Comparison of CT perfusion and angiography and MRI in selecting stroke patients for acute treatment

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Acute ischemic stroke requires timely reperfusion therapy.
• Accurate assessment of infarct core and penumbra is crucial for treatment decisions.
• Comparing advanced neuroimaging techniques is essential for clinical practice.

Purpose of the Study:

• To compare the diagnostic performance of perfusion CT/CT angiography (PCT/CTA) with MRI in acute stroke patients.
• To evaluate the agreement between PCT/CTA and MRI in determining eligibility for reperfusion therapy.
• To assess the correlation of infarct size, cortical involvement, and collateral status between the two imaging modalities.

Main Methods:

• Prospective study of 42 acute stroke patients within 3-9 hours of symptom onset.
• Sequential imaging with PCT/CTA and MRI.
• Analysis of infarct core, penumbra, infarct size, cortical involvement, and internal cerebral artery occlusion.
• Comparison of treatment decisions based on each imaging modality.

Main Results:

• Excellent correlation between PCT/CTA and MRI for infarct size, cortical involvement, and internal cerebral artery occlusion.
• Substantial correlation for the penumbra/infarct ratio.
• 14 patients identified as suitable for reperfusion therapy based on MRI findings.
• Treatment decisions were concordant in all but one case between PCT/CTA and MRI.

Conclusions:

• PCT/CTA and MRI demonstrate high concordance in evaluating acute stroke patients for reperfusion therapy.
• PCT/CTA can be a reliable alternative to MRI for guiding acute stroke treatment decisions.
• Both modalities are effective in assessing key imaging biomarkers within the early hours of stroke onset.