MRI versus CT before endovascular thrombectomy in the early time window: A systematic review and meta-analysis - 29/10/25
, Adnan Mujanovic c, d, 1, Yao Christian Hugues Dokponou e, Corentin Provost f, g, Marco Pasi b, h, Hocine Redjem i, Mikael Mazighi i, Catherine Oppenheim f, g, Urs Fischer c, d, j, Thomas R Meinel c, d, Johannes Kaesmacher c, d, Grégoire Boulouis a, b, l, Fouzi Bala a, k, l, ⁎ Graphical abstract |
Highlights |
• | MRI was associated with lower mortality at 90 days despite longer time intervals between hospital arrival and IVT initiation compared to CT scan. |
• | SICH and successful reperfusion were similar between both imaging paradigms (CT vs MRI). |
• | MRI before EVT is a reasonable alternative to CT scan without significant delays from door to puncture time. |
• | No association between functional outcomes at 90 days and the imaging modality used before EVT when adjusted estimates were pooled. |
Abstract |
Background |
Selection of acute stroke patients for endovascular thrombectomy (EVT) within 6 h from symptom onset can be done using MRI or CT. However, association of either imaging modality with better clinical outcomes or shorter workflow times is still not fully understood.
Methods |
We searched Medline and Ovid-Embase for studies comparing outcomes and workflow metrics between patients selected for EVT using CT or MRI from inception to November 30, 2024. The primary outcome was the association of imaging modality with functional independence (modified Rankin Scale score, 0–2) at 90-days and workflow metrics. Pooled odds ratios with 95% CIs were calculated using a random-effects model.
Results |
Nine studies with 11,202 patients (3018 with MRI vs 8184 with CT) were analysed. Patients selected with MRI had similar odds of 90-day mRS 0–2 (adjusted odds ratio [aOR] 1.1195% CI 0.84–1.47) and lower mortality (aOR 0.6695% CI 0.57–0.76) compared to those selected with CT. Door-to-imaging time (mean difference [MD] 11.2 min 95% CI 4.8 to 18.4) and door-to-intravenous thrombolysis initiation time (MD 10.1 min 95% CI 4.9 to 15.2) were longer in patients selected with MRI. However, door-to-arterial puncture time was similar between both groups (MD 6.8 min 95% CI -4.6 to 18.1).
Conclusion |
In stroke patients undergoing EVT within 6 h from symptom onset, MRI before EVT could be a feasible alternative to CT without significant delays from door to puncture time. Randomized trials are needed before these findings can be generalized.
Le texte complet de cet article est disponible en PDF.Keywords : Stroke, Triage, Computed tomography, Magnetic resonance imaging, Endovascular treatment
Abbreviations : EVT, IVT, SICH, MT
Plan
Vol 52 - N° 6
Article 101384- novembre 2025 Retour au numéro
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