INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN APPLIED SCIENCE (IJRIAS)  
ISSN No. 2454-6194 | DOI: 10.51584/IJRIAS |Volume X Issue XI November 2025  
Comparison of 64-Slice Vs 128-Slice CT in Stroke Imaging: A  
Comprehensive Review  
Lalruatfela., R Lalnunsangi  
Department of Medical Radiology and Imaging Technology Regional Institute of Paramedical and  
Nursing Sciences Aizawl Mizoram  
DOI: https://dx.doi.org/10.51584/IJRIAS.2025.101100091  
Received: 04 December 2025; Accepted: 10 November 2025; Published: 19 December 2025  
ABSTRACT  
Rapid and accurate neuroimaging is essential for acute stroke management, guiding decisions for thrombolysis  
and mechanical thrombectomy. Multidetector computed tomography (MDCT) systems—particularly 64-slice  
and 128-slice scanners—are widely used for non-contrast CT (NCCT), CT angiography (CTA), and CT  
perfusion (CTP). This review compares the performance of 64-slice and 128-slice CT scanners in stroke imaging,  
focusing on spatial/temporal resolution, acquisition speed, radiation dose, diagnostic accuracy, workflow  
efficiency, and suitability for resource-limited settings. Evidence suggests that 128-slice CT provides superior  
temporal resolution, reduced motion artifacts, enhanced CTA and CTP quality, and faster workflow. However,  
64-slice scanners remain highly effective for NCCT and routine CTA, offering cost-efficiency and adequate  
diagnostic accuracy for most emergency stroke pathways.  
INTRODUCTION  
Stroke is a major global health burden, and timely imaging plays a critical role in determining treatment pathways  
such as IV thrombolysis (time window ≤4.5 hours) and mechanical thrombectomy (window ≤24 hours). CT  
remains the first-line imaging modality because of its speed, availability, and high sensitivity for hemorrhage.  
MDCT advancements—from 16-slice to 64-slice and now 128-slice—have improved coverage, z-axis resolution,  
and perfusion imaging.  
This review analyzes the comparative advantages and limitations of 64-slice and 128-slice MDCT systems in  
the context of emergency stroke imaging.  
Technical Differences Between 64-Slice and 128-Slice CT  
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INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN APPLIED SCIENCE (IJRIAS)  
ISSN No. 2454-6194 | DOI: 10.51584/IJRIAS |Volume X Issue XI November 2025  
Detector Configuration  
Parameter  
Detector row configuration 64 × 0.625 mm 128 × 0.6 / 0.625 mm  
64-Slice CT  
128-Slice CT  
z-axis coverage  
~40 mm  
Adaptive array Enhanced adaptive array  
330–400 ms 280–330 ms  
~80 mm  
Detector technology  
Typical rotation time  
Implication:  
Greater z-axis coverage in 128-slice CT improves whole-brain imaging and reduces motion artifacts.  
Spatial and Temporal Resolution  
128-slice CT achieves:  
Higher temporal resolution (due to dual-source options and faster gantry rotation)  
Better isotropic voxels  
More accurate vessel visualization in CTA  
64-slice CT provides:  
Adequate resolution for NCCT and CTA  
Slightly more susceptibility to motion artifact in unstable patients  
Clinical Comparison in Stroke Imaging  
Non-Contrast CT (NCCT)  
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INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN APPLIED SCIENCE (IJRIAS)  
ISSN No. 2454-6194 | DOI: 10.51584/IJRIAS |Volume X Issue XI November 2025  
NCCT is used to detect:  
Intracerebral hemorrhage  
Early ischemic changes (loss of gray–white differentiation)  
Hyperdense artery sign  
ASPECTS scoring  
Performance:  
Both scanners offer similar diagnostic capability for hemorrhage.  
128-slice shows slightly improved gray–white differentiation, but not clinically transformative.  
ASPECTS scoring reliability is comparable.  
Conclusion  
→ 64-slice CT is sufficient for NCCT in acute stroke, and 128-slice gives marginal enhancement.  
