A Critical Review: Comparing MRI and CT Scans for Stroke Imaging

This literature review critically analyzes the comparison between MRI and CT scans for stroke imaging and diagnosis. It highlights the advantages and disadvantages of each method, based on a review of scholarly articles. CT scans are faster and less expensive, providing detailed but non-contrast images, but they involve radiation exposure. MRI, on the other hand, offers clearer, contrasted images using magnetic fields but is more expensive and time-consuming. The review evaluates the importance of this comparison for education and healthcare management, aiming to inform both professionals and the public about the best practices in stroke diagnosis. This analysis will be beneficial for the person as well as for the health care professional, as they can manage the diagnosis of lethal disease faster and in easy way.

Running head: MRI VS CT SCAN TEST FOR STROKE IMAGING
MRI VS CT SCAN TEST FOR STROKE IMAGING
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MRI VS CT SCAN TEST FOR STROKE IMAGING
Executive summary
The primary aim of the study is to critically analyze the comparison between MRI and CT-scan
for imaging and diagnosis of stroke in patients. Critically reviewed article has been taken in
order to know the basic characteristic of the test. Through the analysis, theme has been
highlighted in the project that shows the advantageous and disadvantages of MRI and CT scan.
The thematic analysis has been done by critically reviewing the work of various author basic
search strategy. On the examination of CT scan, its various uses have been discussed. CT scan
gives faster result, less expensive and give detail picture but non-contrast in nature. However, CT
scan has various limitations also. They are invasive and cause various skin disease and cancer.
They use X-ray for the detection of stoke. MRI test uses non-invasive method of imaging the
stroke which employs the use magnetic field. They give clearer image of the stroke and the
picture is contrasted in nature. However, MRI is very expensive test and not affordable by many
people. MRI test is also not feasible as it takes long time to get the outcome of the disease. The
project has explained the various effect of use of CT scan and MRI in various disease detection.
Comparative analysis is done in order to know which test is better for imaging stroke. This
analysis will be beneficial for the person as well as for the health care professional, as they can
manage the diagnosis of lethal disease faster and in easy way.
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MRI VS CT SCAN TEST FOR STROKE IMAGING
Table of Contents
Introduction......................................................................................................................................4
Background..................................................................................................................................4
Rationale......................................................................................................................................5
Research objective.......................................................................................................................6
Research aim................................................................................................................................6
Search strategy.................................................................................................................................7
Literature review..............................................................................................................................9
Advantageous of CT-scan............................................................................................................9
Disadvantageous of CT-scan.....................................................................................................13
Advantageous of MRI................................................................................................................14
Disadvantageous of MRI...........................................................................................................19
References......................................................................................................................................22
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List of abbreviation
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MRI VS CT SCAN TEST FOR STROKE IMAGING
Introduction
The aim of the project is to critically analyses the literature review of MRI and CT scan
test as the mean of diagnosis of stroke. The project highlights the major disadvantages and
advantages of both imaging test by critically examining the literature. Basic search strategy has
been employed in order to find the result. The paper examines the comparative analysis of MRI
and CT scan test, in order to know the benefits of these in health sector.
Background
Stroke or cerebrovascular disease signifies the major cause of global high mortality rate,
an estimated 6 million deaths happening annually. It is the second leading cause of the high
mortality rate in all income group globally (McAloon et al. 2016). Stroke is known to be two
types; ischemic and hemorrhagic (Barrington, Lemarchand and Allan 2017). Looking into the
definition of cause of Ischemic stroke, it is triggered by the inefficient flow of blood in the brain,
which generally happens due to blockage or any blood clot. Hemorrhage is describing as loss of
internal blood. Ischemic stroke is most common accounting 85% of all stroke death (Pascotini et
al. 2018). Morbidity of such strokes is severe and extremely dependent upon diagnosis and
timely treatment. For appropriate diagnosis, a number of clinical tests are developed to aid in the
determination of the presence of any stroke in the human body. Although, these clinical test help
to diagnose the initial acute neurological disorder, they fail to provide a specific and sensitive
imaging test. Earlier no diagnosis had been developed that can differentiate between a
Hemorrhage and Ischemic stroke. With advancement in technology, an initial step has been
taken to manage the suspected stroke inpatient, through imaging examination. The examinations
included Computed tomography CT scan. It is a specialized test the used X-ray for imaging brain
and detecting early blockage as well other pathologies that tend to resemble strokes like migraine
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and spinal stroke (Vanier and Caplan2017). However, ischemia also has an arteriovenous
malfunction, and this calls for a distinction between the arterial occlusion, venous occlusion and
cause of ischemia. The treatment of these type of occlusion requires early diagnosis. For this
MRI known as magnetic resonance imaging was developed which was more sensitive than CT-
scan and can particular in distinguishing both stoke imitators and chronic ischemia. MRI is the
technology that employs the use of radio waves instead of X-ray to produce clear and contrast
picture of organs, neurons, bones or any other internal body structure (Westbrook and Talbot
2018). MRI can identify the cortical pattern of stroke, by lining up hydrogen atom in a person's
body and creating a magnetic field (Bivard et al. 2018). This help in the detection of other
pathologies that resemble stroke. In study, it has been shown that stroke was
spottedcorrectly83% of the time by MRI use as compared to 26% of the time by the CT scan test.
