HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lev, M. H. Articles by Gonzalez, R. G. Search for Related Content PubMed PubMed Citation Articles by Lev, M. H. Articles by Gonzalez, R. G.

Acute Stroke: Improved Nonenhanced CT Detection-Benefits of Soft-Copy Interpretation by Using Variable Window Width and Center Level Settings¹

¹ From the Departments of Radiology (M.H.L., J.F., J.J.G., S.T.H., G.J.H., R.G.G.) and Neurology (W.J.K.), Massachusetts General Hospital, GRB285, 14 Fruit St, Boston, MA 02114-9657. From the 1998 RSNA scientific assembly. Received October 20, 1998; revision requested December 17; revision received March 23, 1999; accepted March 26. R.G.G. supported in part by National Institutes of Health grants NS 34626 and RR 1321 and by an educational grant from GE Medical Systems. M.H.L. supported in part by a 1996 RSNA Seed Grant. Address reprint requests to M.H.L. (e-mail: mlev@partners.org).

PURPOSE: To assess the use of nonstandard, variable window width and level review settings in computed tomography (CT) without contrast material administration in the detection of acute stroke.

MATERIALS AND METHODS: Nonenhanced CT was performed in 21 patients with acute (<6 hours) middle cerebral arterial stroke and nine control patients. Two blinded neuroradiologists rated all scans for presence of parenchymal hypoattenuation. Images were reviewed at a picture archiving and communication system (PACS) workstation, with standard, locally determined center level and window width settings of 20 and 80 HU and with variable soft-copy settings initially centered at a level of 32 HU with a width of 8 HU. Reviewers altered settings to accentuate gray and white matter contrast.

RESULTS: With standard viewing parameters, sensitivity and specificity for stroke detection were 57% and 100%. Sensitivity increased to 71% with variable window width and center level settings, without loss of specificity. Receiver operating characteristic analysis revealed a significant improvement in accuracy with nonstandard, soft-copy review settings (P = .03, one-tailed z test).

CONCLUSION: In nonenhanced CT of the head, detection of ischemic brain parenchyma is facilitated by soft-copy review with variable window width and center level settings to accentuate the contrast between normal and edematous tissue.

Index terms: Brain, CT, 10.781, 174.12111 • Brain, infarction, 10.781, 174.781 • Brain, ischemia, 10.781, 174.781

This article has been cited by other articles:

				K. Lin, O. Rapalino, M. Law, J.S. Babb, K.A. Siller, and B.K. Pramanik Accuracy of the Alberta Stroke Program Early CT Score during the First 3 Hours of Middle Cerebral Artery Stroke: Comparison of Noncontrast CT, CT Angiography Source Images, and CT Perfusion AJNR Am. J. Neuroradiol., May 1, 2008; 29(5): 931 - 936. [Abstract] [Full Text] [PDF]

				R.I. Aviv, J. Mandelcorn, S. Chakraborty, D. Gladstone, S. Malham, G. Tomlinson, A.J. Fox, and S. Symons Alberta Stroke Program Early CT Scoring of CT Perfusion in Early Stroke Visualization and Assessment AJNR Am. J. Neuroradiol., November 1, 2007; 28(10): 1975 - 1980. [Abstract] [Full Text] [PDF]

				E. C. S. Camargo, K. L. Furie, A. B. Singhal, L. Roccatagliata, M. E. Cunnane, E. F. Halpern, G. J. Harris, W. S. Smith, R. G. Gonzalez, W. J. Koroshetz, et al. Acute Brain Infarct: Detection and Delineation with CT Angiographic Source Images versus Nonenhanced CT Scans Radiology, August 1, 2007; 244(2): 541 - 548. [Abstract] [Full Text] [PDF]

				A. Srinivasan, M. Goyal, F. A. Azri, and C. Lum State-of-the-Art Imaging of Acute Stroke RadioGraphics, October 1, 2006; 26(suppl_1): S75 - S95. [Abstract] [Full Text] [PDF]

				S. H. Thomas, L. H. Schwamm, and M. H. Lev Case records of the Massachusetts General Hospital. Case 16-2006. A 72-year-old woman admitted to the emergency department because of a sudden change in mental status. N. Engl. J. Med., May 25, 2006; 354(21): 2263 - 2271. [Full Text] [PDF]

				C. Tanaka, T. Ueguchi, E. Shimosegawa, N. Sasaki, T. Johkoh, H. Nakamura, and J. Hatazawa Effect of CT Acquisition Parameters in the Detection of Subtle Hypoattenuation in Acute Cerebral Infarction: A Phantom Study AJNR Am. J. Neuroradiol., January 1, 2006; 27(1): 40 - 45. [Abstract] [Full Text] [PDF]

