Comparison of magnetic resonance imaging versus computed tomography-based thrombolysis treatment in patients with acute ischemic stroke

Purpose To evaluate the efficacy and safety of magnetic resonance imaging (MRI)-based comparing with computed tomography (CT)-based selection for intravenous thrombolysis in patients with acute ischemic stroke (AIS). Methods Totally 462 consecutive AIS patients treated with intravenous thrombolysis within a 4.5 h window from Jan. 2016 to Dec. 2019 were enrolled. The primary endpoint was the good functional outcome defined by a modified Rankin Scale (mRS) of 0-2 at 3 months. Secondary outcomes include the excellent functional outcome defined by a mRS of 0-1 at 3 months, occurrences of symptomatic intracranial hemorrhage (SICH), 7-day mortality, and 3-month mortality. Results Overall 172 patients received MRI and 290 received CT before they were treated with thrombolysis. The difference in the good or excellent functional outcome was not statistically significant between MRI and CT groups (both P > 0.05). The incidences of 7-day mortality (3.5% vs. 8.6%, P < 0.01), 30-day mortality (12.8% vs. 21.0%, P = 0.03), and SICH (12.2% vs. 20.3%, P < 0.01) were obviously lower for MRI-based regimen compared with CT-based regimen. Multivariate logistic regression indicated that MRI-based regimen was significantly associated with a lower risk of 7-day mortality (OR = 0.72, 95% CI: 0.53-0.91; P < 0.01), 30-day mortality (OR = 0.58, 95% CI: 0.47-0.73; P < 0.01), and SICH (OR = 0.44, 95% CI: 0.20-0.65; P < 0.01) after controlling for potential confounding factors. Conclusion Despite MRI-based thrombolysis was not demonstrated to be associated with the good functional outcome, it significantly reduced risks of mortality and SICH in patients with AIS compared with CT-based thrombolysis.