Ultrafast MRI for acute stroke assessment: a comparative analysis with conventional protocol in motion and stable patients

MRI is a fundamental imaging modality in stroke patients, where the timing from the onset of symptoms to the start of treatment makes fast MRI protocols crucial to eliminate prolonged duration and allow for rapid treatment, thereby decreasing patients’ sequelae.

This study aimed to evaluate the comparative performance and agreement of an ultrafast brain magnetic resonance imaging protocol with a standard MRI stroke protocol. It focused on motion-prone and stable patients, prioritizing protocol agreement over diagnostic accuracy, while achieving reduced scan times.

A total of 50 patients were finally enrolled in our prospective cross-sectional study. The mean age was 58.1 ± 17.1. The age range was between 18 and 81 years. The gender distribution revealed a higher percentage of males (58%) compared to females (42%). Regarding the investigation context, most participants were stable during imaging (86%), while a smaller proportion (14%) showed unstable motion during imaging. Patients included were referred with features of stroke on clinical examination. They underwent MR brain scans using both conventional and UF sequences in a single study.

Both ultrafast protocols showed exceptional diagnostic performance, with a sensitivity and specificity of 100% and 94.44%, respectively, and a near-perfect Kappa value of 0.956, % to the conventional protocol. Among the stable group, both ultrafast protocols achieved perfect diagnostic performance, with 100% sensitivity, specificity, and Kappa values of 1.00, indicating complete agreement with the conventional MRI. Among the motion groups, both UF protocols demonstrated good performance, with 85.7% accuracy in identifying abnormalities, although this still represents a slight reduction compared to their performance in stable groups.

Ultrafast protocols demonstrated sufficient image quality for diagnostic use, with their primary advantage being a shorter scan time compared to routine brain MRI. It also offers additional potential benefits, such as lower rates of scanning failure, reduced need for sedation, and lower anxiety related to MRI examinations.