ArticleJournal of the American College of Radiology : JACR2021
Cost-Effectiveness Study of Initial Imaging Selection in Acute Ischemic Stroke Care.
Article in Journal of the American College of Radiology : JACR, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
27 citing papers in PubMed, 1 synthesis or guideline pooled it.
- CT Perfusion vs Noncontrast CT for Late Window Stroke Thrombectomy: A Systematic Review and Meta-analysis.Neurology · 2023Pooled it
- Timely access to computed tomography and magnetic resonance imaging in acute critical conditions: clinical and health system outcomes. A scoping review.Emergency radiology · 2026Article
- Clinical and Neuroimaging Predictors of Posterior Circulation Stroke: A Retrospective Analysis of In-Hospital Features.Brain sciences · 2026Article
- Comparative cost-effectiveness of cross-sectional imaging strategies in the diagnosis of intervertebral disc extrusion in dogs: a United Kingdom-based decision-analytic study.Journal of veterinary internal medicine · 2026Article
- Recent Advances in Mitochondria-Targeted Delivery Strategies for Ischemic Stroke Therapy.International journal of nanomedicine · 2026Review
- Stroke Action Plan for Europe 2018-2030 (SAP-E): mid-term review and update.European stroke journal · 2026Review
- The impracticality of radiomics research in acute ischemic stroke: from the perspective of primary healthcare institutions.Frontiers in neurology · 2025Review
- Do Deep Learning Algorithms Accurately Segment Intracerebral Hemorrhages on Noncontrast Computed Tomography? A Systematic Review and Meta-Analysis.Stroke (Hoboken, N.J.) · 2024Article
- Cost-effectiveness of CT perfusion for the detection of large vessel occlusion acute ischemic stroke followed by endovascular treatment: a model-based health economic evaluation study.European radiology · 2024Article
- Outcome prediction value of critical area perfusion score for acute basilar artery occlusion.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2023Article
- Safety and Feasibility of an Emergency Department-to-Outpatient Pathway for Patients With TIA and Nondisabling Stroke.Neurology. Clinical practice · 2023Article
- Direct cost analysis of rapid MRI in the emergency department evaluation of patients suspected of having acute ischemic stroke*.The neuroradiology journal · 2023Article
- Article
- Endovascular Thrombectomy for Acute Basilar Artery Occlusion: Latest Findings and Critical Thinking on Future Study Design.Translational stroke research · 2022Review
- Article
- Comparison of Outcomes of Ischemic Stroke Initially Imaged With Cranial Computed Tomography Alone vs Computed Tomography Plus Magnetic Resonance Imaging.JAMA network open · 2022Article
- Updated Trends, Disparities, and Clinical Impact of Neuroimaging Utilization in Ischemic Stroke in the Medicare Population: 2012 to 2019.Journal of the American College of Radiology : JACR · 2022Article
- Potential of Stroke Imaging Using a New Prototype of Low-Field MRI: A Prospective Direct 0.55 T/1.5 T Scanner Comparison.Journal of clinical medicine · 2022Article
- Applying Machine Learning to Carotid Sonographic Features for Recurrent Stroke in Patients With Acute Stroke.Frontiers in cardiovascular medicine · 2022Article
- Correlation between the CT Perfusion Parameter Values and Response to Recanalization in Patients with Acute Ischemic Stroke.Journal of neuroendovascular therapy · 2022Article
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Authors and funding
8 authors.
Funding
Abstract
purposeNational guidelines recommend prompt identification of candidates for acute ischemic stroke (AIS) treatment, requiring timely neuroimaging with CT and/or MRI. CT is often preferred because of its widespread availability and rapid acquisition. Despite higher diagnostic accuracy of MRI, it commonly involves complex workflows that could potentially cause treatment time delays. The purpose of this study was to analyze the impact on outcomes of imaging utilization before treatment decisions at comprehensive stroke centers for patients presenting with suspected AIS in the anterior circulation with last-known-well-to-arrival time 0 to 24 hours.
methodsA decision simulation model based on the American Heart Association's recommendations for AIS care pathways was developed from a health care perspective to compare initial imaging strategies: (1) stepwise-CT: noncontrast CT (NCCT) at the time of presentation, with CT angiography (CTA) ± CT perfusion (CTP) only in select patients (initial imaging to exclude hemorrhage and extensive ischemia) for mechanical thrombectomy (MT) evaluation; (2) stepwise-hybrid: NCCT at the time of presentation, with MR angiography (MRA) ± MR perfusion (MRP) only for MT evaluation; (3) stepwise-advanced: NCCT + CTA at presentation, with MR diffusion-weighted imaging (MR DWI) + MRP only for MT evaluation; (4) comprehensive-CT: NCCT + CTA + CTP at the time of presentation; and (5) comprehensive-MR: MR DWI + MRA + MRP at the time of presentation. Model parameters were defined using evidence-based data. Cost-effectiveness and sensitivity analyses were performed.
resultsThe cost-effectiveness analyses revealed that comprehensive-CT and comprehensive-MR yield the highest lifetime quality-adjusted life-years (QALYs) (4.81 and 4.82, respectively). However, the incremental cost-effectiveness ratio of comprehensive-MR is $233,000/QALY compared with comprehensive-CT. Stepwise-CT, stepwise-hybrid, and stepwise-advanced strategies are dominated, yielding lower QALYs and higher costs compared with comprehensive-CT.
conclusionsPerforming comprehensive-CT at presentation is the most cost-effective initial imaging strategy at comprehensive stroke centers.
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