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) All Versions of this Article: 2331030028v1 233/1/79    most recent 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 Kloska, S. P. Articles by Heindel, W. Search for Related Content PubMed PubMed Citation Articles by Kloska, S. P. Articles by Heindel, W.

Acute Stroke Assessment with CT: Do We Need Multimodal Evaluation?¹

¹ From the Departments of Clinical Radiology (S.P.K., C.G., W.H.) and Neurology (D.G.N., E.M.N., E.B.R.), University Hospital of Muenster, Albert-Schweitzer-Strasse 33, 48149 Muenster, Germany; and Siemens Medical Solutions, Forchheim, Germany (E.K.). From the 2002 RSNA scientific assembly. Received January 28, 2003; revision requested April 15; final revision received January 21, 2004; accepted February 24. Supported by an interdisciplinary grant of the commission Innovative Medizinische Forschung (grant NA-229910). Address correspondence to S.P.K. (e-mail: kloska@uni-muenster.de).

PURPOSE: To assess detection of stroke and prediction of extent of infarction with multimodal computed tomographic (CT) evaluation (unenhanced CT, perfusion CT, and CT angiography) in patients suspected of having acute stroke.

MATERIALS AND METHODS: Forty-four consecutive patients with a mean National Institutes of Health Stroke Scale score of 10.45 and suspected of having ischemic stroke of the anterior circulation were examined with multi–detector row CT within 8 hours (mean, 3.05 hours) of onset of symptoms. All evaluations were performed with the knowledge that acute stroke was suspected but without detailed clinical information. The extent of ischemia or final infarction on the baseline unenhanced CT scan and follow-up images was assessed with the Alberta Stroke Program Early CT score. Different perfusion maps and follow-up images were assessed to determine the percentage of the ischemia-affected hemisphere. Each component, as well as the multimodal CT evaluation, was compared with follow-up unenhanced CT scans or magnetic resonance images after a mean time of 2.32 days.

RESULTS: Multimodal CT revealed true-positive findings in 30 of 41 patients and true-negative findings in three, resulting in a sensitivity of 78.9%. Unenhanced CT, CT angiography, and perfusion CT showed sensitivities of 55.3%, 57.9%, and 76.3%, respectively. In eight patients, small infarctions (mean size, 1.47 cm) that were proved at follow-up were missed with all modalities at initial multimodal CT. With perfusion CT, four of these small infarctions were missed within the white matter of the section levels. Maps of cerebral blood flow showed the best correlation with the final size of infarction with an r² value of 0.71.

CONCLUSION: The presented multimodal CT evaluation improves detection rate and prediction of the final size of infarction in comparison with unenhanced CT, CT angiography, and perfusion CT alone.

© RSNA, 2004

Index terms: Brain, CT, 10.12111, 10.12113 • Brain, infarction, 10.78 • Cerebral blood vessels, flow dynamics • Computed tomography (CT), angiography, 10.12116 • Computed tomography (CT), perfusion study

This article has been cited by other articles:

				E. M. de Lucas, E. Sanchez, A. Gutierrez, A. G. Mandly, E. Ruiz, A. F. Florez, J. Izquierdo, J. Arnaiz, T. Piedra, N. Valle, et al. CT Protocol for Acute Stroke: Tips and Tricks for General Radiologists RadioGraphics, October 1, 2008; 28(6): 1673 - 1687. [Abstract] [Full Text] [PDF]

				S. Bisdas, P. Therapidis, J. M. Kerl, N. Papadopoulos, I. Burck, C. Herzog, and T. J. Vogl Value of cerebral perfusion computed tomography in the management of intensive care unit patients with suspected ischaemic cerebral pathology after cardiac surgery Eur. J. Cardiothorac. Surg., September 1, 2007; 32(3): 521 - 526. [Abstract] [Full Text] [PDF]

				G TAN and T GODDARD Neuroimaging applications of multislice CT perfusion Imaging, June 1, 2007; 19(2): 142 - 152. [Abstract] [Full Text] [PDF]

				H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation, May 22, 2007; 115(20): e478 - e534. [Abstract] [Full Text] [PDF]

				H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists Stroke, May 1, 2007; 38(5): 1655 - 1711. [Abstract] [Full Text] [PDF]

				M. Cohnen, H.-J. Wittsack, S. Assadi, K. Muskalla, A. Ringelstein, L.W. Poll, A. Saleh, and U. Modder Radiation exposure of patients in comprehensive computed tomography of the head in acute stroke. AJNR Am. J. Neuroradiol., September 1, 2006; 27(8): 1741 - 1745. [Abstract] [Full Text] [PDF]

				M. Rosenkranz, J. Fiehler, W. Niesen, C. Waiblinger, B. Eckert, O. Wittkugel, T. Kucinski, J. Rother, H. Zeumer, C. Weiller, et al. The Amount of Solid Cerebral Microemboli during Carotid Stenting Does Not Relate to the Frequency of Silent Ischemic Lesions AJNR Am. J. Neuroradiol., January 1, 2006; 27(1): 157 - 161. [Abstract] [Full Text] [PDF]