Download PDF
CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2022; 06(02): 083-089
DOI: 10.1055/s-0041-1736085
Original Article

Predicting Imaging Outcomes in Acute Stroke Therapy—Comparison of Magnetic Resonance Imaging and Computed Tomography

Deepa Krishnaswamy
1   Department of Radio-diagnosis, Ahalia Diabetes Hospital, Palakkad, Kerala, India
,
Seetharaman Cannane
2   Department of Radiology, KMCH institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
,
Meena Nedunchelian
3   Ganga Hospital, Coimbatore, Tamil Nadu, India
,
Shriram Varadharajan
4   Department of Radiodiagnosis, Kovai Medical Center and Hospitals, Coimbatore, Tamil Nadu, India
,
Santhosh Poyyamoli
4   Department of Radiodiagnosis, Kovai Medical Center and Hospitals, Coimbatore, Tamil Nadu, India
,
Pankaj Mehta
4   Department of Radiodiagnosis, Kovai Medical Center and Hospitals, Coimbatore, Tamil Nadu, India
,
Mathew Cherian
4   Department of Radiodiagnosis, Kovai Medical Center and Hospitals, Coimbatore, Tamil Nadu, India
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Background Imaging of acute stroke patients in emergency settings is critical for treatment decisions. Most commonly, CT with CTA is used worldwide for acute stroke. However, MRI may be advantageous in certain settings. With advancements in endovascular clot retrieval techniques, there is a need to identify and use the best possible imaging for the diagnosis and outcome prediction of hyperacute stroke.

Methods This mixed retrospective and prospective observational study was conducted over 2 years in patients who underwent reperfusion therapies. Patients were included in this study if they had a baseline as well as follow-up noncontrast CT and diffusion-weighted imaging (DWI) MRI. We compared them for estimating final infarct size and outcomes after reperfusion therapy.

Results A total of 86 patients were included in the study. Baseline DWI found new infarcts in 33 patients compared to baseline CT. Sensitivity and specificity of CT and DWI in predicting the final infarct size was 75.3% and 76.9% and 97.2% and 92.3%, respectively. A positive correlation of 51.2% and 84.4% was noted between b-CT Alberta stroke programme early CT score (ASPECTS) and b-DWI with 72 hours DWI ASPECTS, respectively (p < 0.001). The positive predictive value of CT was 94.8% and DWI was 98.6%. None of the patients had reversible hyperintensities in the follow-up DWI.

Conclusion MRI is more sensitive and specific than noncontrast CT in predicting final infarct volume. It predicts final outcomes better and could be an alternative if available in acute stroke settings.