Rationale
The importance of proper imaging for the diagnosis of stroke is the primary step for the
initiation of necessary treatment. With the rise in technology, two most vital test has been
popularized are CT scan and MRI. CT scan is broadly used than MRI as it is less expensive, non-
invasive and provide faster imaging of tissue and internal organ. However, MRI gives detailed
and depth information at the tissue level and does not use X-ray. Both of these tests is
contradicting in nature and involves both risk and benefit (Irshad et al. 2018). The primary issue
of today's health care sector is to determine which method is best for the patient diagnosis for
stroke.This is an issue as because health care professional often goesfor CT scan as it is less
expensive, but sometimes it fails to give an accurate result, the doctor then conducts MRI test for
detail information. This involves more cost and late diagnosis, thus late treatment (Frye et al.
2015). This has been the major issue of today health care sector, today’s doctors are directly
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going for MRI test in cases where it does not require, hence, making expensive and non-
affordable for many patients. The principal rationale for the research project that distinguishes
the imaging tests CT scan and MRI is to identify its potential uses in early diagnosis and
treatment. It will be necessary for the people as they will getcorrectly diagnosedand can proceed
with the procedure. For the medical students and health care staff, it is essential to know which
test will be more beneficial. There is the need for them to see the theory of each analysis and
bring this in practice for managing of lethal disease.
Research objective
The primary aim of the study is to critically analyses the comparison between MRI and
CT-scan for imaging and diagnosis of stroke in patients.
Research aim
The major objectives of the study are:
1. To determine the advantageous and disadvantageous of CT-scan
2. To identify the advantageous and disadvantageous of MRI.
3. To critically analyses the comparison between CT scan and MRI.
4. To evaluate the importance of comparison for the purpose of education and health care
management.
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Search strategy
The primary purpose of conducting a literature review is to provide an exhaustive and
detailed information on the research phenomenon being investigated, by undertaking a
theoretical and structural review of already published scholarly pieces of evidences. Literature
reviews based on an assortment of qualitative scientific articles facilitate the collection of
findings that represent opinions, perceptions and thoughts. In addition, inclosing quantitative
articles helps in providing a theoretical framework to the study and also facilitates summarisation
of pertinent numerical information on the phenomenon under investigation.
The literature review was based on a thorough computerised investigation for relevant
scientific literature that was outlined by the proposed research question, aims, and objectives.
The procedure of collecting scholarly articles focused on gathering information from appropriate
texts that had been published in peer-reviewed journals and/or professional-body periodicals.
Additional search was also piloted for including ‘grey’ literature sources. These sources were
generally produced in electronic and/or printed format by academic, industry, government, and
business organisations.
The literature search strategy comprised of using snowball technique that primarily involved
conducting a manual search of the reference list and/or bibliography of the identified articles and
associated journals, with the aim of recognising additional significant literature. This was
followed by conducting a literature explorations that was continually updated at numerous stages
of the investigation, in order to evaluate the quality of the included articles. Scholarly evidences
were selected from four electronic clinical databases that had been recommended by the library
services at the university and Aveyard for undertaking a comprehensive investigation associated
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to medicine and health (Aveyard 2014). The databases and search engines that were searched
included the following:
 Cumulative Index of Nursing and Allied Health Literature (CINAHL)
 PubMed Central (PMC)
 Medical Literature Analysis and Retrieval System Online (MEDLINE)
The electronic databases and search engine mentioned above were typically selected for
article extraction taking into consideration their prominence in the domain of healthcare and
bioscience. These databases only contained literature that had already been published and
excluded any unpublished material such as, manuscripts. In order to eliminate chances of
publication bias, efforts were also taken to include grey literature sources (if any) from the
source given below:
 Google Scholar
The key words and search phrases that were used for the extraction of pertinent articles from
the aforementioned sources were namely, “computed tomography”, “CT”, “MRI”, “magnetic
resonance imaging”, “effectiveness”, “comparison”, “scanning”, “modality”, “efficacy”, and
“stroke”. With the aim of ensuring the inclusion and acknowledgment of important articles,
several strategies were followed that augmented the search procedure.
 exploring applicable keywords by grouping them and searching for their synonyms with
the use of free-text terms and ‘medical subject heading’ (MeSH), which were combined
with truncation (‘*’ or ‘$’)
 searching for catchwords in quote symbols
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 using Boolean operators (‘AND’ and ‘OR’) for joining the key terms (McGowan et al.
