Researchers Strengthen Case for MRI as Acute Stroke Modality of the Future

January 23, 2008 Diagnostic Imaging. Researchers Strengthen Case for MRI as Acute Stroke Modality of the Future Prospective single-site study sets stroke community buzzing about performance of MR imaging versus unenhanced CT for triage of stroke type and severity Jordana Bieze Foster -------------------------------------------------------------------------------- In the weeks leading up to the 2007 International Stroke Conference, stroke imaging experts could have been preparing to debate such cutting-edge topics as whether MRI or CT is best suited for the ischemic mismatch imaging techniques that one day will routinely be used to select patients for thrombolytic therapy. But 2 weeks before the February conference, the stroke imaging community instead was buzzing about a Jan. 27 Lancet study1 that was decidedly free of bells and whistles: a 356-patient single-site prospective comparison in which conventional gradient-echo and diffusion-weighted MRI outperformed unenhanced CT for the diagnosis of patients with suspected acute stroke. Since noncontrast CT-based acute stroke diagnosis has become the norm in all but the most progressive centers, the financial and logistical barriers to augmenting or replacing frontline CT with MRI are formidable. Even so, the results of one clinical trial after another suggest the next generation of stroke therapies will almost certainly depend on penumbral imaging, for which researchers have for the most part favored perfusion-diffusion MRI techniques over CT perfusion. For physicians wary of making that philosophical leap, the results of the Lancet study, funded by the National Institute of Neurological Disorders and Stroke, may represent an important intermediate step.

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