Editorial Comment—Specificity of Stroke Imaging

Abstract

Brain imaging in acute stroke patients can be effective on 6 different levels:1 (1) It will reduce health care costs, if it prevents disability and death of stroke victims. (2) Brain imaging will improve the clinical outcome of stroke patients, if it identifies the patients who benefit from specific treatment. (3) To identify these patients, brain imaging must provide relevant information that is unavailable from other sources for the appropriate choice of treatment. (4) This could be brain images that allow the exclusion of brain hemorrhage and other diseases that mimic ischemic stroke, and allow assessment of ischemic edema and perfusion disturbance, mass effect, arterial wall pathology, and obstruction. (5) The imaging modality should be sensitive and specific for stroke pathology early after symptom onset. (6) This requires the imaging modality to have the technical capacity to reliably detect the relevant stroke pathology. In this issue, Schramm et al2 compare computed tomography (CT) and MRI (MRI) techniques that assessed brain perfusion, brain water diffusion, and the resulting ischemic infarct in acute stroke patients. In a group of 22 patients, among them 9 patients without a brain infarct on follow-up CT, Schramm et al did not detect a statistical difference …