Background and Aims

Worldwide CT and CTA is the preferred imaging modality for acute stroke. However, MRI in acute stroke has been shown to be feasible and can even be cost-effective in developing countries such as India.

Imaging patterns can also help in the final reclassification of aetiopathogenesis and decide further medical management. We are MRI based tertiary stroke center performing non-contrast MRI in the emergency for treatment decisions regarding acute revascularisation and selected patients undergo modified CTA within 24-48 hours for further management such as secondary prevention.

We aim to re-classify stroke (updated ASCOD using imaging) based on MRI and modified CTA if available (I-ASCOD) in a dataset of ~1000 stroke codes.

Methods

In this study, we aim to describe our imaging experience of MRI based acute stroke workup over the last 3 years (2019 - 2022) and their imaging patterns based on MRI and correlate it with clinical details, labs, other available imaging (including modified CTA) and ancillary details at the time of discharge. Updated imaging-based ASCO-D phenotyping will be done.

Results

UNMASK-I: Published in WSC 2021, establishing the feasibility of MRI in acute stroke without significant delay compared to the currently recommended guidelines.

UNMASK- II Results pending

Conclusions

MRI can help in acute decision making as well as plan further management in the vast majority of stroke patients based on radiological patterns. The majority of centers around the world use combination of CTA and MRI during the hospitalization of acute stroke patients and updated I-ASCOD phenotyping can help overcome a few current shortcomings in stroke classification.