				T. Hirano, T. Yonehara, Y. Inatomi, Y. Hashimoto, and M. Uchino Presence of Early Ischemic Changes on Computed Tomography Depends on Severity and the Duration of Hypoperfusion: A Single Photon Emission-Computed Tomographic Study Stroke, December 1, 2005; 36(12): 2601 - 2608. [Abstract] [Full Text] [PDF]

				L. H. Schwamm, E. S. Rosenthal, C. J. Swap, J. Rosand, G. Rordorf, F. S. Buonanno, M. G. Vangel, W. J. Koroshetz, and M. H. Lev Hypoattenuation on CT Angiographic Source Images Predicts Risk of Intracerebral Hemorrhage and Outcome after Intra-Arterial Reperfusion Therapy AJNR Am. J. Neuroradiol., August 1, 2005; 26(7): 1798 - 1803. [Abstract] [Full Text] [PDF]

				J. M. Wardlaw and O. Mielke Early Signs of Brain Infarction at CT: Observer Reliability and Outcome after Thrombolytic Treatment--Systematic Review Radiology, May 1, 2005; 235(2): 444 - 453. [Abstract] [Full Text] [PDF]

				H. J. Kim, C. G. Choi, D. H. Lee, J. H. Lee, S. J. Kim, and D. C. Suh High-b-Value Diffusion-Weighted MR Imaging of Hyperacute Ischemic Stroke at 1.5T AJNR Am. J. Neuroradiol., February 1, 2005; 26(2): 208 - 215. [Abstract] [Full Text] [PDF]

				S. B. Coutts, M. H. Lev, M. Eliasziw, L. Roccatagliata, M. D. Hill, L. H. Schwamm, J.H. W. Pexman, W. J. Koroshetz, M. E. Hudon, A. M. Buchan, et al. ASPECTS on CTA Source Images Versus Unenhanced CT: Added Value in Predicting Final Infarct Extent and Clinical Outcome Stroke, November 1, 2004; 35(11): 2472 - 2476. [Abstract] [Full Text] [PDF]

				S. B. Coutts, A. M. Demchuk, P. A. Barber, W. Y. Hu, J. E. Simon, A. M. Buchan, M. D. Hill, and for the VISION Study Group Interobserver Variation of ASPECTS in Real Time Stroke, May 1, 2004; 35(5): e103 - e105. [Abstract] [Full Text] [PDF]

				J. M. Provenzale, R. Jahan, T. P. Naidich, and A. J. Fox Assessment of the Patient with Hyperacute Stroke: Imaging and Therapy Radiology, November 1, 2003; 229(2): 347 - 359. [Abstract] [Full Text] [PDF]

				J. D. Eastwood, M. H. Lev, M. Wintermark, C. Fitzek, D. P. Barboriak, D. M. Delong, T.-Y. Lee, T. Azhari, M. Herzau, V. R. Chilukuri, et al. Correlation of Early Dynamic CT Perfusion Imaging with Whole-Brain MR Diffusion and Perfusion Imaging in Acute Hemispheric Stroke AJNR Am. J. Neuroradiol., October 1, 2003; 24(9): 1869 - 1875. [Abstract] [Full Text] [PDF]

				S. B. Coutts, M. D. Hill, A. M. Demchuk, P. A. Barber, J.H. W. Pexman, A. M. Buchan, H. K.F. Mak, K. K.W. Yau, and B. P.L. Chan ASPECTS Reading Requires Training and Experience * Response Stroke, October 1, 2003; 34 (10): e179 - e179. [Full Text] [PDF]

				D. Saur, T. Kucinski, U. Grzyska, B. Eckert, C. Eggers, W. Niesen, V. Schoder, H. Zeumer, C. Weiller, and J. Rother Sensitivity and Interrater Agreement of CT and Diffusion-Weighted MR Imaging in Hyperacute Stroke AJNR Am. J. Neuroradiol., May 1, 2003; 24(5): 878 - 885. [Abstract] [Full Text] [PDF]

				R. E. Latchaw, H. Yonas, G. J. Hunter, W. T.C. Yuh, T. Ueda, A. G. Sorensen, J. L. Sunshine, J. Biller, L. Wechsler, R. Higashida, et al. Guidelines and Recommendations for Perfusion Imaging in Cerebral Ischemia: A Scientific Statement for Healthcare Professionals by the Writing Group on Perfusion Imaging, From the Council on Cardiovascular Radiology of the American Heart Association Stroke, April 1, 2003; 34(4): 1084 - 1104. [Full Text] [PDF]

