Comparison of the Effectiveness of Computed Tomography and Magnetic Resonance Imaging Techniques in Patient Groups Aged under and over 65 Years and Diagnosed with Ischemic Stroke in the Emergency Department

Abstract

Objectives: Stroke is a condition with high morbidity and mortality. This study aims to investigate whether the effectiveness of Computed Tomography (CT) and diffusion-weighted Magnetic Resonance Imaging (MRI), the techniques that have a significant place in the diagnosis of ischemic stroke, the most common form of stroke, are affected by the physiological changes of advanced age. Methods: A total of 436 patients were included in the study. The study population was divided into two groups depending on age: those above 65 and those under 65. Medical files, both the emergency department and clinical ward files, of the patients who were admitted to the emergency department in nine months and admitted to the neurology clinic with the diagnosis of ischemic stroke were retrospectively analyzed. The time from admission to imaging was determined depending on patient files and the Hospital Management Information System (HBYS). The CT and MRI reports interpreted by radiologists were also reviewed. While recording the data, the presence of a lesion, its direction, and localization were also noted. Results: CT positivity was 21.3%, and the positivity of diffusion-weighted imaging was 82.1% in the study population. The time was shorter in the group of patients with positive CT results than in the group with negative CT results. In subjects under 65, the time between onset and imaging was shorter in the group with positive CT results than in the group with negative CT results. In subjects over 65, the time with positive CT results was not different from the group with negative CT results. It was determined that the mean time was shorter in the group with positive MRI results than in the group with negative results. In both the groups under the age of 65 and over the age of 65, the time interval was shorter in the patients with positive MRI results compared to those with negative MRI results. Conclusions: Regardless of the positivity or negativity of CT and MRI results, the mean time from symptom onset to imaging was shorter in the group under 65 years of age compared to the group over 65 years. Aging prolongs the time to admission and the neuroradiological response of geriatric patients.

Keywords

• Emergency department
• stroke
• geriatrics
• penumbra

References

1. Feigin VL, Brainin M, Norrving B, Martins S, Sacco RL, Hacke W, et al. International journal of stroke: official journal of the International Stroke Society. 2022;17(1):18-29
2. Rosamond W, Flegal K, Friday G, Furie K, Go A, Greenlund K, et al. Circulation. 2007;115(5): e69-171.
3. Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, et al. Circulation. 2022;145(8): e153-e639.
4. Von Kummer R. Imaging of stroke pathology without predefined gold standard. Cerebrovascular diseases (Basel, Switzerland). 2002;14(3-4):270.
5. Kang DW, Sohn SI, Hong KS, Yu KH, Hwang YH, Han MK, et al. Reperfusion therapy in unclear-onset stroke based on MRI evaluation (RESTORE): a prospective multicenter study. Stroke. 2012;43(12):3278-83.
6. Petty GW, Brown RD, Jr., Whisnant JP, Sicks JD, O’Fallon WM, Wiebers DO. Ischemic stroke subtypes: a population-based study of incidence and risk factors. Stroke. 1999;30(12):2513-6.
7. İnal T, Armağan E, Kose A, Köksal Ö, Özdemir F, Akkose s, et al. Evaluation of Retrospective Clinical and İmaging Characteristics in 65 years and older patients diagnosed with stroke in emergency department. Turkish Journal of Geriatrics 2013;16(4).
8. Kıyan S, Özsaraç M, Ersel M, Aksay E, Yürüktümen A, Musalar E, et al. Acil servise başvuran akut iskemik inmeli 124 hastanın geriye yönelik bir yıllık incelenmesi. Akademik Acil Tıp Dergisi. 2009;8(3):15-20.

9. Schroeder EB, Rosamond WD, Morris DL, Evenson KR, Hinn AR. Determinants of use of emergency medical services in a population with stroke symptoms: the Second Delay in Accessing Stroke Healthcare (DASH II) Study. Stroke. 2000;31(11):2591-6.
10. Taşdemir N, Tamam Y, Tabak V, Dedeoğlu A. Akut iskemik strokta beyin tomografisi erken bulgularının değerlendirilmesi. Dicle Tıp Dergisi. 2008;35(1):50-7.
11. Osborn AG. Diagnostic neuroradiology. Mosby. 1994.
12. Sorensen AG, Wu O, Copen WA, Davis TL, Gonzalez RG, Koroshetz WJ, et al. Human acute cerebral ischemia: detection of changes in water diffusion anisotropy by using MR imaging. Radiology. 1999;212(3):785-92.
13. Simonsen CZ, Madsen MH, Schmitz ML, Mikkelsen IK, Fisher M, Andersen G. Sensitivity of diffusion- and perfusion-weighted imaging for diagnosing acute ischemic stroke is 97.5%. Stroke. 2015;46(1):98-101.
14. Petkova M, Rodrigo S, Lamy C, Oppenheim G, Touzé E, Mas JL, et al. MR imaging helps predict time from symptom onset in patients with acute stroke: implications for patients with unknown onset time. Radiology. 2010;257(3):782-92.
15. Brazzelli M, Sandercock PA, Chappell FM, Celani MG, Righetti E, Arestis N, et al. Magnetic resonance imaging versus computed tomography for detection of acute vascular lesions in patients presenting with stroke symptoms. The Cochrane database of systematic reviews. 2009(4): Cd007424.