open access

Vol 50, No 4 (2016)
Original research articles
Submitted: 2015-10-19
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Comprehensive imaging of stroke – Looking for the gold standard

Agnieszka Piliszek, Grzegorz Witkowski, Katarzyna Sklinda, Cezary Szary, Danuta Ryglewicz, Małgorzata Dorobek, Jerzy Walecki
DOI: 10.1016/j.pjnns.2016.04.009
·
Neurol Neurochir Pol 2016;50(4):241-250.

open access

Vol 50, No 4 (2016)
Original research articles
Submitted: 2015-10-19

Abstract

Background and purpose

Stroke is the third cause of death worldwide. In recent decade there has been a marked progress in treatment and prevention of stroke, which was possible largely due to modern neuroimaging techniques. Early radiological confirmation of the diagnosis allows for introduction of fibrinolytic therapy and evaluation of ischaemic penumbra.

Material and methods

We have analysed clinical and imaging data of 92 patients with early stages of stroke. The sensitivity, specificity and possible influence on the choice of treatment were assessed for different neuroimaging techniques, including diffusion weighted and perfusion imaging in patients with hyperacute and acute stroke.

Results

A non-contrast computed tomography (CT) allowed for the detection of early ischaemic changes with an overall sensitivity of 38% and 42% in patients in hyperacute phase. In a perfusion CT study the perfusion abnormalities in the area corresponding to the clinical symptoms were present in 79% of patients. The sensitivity of diffusion weighted imaging (DWI) alone was 95% and in conjunction with perfusion MR reached 100%.

Conclusions

Our study proves that advanced neuroimaging modalities allow for a substantial increase of sensitivity when detecting changes in patients with acute ischaemic strokes and confirming the clinical diagnosis. We believe that MR in combination with DWI should be the imaging methods of choice in diagnosing acute stroke patients. Perfusion adds significant diagnostic value to structural techniques, particularly in clinically ambiguous cases. In cases with a clear clinical picture the data provided by a non-contrast CT study is sufficient for therapeutic decision making.

Abstract

Background and purpose

Stroke is the third cause of death worldwide. In recent decade there has been a marked progress in treatment and prevention of stroke, which was possible largely due to modern neuroimaging techniques. Early radiological confirmation of the diagnosis allows for introduction of fibrinolytic therapy and evaluation of ischaemic penumbra.

Material and methods

We have analysed clinical and imaging data of 92 patients with early stages of stroke. The sensitivity, specificity and possible influence on the choice of treatment were assessed for different neuroimaging techniques, including diffusion weighted and perfusion imaging in patients with hyperacute and acute stroke.

Results

A non-contrast computed tomography (CT) allowed for the detection of early ischaemic changes with an overall sensitivity of 38% and 42% in patients in hyperacute phase. In a perfusion CT study the perfusion abnormalities in the area corresponding to the clinical symptoms were present in 79% of patients. The sensitivity of diffusion weighted imaging (DWI) alone was 95% and in conjunction with perfusion MR reached 100%.

Conclusions

Our study proves that advanced neuroimaging modalities allow for a substantial increase of sensitivity when detecting changes in patients with acute ischaemic strokes and confirming the clinical diagnosis. We believe that MR in combination with DWI should be the imaging methods of choice in diagnosing acute stroke patients. Perfusion adds significant diagnostic value to structural techniques, particularly in clinically ambiguous cases. In cases with a clear clinical picture the data provided by a non-contrast CT study is sufficient for therapeutic decision making.

Get Citation

Keywords

Acute stroke, Imaging, Diffusion, Perfusion

About this article
Title

Comprehensive imaging of stroke – Looking for the gold standard

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 50, No 4 (2016)

Pages

241-250

DOI

10.1016/j.pjnns.2016.04.009

Bibliographic record

Neurol Neurochir Pol 2016;50(4):241-250.

Keywords

Acute stroke
Imaging
Diffusion
Perfusion

Authors

Agnieszka Piliszek
Grzegorz Witkowski
Katarzyna Sklinda
Cezary Szary
Danuta Ryglewicz
Małgorzata Dorobek
Jerzy Walecki

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