S.A., Alladi, S., Meena, A.K. & Borgohain, R. (2012). Risk factors, clinical profile, and long-term outcome of 428 patients of cerebral sinus venous thrombosis: Insights from Nizam's Institute Venous Stroke Registry, Hyderabad (India). Neurology India, 60(2), 154. https://doi.org/10.4103/0028-3886.96388 DOI: https://doi.org/10.4103/0028-3886.96388
Oppenheim, C., Logak, M., Dormont, D., Lehericy, S., Manai, R., Samson, Y., Marsault, C. & Rancurel, G. (2000). Diagnosis of acute ischaemic stroke with fluid-attenuated inversion recovery and diffusion-weighted sequences. Neuroradiology, 42(8), 602-607. https://doi.org/10.1007/s002340000356 DOI: https://doi.org/10.1007/s002340000356
Schellinger, P.D., Bryan, R.N., Caplan, L.R., Detre, J.A., Edelman, R.R., Jaigobin, C., Kidwell, C.S., Mohr, J.P., Solan, M., Sorensen, A.G. & Warach, S. (2010). Evidence-based guideline: the role of diffusion and perfusion MRI for the diagnosis of acute ischemic stroke: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 75(2), 177-185. https://doi.org/10.1212/WNL.0b013e3181e7c9dd DOI: https://doi.org/10.1212/WNL.0b013e3181e7c9dd
Urbach, H., Flacke, S., Keller, E., Textor, J., Berlis, A., Hartmann, A., Reul, J., Solymosi & Schild, H. H. (2000). Detectability and detection rate of acute cerebral hemisphere infarcts on CT and diffusion-weighted MRI. Neuroradiology, 42(10), 722-727. https://doi.org/10.1007/s002340000401 DOI: https://doi.org/10.1007/s002340000401
Wardlaw, J.M., Keir, S.L., & Dennis, M.S. (2003). The impact of delays in computed tomography of the brain on the accuracy of diagnosis and subsequent management in patients with minor stroke. Journal of Neurology, Neurosurgery & Psychiatry, 74(1), 77-81. https://doi.org/10.1136/jnnp.74.1.77 DOI: https://doi.org/10.1136/jnnp.74.1.77
Wintermark, M., Meuli, R., Browaeys, P., Reichhart, M., Bogousslavsky, J., Schnyder, P. & Michel, P. (2007). Comparison of CT perfusion and angiography and MRI in selecting stroke patients for acute treatment. Neurology, 68(9), 694-697. https://doi.org/10.1212/01.wnl.0000255959.30107.08 DOI: https://doi.org/10.1212/01.wnl.0000255959.30107.08
Wycliffe, N.D., Choe, J., Holshouser, B., Oyoyo, U.E., Haacke, E.M., & Kido, D.K. (2004). Reliability in detection of hemorrhage in acute stroke by a new three‐dimensional gradient recalled echo susceptibility‐weighted imaging technique compared to computed tomography: a retrospective study. Journal of Magnetic Resonance Imaging, 20(3), 372-377. https://doi.org/10.1002/jmri.20130 DOI: https://doi.org/10.1002/jmri.20130
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