2016)
A pre-specified eligibility criteria was used for inclusion of prospective articles in the review.
All articles that failed to match the inclusion criteria was eliminated from the study (Moule,
Aveyard and Goodman 2016). This helped in retrieval of an estimated 25 articles from the
databases. The table given below highlights the criteria, based on which articles were included in
the literature review:
Inclusion criteria Exclusion criteria
Published in English Published in foreign language
Published on or after 2013 Published prior to 2013
Focuses on either MRI, CT or both Focuses on any other scanning modality
Any country of publication Manuscripts, abstracts
Table 1- Inclusion and exclusion criteria for literature review
Literature review
With the objective to analyses the comparison between the two imaging test CT scan and
MRI, it is essential to evaluate it's various advantageous and disadvantageous in relation to
health care sector and care of the person. Therefore, the theme has been analyzed to get the
correct outcome.
Advantageous of CT-scan
Nam, Barrack and Potter (2014) has conducted a systematic literature review and
recognized the comparative analysis of CT-scan and MRI test. With the aim of evaluating the
disadvantages and advantages of CT, MRI, and US as diagnostic tools for assessing wear-
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associated corrosion difficulties, the researchers conducted a systematic literature review. Pieces
of scholarly evidences were collected from electronic databases namely, CINAHL, MEDLINE,
Scopus, and EMBASE, based on evaluation of the quality of evidences, intervention allocation
method, and outcome assessments. In his study they said that CT scan is the most sensitive test
that give information about the component positioning in human body but they are also limited
in giving information regarding soft tissue contrast one. Some of the major advantages of CT
scan modality, in relation to conducting body scans were attributed to the widespread
acceptability and availability of this screening technique across healthcare facilities.
Furthermore, collection of evidence from the databases also suggested that several companies
have formulated metal artifact decrease software and/or protocols, in order to lessen the beam-
hardening artifact, which is typically created at the time of reconstruction of filtered back CT
projection. This systematic literature review also provided evidence for the fact that CT
modalities are less dependant on operators, which acts as a potential advantage of the procedure
over other screening processes. Nonetheless, one major methodological issue with this article can
be accredited to the fact that this secondary research did not take into consideration unpublished
articles that might have added evidence to the research phenomenon. In addition, it is also
difficult to combine results from a plethora of studies owing to different research approaches,
used in the individual studies.
Study of Nanavaty, Alvarez and Alberts (2014) in their study in National Lung Screening
Trial, found that, low dose CT test can be useful in detecting the presence of lung neoplasm in
person. The researchers also conducted a systematic review of numerous randomized clinical
trials and also took into consideration the costs and adverse reactions that were associated with
the screening process. Upon searching for relevant articles in electronic databases, the
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researchers found that Low-dose CT was highly successful in identifying presence of both
cancerous and benign non-calcified nodules. In addition, it also considered benign non-calcified
nodules as false positives. Low-dose CT testing procedure was found to include supplementary
invasive and imaging procedures, either through bronchoscopic fine-needle aspiration,
transthoracic needle biopsy, or surgical approaches, which had a low likelihood. The review of
literature also elaborated on the effects that the screening procedure created on rates of mortality,
among people who had been identified to remain at high-risk, thus elucidating the potential
advantages that CT scan process offered, over other scanning methods. However, one major
limitation can be associated with the role of unpublished literature, and the decision of peer
reviewers and editors that might have resulted in publication bias in the article.
The authors assessed and compared the feasibility of introducing CTP and diagnostic
accuracy with non-contrast CT (NCCT) where total 1152 patients were found with acute stroke.
The patients in the hospital from stroke onset or with wake-up stroke were eligible for CTP
unless glomerular filtration rate is estimated more than 50 ml was highlighted in the patient.
Moreover, CTP was assessed by authors for long until the peak of the cerebral blood flow until
the flow of the cerebral blood is reduced in the patient and obtained the result discussed before.
However, the researchers highlighted few limitations which reduced the accuracy of the study.
The first limitation of the study is that the researchers used 16 slice CT scanner with the spatial
brain coverage along with the limited acquisition duration time. Therefore, this limitation may
increase the generalizability of the result since a considerate number of institutions have better
technology or this technology. In order to avoid the problem discussed before International
consensus guidelines recommend a length of 70–90s CT scan is required to use. Fortunately, the
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