Prognostic Value of Adding Magnetic Resonance Imaging to Computed Tomography in Acute Ischemic Stroke

To assess if magnetic resonance imaging (MRI) provides additional benefits over computed tomography (CT) in patients with acute ischemic stroke (AIS).

We retrospectively reviewed adult AIS patients who underwent an initial CT scan and received intravenous thrombolysis using rt-PA, dividing them into two groups: MRI plus CT and CT alone. Propensity-score matching (PSM) analysis was employed to reduce confounding biases.

After PSM, two matched groups (168 pairs, n = 336 patients) were generated. There were no significant differences in the modified Rankin Scale (mRS) scores of 0-2 or 0-1 at 3 months between the two groups (both p > 0.05). Patients in the MRI plus CT group had significantly lower incidence rates of 7-day mortality (3.0% vs. 8.9%, p = 0.04), 30-day mortality (11.3% vs. 21.4%, p = 0.02), and symptomatic intracranial hemorrhage (SICH, 11.9% vs. 23.2%, p = 0.01). Multivariate logistic regression showed that the MRI plus CT-based regimen significantly reduced the risks of 7-day (OR = 0.02, 95% CI: 0.01-0.18; p < 0.01) and 30-day mortality (OR = 0.03, 95% CI: 0.01-0.13; p < 0.01), as well as SICH (OR = 0.27, 95% CI: 0.09-0.76; p = 0.01).

The addition of MRI to CT enhances prognostic value in AIS patients, as it is associated with significantly reduced risks of mortality and SICH.