CT Angiography (CTA)  
CTA is crucial for detecting:  
Large vessel occlusion (LVO)  
Stenosis of ICA, MCA  
Collateral circulation  
64-slice CTA:  
Good visualization of major intracranial arteries  
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INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN APPLIED SCIENCE (IJRIAS)  
ISSN No. 2454-6194 | DOI: 10.51584/IJRIAS |Volume X Issue XI November 2025  
Susceptible to venous contamination due to slower acquisition  
128-slice CTA:  
Faster table speed minimizes venous overlap  
Higher resolution improves detection of distal M2/M3 occlusions  
Better depiction of collaterals  
Conclusion:  
→ 128-slice CTA is superior for LVO detection and pre-thrombectomy evaluation.  
CT Perfusion (CTP)  
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INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN APPLIED SCIENCE (IJRIAS)  
ISSN No. 2454-6194 | DOI: 10.51584/IJRIAS |Volume X Issue XI November 2025  
Why CTP matters:  
Estimates infarct core  
Defines salvageable penumbra  
Determines eligibility for late-window thrombectomy (DAWN/DEFUSE-3 criteria)  
Performance Comparison:  
64-Slice CT  
Limited coverage (~4–8 cm), may miss posterior circulation strokes  
Lower temporal sampling → potential errors in time-to-peak (TTP) and cerebral blood flow (CBF) maps  
More prone to noise in low-dose protocols  
128-Slice CT  
Whole-brain perfusion possible with 80–100 mm coverage  
Higher temporal resolution yields:  
More accurate perfusion maps  
Better core/penumbra differentiation  
Reduced truncation artifacts  
Conclusion:  
→ 128-slice CT is significantly superior for CTP, especially in comprehensive stroke centers.  
4. Workflow Efficiency in Emergency Stroke Pathways  
64-Slice CT Workflow  
Slightly longer acquisition  
Limited perfusion coverage requires multiple scans → delays  
Quality depends heavily on patient motion  
128-Slice CT Workflow  
Faster acquisition (entire brain in <1 second for CTA)  
Ideal for unstable patients (agitated, tachypneic)  
Reduces movement-related nondiagnostic scans  
Supports “One-Stop Stroke Imaging” (NCCT + CTA + CTP in <5 min)  
Impact: Faster workflow improves “door-to-needle” and “door-to-puncture” times—critical for stroke  
outcomes.  
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INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN APPLIED SCIENCE (IJRIAS)  
ISSN No. 2454-6194 | DOI: 10.51584/IJRIAS |Volume X Issue XI November 2025  
Radiation Dose Comparison  
Parameter 64-Slice CT  
128-Slice CT  
NCCT  
CTA  
CTP  
Comparable  
Comparable  
Slightly higher  
Lower due to faster rotation  
Higher cumulative dose Lower due to optimized temporal sampling  
128-slice scanners often reduce dose by 10–25% because of:  
Shorter acquisition times  
Iterative reconstruction  
Advanced detector efficiency  
Cost, Maintenance & Suitability for Resource-Limited Settings  
64-Slice CT  
Lower cost (₹3–5 crores)  
Widely available  
Ideal for district hospitals and emergency trauma units  
Adequate for:  
NCCT  
Standard CTA  
Limited perfusion  
128-Slice CT  
Higher cost (₹6–10+ crores)  
More demanding maintenance  
Best for medical colleges and tertiary stroke centers  
Essential if performing:  
Whole-brain CTP  
High-throughput stroke imaging  
Summary of Advantages and Limitations  
Advantages of 128-Slice CT  
Faster acquisition  
Better CTA (LVO + collaterals)  
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INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN APPLIED SCIENCE (IJRIAS)  
ISSN No. 2454-6194 | DOI: 10.51584/IJRIAS |Volume X Issue XI November 2025  
Whole-brain CTP  
Lower motion artifacts  
Lower radiation dose  
Better workflow in stroke alerts  
Advantages of 64-Slice CT  
Cost-effective  
Adequate for NCCT and routine CTA  
Sufficient for basic stroke pathways  
Lower operational complexity  
CONCLUSION  
Both 64-slice and 128-slice CT scanners play important roles in acute stroke imaging. While 64-slice CT remains  
reliable for NCCT and standard CTA, the 128-slice CT provides substantial advantages in speed, perfusion  
imaging, motion reduction, and workflow optimization. For comprehensive stroke centers aiming to support  
thrombectomy programs, 128-slice CT is the superior choice. However, in resource-limited settings, 64-slice CT  
remains a cost-effective and clinically acceptable solution, especially when complemented with improved  
radiographer protocols.  
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