MR Imaging versus Noncontrast CT for Selecting Patients with Acute Ischemic Stroke of Large Vessel Occlusion for Endovascular Thrombectomy: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
ABSTRACT BACKGROUND: Neuroimaging in the acute phases after the onset of the stroke symptoms is necessary to determine large vessel occlusion presence as well as the extent of the ischemic insult before deeming eligibility for endovascular thrombectomy (EVT). PURPOSE: To evaluate the clinical outcomes in acute ischemic stroke patients selected for EVT based on initial imaging; non-contrast computed tomography (NCCT) compared to those selected using magnetic resonance imaging (MRI). DATA SOURCES: PubMed, Embase, Scopus, and Web of Science were searched from inception to August, 2024. STUDY SELECTION: We included observational studies comparing functional independence (mRS 0-2), successful reperfusion (TICI 2b-3), symptomatic intracerebral hemorrhage (sICH) or mortality in patients selected for EVT using NCCT±CT angiography versus MRI ±MR angiography. We excluded studies that used perfusion imaging in their patient selection for EVT. DATA ANALYSIS: Data were pooled using random-effects model, and heterogeneity was assessed using I2 statistics. A subgroup analysis was performed to determine the effect of treatment window (<6h vs >6h from last known well). The quality of eligible studies was assessed by using Newcastle Ottawa Scale. DATA SYNTHESIS: Seven studies (n=3,940 patients) met the inclusion criteria. Two studies had low risk of bias and others had some concerns. Patients with MRI selection showed better chances of functional independence (Odds ratio (OR), 1.85 [95% CI, 1.28-2.67]; p<0.01, I2=45%), lower rates of sICH (OR 0.59, 95% CI 0.39–0.89; p=0.01, I2=0%), reduced 90 days mortality (OR 0.63, 95% CI 0.51–0.78; p<0.01, I2=0%) and no difference in successful reperfusion (OR 0.99, 95% CI 0.62–1.58; p=0.95, I2=0%) compared to NCCT in patients treated within 6 hours of stroke onset. There were no significant differences in any endpoints between MRI and NCCT for patients treated beyond 6 hours. LIMITATIONS: Our meta-analysis comprised only observational studies, with different populations and imaging protocols limiting the strength of the conclusions. CONCLUSIONS: Within the crucial <6-hour window, MRI9s superior patient selection justifies its use despite longer acquisition times. Beyond 6 hours, the focus should shift to rapid EVT access rather than imaging modality choice, as the benefits of MRI diminish. ABBREVIATIONS: EVT = Endovascular Thrombectomy; IVT = Intravenous Thrombolysis; AIS-LVO = Acute Ischemic Stroke-Large Vessel Occlusion
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.025 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.033 |
| Bibliometrics | 0.005 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".