Comprehensive CT is the most cost-effective initial imaging strategy in stroke patients
A comprehensive CT approach is the most cost-effective initial imaging strategy for guiding treatment decisions in patients with acute ischemic stroke, according to new evidence.
Stroke centers have an array of imaging options and approaches to help inform their treatment choices, including comprehensive CT and MRI, which involves performing a variety of exams upon a patient's arrival. Detailed stepwise approaches are also common and utilize a more selective imaging process.
A large team of East Coast researchers created a simulation model to compare five imaging strategies used at such centers. They found comprehensive CT (noncontrast CT, CT angiography and CT perfusion at time of presentation) to be the most cost-effective approach, yielding the best clinical outcomes, the authors explained Dec. 30 in JACR.
This knowledge is needed to keep pace with the growing number of patients undergoing life-saving mechanical thrombectomy, they added.
“The number of patients with AIS undergoing MT has grown significantly, highlighting the need for efficient and timely imaging protocols at comprehensive stroke centers—at which a full spectrum of care services to treat complex patients with stroke, including advanced imaging, neurologic, neurosurgical and neurologic intensive care services—are available,” Pina C. Sanelli, MD, MPH, vice chair of research at the Donald and Barbara Zucker School of Medicine in New York, and colleagues wrote.
For their research, Sanelli et al. developed their decision simulation model based on American Heart Association recommendations for acute ischemic stroke care, comparing five initial imaging strategies. They used parameters for patients admitted with suspected stroke in the anterior circulation with last-known-well-to-arrival time of 0 to 24 hours.
The group’s cost-effectiveness analyses found that comprehensive CT and MR (MR diffusion-weighted imaging, MR angiography and MR perfusion at the time of presentation) afforded the highest lifetime quality-adjusted life-years (4.81 and 4.82, respectively). Furthermore, stepwise CT, hybrid and advanced strategies yielded lower QALYs and higher costs compared with comprehensive CT.
A key component of comprehensive CTs’ success is the added insight of perfusion imaging prior to treatment in the first six hours after symptom onset, the researchers explained.
“The main driver of the results is the value of added information from angiography and perfusion regarding large anterior vessel occlusion and perfusion deficit status at presentation, allowing more accurate and rapid patient selection for MT, thus enabling more patients to receive potential benefits from treatment while avoiding unnecessary treatment time delays,” the authors noted.
Radiation risks from CT imaging also showed a minimal impact on clinical outcomes for patients with stroke whose average age is 70 years.
This study included models that could be deployed at comprehensive stroke centers, which retain the highest level of care certification with advanced imaging and treatment.
There’s a lot more to glean from the study published in the Journal of the American College of Radiology here.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.