Magnetic resonance imaging vs computed tomography for baseline imaging evaluation in acute basilar artery occlusion.
Feiyang Gao, Thanh N Nguyen, Anmo Wang et al.
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In 30 seconds
This post hoc analysis of the ATTENTION trial compared baseline MRI with CT for patient selection in acute basilar-artery occlusion. Among 340 patients (277 assessed with CT and 63 with MRI), imaging modality was not significantly associated with functional outcome at 90 days, defined as mRS 0–3 (OR 0.99, 95% CI 0.50-1.95; P = 0.976). The finding was consistent across treatment subgroups and time windows. MRI was also not associated with significant delays in randomization or arterial puncture compared with CT.
Key findings
- Baseline imaging modality was not significantly associated with 90-day mRS 0–3 (OR 0.99, 95% CI 0.50-1.95; P = 0.976).
- MRI versus CT showed no significant difference in time from onset to randomization (MD 5.23 min; P = 0.843) or time to puncture (MD 13.16 min; P = 0.701).
- The association between imaging modality and outcomes was consistent across endovascular treatment and best medical management subgroups, and across time windows.
Why it matters
For acute basilar-artery occlusion, imaging choice is part of rapid treatment selection. These findings provide no evidence that MRI improves the measured clinical outcome over CT, while also showing no significant workflow delay associated with MRI in this analysis. The results help frame modality choice without establishing that the approaches are interchangeable in every clinical setting.
What to keep in mind
This was a post hoc analysis, and the MRI group was smaller than the CT group (63 versus 277 patients); the findings do not establish equivalence between modalities.