Comparative Diagnostic Performance of CT and MRI in Acute Ischemic Stroke: A Retrospective Analysis From A Tertiary Care Center

Q: What are the key findings of this study?

MRI detected acute ischemic infarcts in 92% of patients compared to 66% with non-contrast CT, achieving an AUC of.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Acute ischemic stroke (n=200). Intervention: Magnetic Resonance Imaging (MRI) vs. Non-contrast Computed Tomography (CT). Primary outcome: Detection of acute ischemic infarction (p=<0.001).

Q: What does this research mean for the field?

MRI demonstrates superior diagnostic accuracy over non-contrast CT for detecting acute ischemic stroke, achieving a 92% detection rate versus 66% (AUC 0.95 vs 0.75), with marked superiority in posterior circulation infarcts. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess and compare the diagnostic proficiency of non-contrast CT and MRI in acute ischemic stroke, focusing on infarct detection, hemorrhagic transformation, and posterior circulation involvement.

Amina Iftikhar; Zeenat Adil; Abdul Majid; Ambareen Muhammad; Rida Saleem; Iftikhar Saleem

doi:10.36552/pjns.v29i3.1129

August 31, 2025Pakistan Journal Of Neurological SurgeryOpen Access

Comparative Diagnostic Performance of CT and MRI in Acute Ischemic Stroke: A Retrospective Analysis From A Tertiary Care Center

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Key result

MRI yields ~26-point higher acute infarct detection than non-contrast CT.

P<0.001
n=200

Why the study?

The comparative diagnostic proficiency of non-contrast CT and MRI in acute ischemic stroke needed assessment regarding infarct delineation, hemorrhagic conversion, and posterior circulation involvement.

Does brain MRI improve the diagnostic detection of acute ischemic infarction compared to non-contrast CT in adults presenting within 24 hours of suspected acute ischemic stroke?

Key Points

To assess and compare the diagnostic proficiency of non-contrast CT and MRI in acute ischemic stroke, focusing on infarct detection, hemorrhagic transformation, and posterior circulation involvement.
Retrospective observational study of 200 patients (mean age 60.7 ± 12.5 years; 122 males, 78 females) presenting with acute focal neurological deficits within 24 hours of onset at a tertiary center.
Patients underwent both 128-slice non-contrast CT and 1.5 Tesla MRI (DWI, ADC, FLAIR, T2, T1, and SWI) within 24 hours of symptom onset (mean onset-to-imaging time 5.4 ± 2.3 hours).
Scans were independently assessed by two consultant radiologists blinded to clinical outcomes, with discrepancies resolved by consensus.
MRI detected acute infarcts in 184 patients (92%) compared to 132 patients (66%) on CT (p < 0.001), including 60 versus 24 posterior circulation strokes (p < 0.001).
MRI demonstrated higher diagnostic accuracy than CT, with a sensitivity of 92% versus 66%, specificity of 87% versus 81%, and AUC of 0.95 versus 0.75, while also identifying significantly larger infarct volumes (p < 0.01).
Hemorrhagic transformation detection showed no statistically significant difference between modalities, identified in 49 patients (87.5%) on CT and 48 patients (85.7%) on MRI (p = 0.68).

Study Design

Type

Observational (n=200)

Blinding

Radiologists blinded to clinical outcomes and each other's interpretations

Multicenter

No

Structured PICO

Does brain MRI improve the diagnostic detection of acute ischemic infarction compared to non-contrast CT in adults presenting within 24 hours of suspected acute ischemic stroke?

P

Population

200 adults (mean age 60.7 years, 39% female) presenting with suspected acute ischemic stroke who underwent both non-contrast CT and MRI within 24 hours of symptom onset at a single tertiary care center in Pakistan.

E

Exposure

Brain Magnetic Resonance Imaging (1.5 Tesla system including DWI, ADC, FLAIR, T2, T1, and SWI sequences) performed within 24 hours of symptom onset

C

Comparator

Non-contrast cranial Computed Tomography (128-slice multidetector CT scanner, 5 mm slice thickness) performed within 24 hours of symptom onset in the same cohort

O

Outcome

Detection of acute ischemic infarction and diagnostic accuracy (sensitivity, specificity, AUC) within 24 hours of symptom onset, independently reviewed by two blinded consultant neuroradiologists using MRI-DWI as the reference standardsurrogate

Main Result

Absolute Event Rate: 92% vs 66%

p-value: p=<0.001

MRI provides superior sensitivity and overall diagnostic accuracy compared to non-contrast CT for detecting acute ischemic stroke—particularly in the posterior circulation—while CT remains reliable for rapid exclusion of hemorrhage.

Limitations

Retrospective methodology
Single-center study (solitary clinical institution)
Selection bias due to exclusion of individuals with MRI contraindications
Retrospective study design
Single-center study at a solitary clinical institution
Selection bias due to omission of patients with MRI contraindications (e.g., pacemakers, metallic implants, claustrophobia)

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Answers are grounded in this paper and cite their sources.

Implication

MRI may enhance acute infarct detection over CT; leaves open effects on management and outcomes in prospective trials.

Abstract

Objective: This study sought to assess and juxtapose the diagnostic proficiency of non-contrast CT and MRI in acute ischemic stroke, focusing on infarct delineation, hemorrhagic conversion, and posterior circulation involvement. Materials and Methods: This retrospective observational study was conducted at the Department of Radiology, Lady Reading Hospital, Peshawar. A total of 200 patients aged 18 years or older, presenting with clinical suspicion of AIS, were included. All patients underwent both non-contrast CT and MRI within 24 hours of symptom onset. Imaging was reviewed independently by two experienced neuro-radiologists. Data on infarct detection, infarct volume, posterior circulation involvement, and hemorrhagic transformation were recorded. Results: MRI detected acute infarcts in 92% of patients, significantly more than CT (66%) (p < 0.001). In posterior circulation strokes, MRI identified 60 cases versus 24 on CT (p < 0.001). Detection of hemorrhagic transformation was similar between modalities (CT: 87.5%, MRI: 85.7%; p = 0.68). MRI showed higher diagnostic accuracy with a sensitivity of 92%, specificity of 87%, and AUC of 0.95, compared to CT (sensitivity: 66%, specificity: 81%, AUC: 0.75). MRI also identified larger infarct volumes (p < 0.01). Conclusion: MRI provides superior diagnostic performance in acute ischemic stroke, especially for early and posterior circulation infarcts, while CT remains crucial for initial hemorrhage exclusion. A combined approach may enhance diagnostic accuracy and improve outcomes in stroke care.

Discussion

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Cite This Study

Iftikhar et al. (2025) conducted an observational in Acute ischemic stroke (n=200). Magnetic Resonance Imaging (MRI) vs. Non-contrast Computed Tomography (CT) was evaluated on Detection of acute ischemic infarction (p=<0.001). MRI detected acute ischemic infarcts in 92% of patients compared to 66% with non-contrast CT, achieving an AUC of.

synapsesocial.com/papers/6af539e55552f9c73d34dc5f https://doi.org/10.36552/pjns.v29i3.1129

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Comparative Diagnostic Performance of CT and MRI in Acute Ischemic Stroke: A Retrospective Analysis From A Tertiary Care Center

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Comparative Diagnostic Performance of CT and MRI in Acute Ischemic Stroke: A Retrospective Analysis From A Tertiary Care Center

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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