				Clinical MRI AJNR Am. J. Neuroradiol., February 1, 2003; 24(2): 294 - 295. [Full Text] [PDF]

				P. D. Schellinger, J. B. Fiebach, W. Hacke, and J. Rother Imaging-Based Decision Making in Thrombolytic Therapy for Ischemic Stroke: Present Status Stroke, February 1, 2003; 34(2): 575 - 583. [Abstract] [Full Text] [PDF]

				J. D. Eastwood, M. H. Lev, and J. M. Provenzale Perfusion CT with Iodinated Contrast Material Am. J. Roentgenol., January 1, 2003; 180(1): 3 - 12. [Full Text] [PDF]

				B. I. Reiner, E. L. Siegel, and F. J. Hooper Accuracy of Interpretation of CT Scans: Comparing PACS Monitor Displays and Hard-Copy Images Am. J. Roentgenol., December 1, 2002; 179(6): 1407 - 1410. [Abstract] [Full Text] [PDF]

				S. C. Wagner, W. B. Morrison, J. A. Carrino, M. E. Schweitzer, and H. Nothnagel Picture Archiving and Communication System: Effect on Reporting of Incidental Findings Radiology, November 1, 2002; 225(2): 500 - 505. [Abstract] [Full Text] [PDF]

				M. E. Mullins, M. H. Lev, D. Schellingerhout, W. J. Koroshetz, and R. G. Gonzalez Influence of Availability of Clinical History on Detection of Early Stroke Using Unenhanced CT and Diffusion-Weighted MR Imaging Am. J. Roentgenol., July 1, 2002; 179(1): 223 - 228. [Abstract] [Full Text] [PDF]

				M. A. Ezzeddine, M. H. Lev, C. T. McDonald, G. Rordorf, J. Oliveira-Filho, F. G. Aksoy, J. Farkas, A. Z. Segal, L. H. Schwamm, R. G. Gonzalez, et al. CT Angiography With Whole Brain Perfused Blood Volume Imaging: Added Clinical Value in the Assessment of Acute Stroke Stroke, April 1, 2002; 33(4): 959 - 966. [Abstract] [Full Text] [PDF]

				J. H. W. Pexman, P. A. Barber, M. D. Hill, R. J. Sevick, A. M. Demchuk, M. E. Hudon, W. Y. Hu, and A. M. Buchan Use of the Alberta Stroke Program Early CT Score (ASPECTS) for Assessing CT Scans in Patients with Acute Stroke AJNR Am. J. Neuroradiol., September 1, 2001; 22(8): 1534 - 1542. [Abstract] [Full Text] [PDF]

				M. H. Lev, A. Z. Segal, J. Farkas, S. T. Hossain, C. Putman, G. J. Hunter, R. Budzik, G. J. Harris, F. S. Buonanno, M. A. Ezzeddine, et al. Utility of Perfusion-Weighted CT Imaging in Acute Middle Cerebral Artery Stroke Treated With Intra-Arterial Thrombolysis:: Prediction of Final Infarct Volume and Clinical Outcome Editorial Comment: Prediction of Final Infarct Volume and Clinical Outcome Stroke, September 1, 2001; 32(9): 2021 - 2028. [Abstract] [Full Text] [PDF]

				J. A. Maldjian, J. Chalela, S. E. Kasner, D. Liebeskind, and J. A. Detre Automated CT Segmentation and Analysis for Acute Middle Cerebral Artery Stroke AJNR Am. J. Neuroradiol., June 1, 2001; 22(6): 1050 - 1055. [Abstract] [Full Text] [PDF]

				R. von Kummer, M. H. Lev, R. G. Gonzalez, W. J. Koroshetz, J. Farkas, J. J. Gemmete, G. J. Hunter, and S. T. Hossain Acute Stroke: How to Improve CT Detection and Avoid Errors in Radiology Dr Lev and colleagues respond: Radiology, September 1, 2000; 216(3): 920 - 922. [Full Text]

				J. D. Eastwood, M. H. Lev, T. Azhari, T.-Y. Lee, D. P. Barboriak, D. M. Delong, C. Fitzek, M. Herzau, M. Wintermark, R. Meuli, et al. CT Perfusion Scanning with Deconvolution Analysis: Pilot Study in Patients with Acute Middle Cerebral Artery Stroke Radiology, January 1, 2002; 222(1): 227 - 236. [Abstract] [Full Text] [PDF]