Keywords

Stroke - reperfusion - CT - MRI - predictive value


Publication History

Article published online:
05 October 2021

© 2021. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Kamalakannan S, Gudlavalleti ASV, Gudlavalleti VSM, Goenka S, Kuper H. Incidence & prevalence of stroke in India: a systematic review. Indian J Med Res 2017; 146 (02) 175-185
    CrossrefPubMedGoogle Scholar
  • 2 Powers WJ, Rabinstein AA, Ackerson T. et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2019; 50 (12) e344-e418
    CrossrefPubMedGoogle Scholar
  • 3 Nogueira RG, Jadhav AP, Haussen DC. et al. DAWN Trial Investigators. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018; 378 (01) 11-21
    CrossrefPubMedGoogle Scholar
  • 4 Albers GW, Marks MP, Kemp S. et al. DEFUSE 3 Investigators. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 2018; 378 (08) 708-718
    CrossrefPubMedGoogle Scholar
  • 5 Kang D-W, Sohn S-I, Hong K-S. et al. Reperfusion therapy in unclear-onset stroke based on MRI evaluation (RESTORE): a prospective multicenter study. Stroke 2012; 43 (12) 3278-3283
    CrossrefPubMedGoogle Scholar
  • 6 Provost C, Soudant M, Legrand L. et al. Magnetic resonance imaging or computed tomography before treatment in acute ischemic stroke. Stroke 2019; 50 (03) 659-664
    CrossrefPubMedGoogle Scholar
  • 7 Fugate JE, Klunder AM, Kallmes DF. What is meant by “TICI”?. AJNR Am J Neuroradiol 2013; 34 (09) 1792-1797
    CrossrefPubMedGoogle Scholar
  • 8 Rudilosso S, Urra X, Amaro S. et al. Timing and relevance of clinical improvement after mechanical thrombectomy in patients with acute ischemic stroke. Stroke 2019; 50 (06) 1467-1472
    CrossrefPubMedGoogle Scholar
  • 9 Hsia AW, Luby ML, Leigh R. et al. Prevalence of imaging targets in patients with minor stroke selected for IV tPA treatment using mri: the treatment of minor stroke with MRI evaluation study (TIMES. Neurology 2021; 96 (09) e1301-e1311
    CrossrefPubMedGoogle Scholar
  • 10 Nezu T, Koga M, Nakagawara J. et al. Early ischemic change on CT versus diffusion-weighted imaging for patients with stroke receiving intravenous recombinant tissue-type plasminogen activator therapy: stroke acute management with urgent risk-factor assessment and improvement (SAMURAI) rt-PA registry. Stroke 2011; 42 (08) 2196-2200
    CrossrefPubMedGoogle Scholar
  • 11 Barber PA, Hill MD, Eliasziw M. et al. ASPECTS Study Group. Imaging of the brain in acute ischaemic stroke: comparison of computed tomography and magnetic resonance diffusion-weighted imaging. J Neurol Neurosurg Psychiatry 2005; 76 (11) 1528-1533
    CrossrefPubMedGoogle Scholar
  • 12 McTaggart RA, Jovin TG, Lansberg MG. et al. DEFUSE 2 Investigators. Alberta stroke program early computed tomographic scoring performance in a series of patients undergoing computed tomography and MRI: reader agreement, modality agreement, and outcome prediction. Stroke 2015; 46 (02) 407-412
    CrossrefPubMedGoogle Scholar
  • 13 Mitomi M, Kimura K, Aoki J, Iguchi Y. Comparison of CT and DWI findings in ischemic stroke patients within 3 hours of onset. J Stroke Cerebrovasc Dis 2014; 23 (01) 37-42
    CrossrefPubMedGoogle Scholar
  • 14 Kawano H, Hirano T, Nakajima M, Inatomi Y, Yonehara T. Diffusion-weighted magnetic resonance imaging may underestimate acute ischemic lesions: cautions on neglecting a computed tomography-diffusion-weighted imaging discrepancy. Stroke 2013; 44 (04) 1056-1061
    CrossrefPubMedGoogle Scholar
  • 15 Chemmanam T, Campbell BCV, Christensen S, Nagakane Y, Desmond PM, Bladin CF. et al. Ischemic diffusion lesion reversal is uncommon and rarely alters perfusion-diffusion mismatch. Neurology 2010; 75 (12) 1040-1047
    CrossrefPubMedGoogle Scholar
  • 16 Nagaraja N, Forder JR, Warach S, Merino JG. Reversible diffusion-weighted imaging lesions in acute ischemic stroke: A systematic review. Neurology 2020; 31 94 (13) 571-587
    CrossrefPubMedGoogle Scholar
  • 17 Asdaghi N, Campbell BCV, Butcher KS. et al. DWI Reversal Is Associated with Small Infarct Volume in Patients with TIA and Minor Stroke. Am J Neuroradiol 2014; 35 (04) 660-666
    CrossrefPubMedGoogle Scholar
  • 18 Lövblad KO, Pereira VM. MRI of Acute Stroke: What Went Wrong?. AJNR Am J Neuroradiol 2015; 36 (11) 1996-1997
    CrossrefPubMedGoogle Scholar