Abstract

Introduction. Noncontrast head CT (NCCT) is the standard radiologic test for patients presenting with acute stroke. Early ischemic changes (EIC) are often overlooked on initial NCCT. We determine the sensitivity and specificity of improved EIC detection by a standardized method of image evaluation (Stroke Windows). Methods. We performed a retrospective chart review to identify patients with acute ischemic stroke who had NCCT at presentation. EIC was defined by the presence of hyperdense MCA/basilar artery sign; sulcal effacement; basal ganglia/subcortical hypodensity; and loss of cortical gray-white differentiation. NCCT was reviewed with standard window settings and with specialized Stroke Windows. Results. Fifty patients (42% females, 58% males) with a mean NIHSS of 13.4 were identified. EIC was detected in 9 patients with standard windows, while EIC was detected using Stroke Windows in 35 patients (18% versus 70%; P < 0.0001). Hyperdense MCA sign was the most commonly reported EIC; it was better detected with Stroke Windows (14% and 36%; P < 0.0198). Detection of the remaining EIC also improved with Stroke Windows (6% and 46%; P < 0.0001). Conclusions. Detection of EIC has important implications in diagnosis and treatment of acute ischemic stroke. Utilization of Stroke Windows significantly improved detection of EIC.

Highlights

  • Noncontrast head computed tomographic (CT) (NCCT) is the standard radiologic test for patients presenting with acute stroke

  • The detection of Early ischemic changes (EIC) with Stroke Windows was significantly higher: 70% (35 out of 50 patients) compared to 18% (9 out of 50 patients) in the standard window group (P < 0.0001)

  • We have demonstrated that the detection of EIC by Noncontrast head CT (NCCT) is significantly improved by utilization of standard Stroke Windows and can be utilized by the initial providers assessing acute stroke, including the trainees

Read more

Summary

Introduction

Noncontrast head CT (NCCT) is the standard radiologic test for patients presenting with acute stroke. We determine the sensitivity and specificity of improved EIC detection by a standardized method of image evaluation (Stroke Windows). We performed a retrospective chart review to identify patients with acute ischemic stroke who had NCCT at presentation. Noncontrast head CT (NCCT) is the first-line diagnostic test for emergency evaluation of acute stroke due to its speed of imaging, widespread availability, and low cost. Decreases in CT attenuation accompanying early stroke are small; their conspicuity may be increased by using narrow window settings centered at approximately the mean attenuation in HUs of gray and white matter. We hypothesize that detection of EIC can be improved by a standardized method of image evaluation that can be implemented by the treating physicians (including trainees)

Methods
Results
Discussion
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call