Vol. 7, Issue 2, Part B (2025)

Acute Ischemic Stroke (AIS) management increasingly relies on advanced imaging to identify salvageable brain tissue (the ischemic penumbra) and guide reperfusion therapy. This review examines and contrasts Computed Tomography Perfusion (CTP) and magnetic resonance perfusion (MRP) imaging in stroke, focusing on diagnostic accuracy, clinical outcomes, and emerging technologies (2018-2025). Key findings from recent studies are summarized: adding CTP to standard CT protocols significantly improves detection of ischemia (sensitivity rising ~19.5%) without compromising specificity, and CTP notably enhanced diagnostic accuracy (residents’ AUC from ~88% to 97%). MRI-based protocols detect strokes with higher sensitivity than CT and substantially reduce treatment of stroke mimics (CTP vs MRI mimic thrombolysis: 8.6% vs 4.3%, p<0.05). However, large cohort data indicate similar 90-day functional outcomes regardless of selection modality. We also consider technical differences (radiation exposure, scan time, cost), and innovations such as non-contrast MRI methods and AI-assisted analysis. Table 1 and Table 2 (proposed) compare the modalities’ technical parameters and clinical performance. In conclusion, both CTP and MRP provide valuable information: CT is rapid and widely available, while MRI offers greater tissue contrast and specificity. The choice of modality should be tailored to clinical context and resources, and ongoing advances (e.g. faster MRI, AI) may further optimize stroke imaging.