Stroke-related imaging costs have tripled in recent years, despite declining reperfusion rates

Hannah Murphy | August 24, 2026 | Radiology Business | Neuroimaging

doctor comparing the costs of different medical treatments

Despite an increase in imaging utilization for acute stroke evaluations in recent years, the use of interventional treatments has not followed suit.

That’s according to a new analysis of "code stroke" activations that compares the costs and utilization of stroke-related imaging and treatments. Researchers reviewed all sode stroke activations from a single center between 2020 and 2025, examining the initial neuroimaging modality ordered and the use of intravenous thrombolysis (IVT) or endovascular thrombectomy (EVT) to calculate costs.

Their work revealed an unexpected relationship between imaging volume and the use of IVT and EVT. The team hypothesized that a rise in imaging would increase the number of eligible patients for interventional treatment and, consequently, the use of these procedures.

“The implementation of ‘code stroke activations’ at hospitals across the country has led to increased reliance and liberal use of advanced neuroimaging to identify a select few patients eligible for intervention, including a 250% increase in CTA utilization. Ultimately, these code stroke pathways, particularly in emergency departments, have become broad ‘screening strategies’ which aim to maximize sensitivity with lower specificity,” Nisharg Parikh, with the department of radiology at Rutgers Robert Wood Johnson Medical School, New Jersey, and colleagues noted. “Prior studies have demonstrated an association between advanced neuroimaging and increased rates of reperfusion with IVT/EVT as more eligible patients are identified.”

However, this was not the case, the group learned.

The number of annual code stroke activations increased from 133 in 2020 to 298 in 2025, nearly tripling during the study period. The increase was driven by an approximately 800% rise in the use of CTA of the head and neck. This had a significant impact on costs; as imaging volumes increased, annual imaging expenditures rose from $70,616 to $259,290. The estimated imaging cost per treated stroke patient also increased more than fourfold, from $3,717 in 2020 to $16,205 in 2025.

However, the number of patients who underwent IVT or EVT did not follow the same trend. In fact, use of these procedures declined slightly from 19 patients in 2020 to 16 in 2025. Overall, reperfusion treatment fell from 14.3% to 5.4%.

The team suggested that their findings highlight a widening gap between the resources devoted to acute stroke imaging and the number of patients who receive reperfusion therapy. They also underscore the growing financial burden associated with modern stroke evaluations; though advanced imaging is critical for identifying patients who may benefit from time-sensitive interventions, the declining treatment yield raises questions about how efficiently imaging resources are being used.

“Our findings suggest an opportunity for radiologists to lead efforts in stroke coordination and evaluation of imaging strategies, as well as a framework for future investigations whether refinement of existing triaging protocols can optimize resource utilization while maintaining timely diagnosis,” the team concluded.