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ESTIMATION OF LESION AGE IN STROKE PATIENTS–DIRECT COMPARISON OF NON-CONTRAST ENHANCED COMPUTED TOMOGRAPHY–TO DWI-FLAIR MISMATCH
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Journal Article
ESTIMATION OF LESION AGE IN STROKE PATIENTS–DIRECT COMPARISON OF NON-CONTRAST ENHANCED COMPUTED TOMOGRAPHY–TO DWI-FLAIR MISMATCH
2019
Overview
Hintergrund: In recent studies, magnetic resonance imaging (MRI) has been used to estimate lesion age in patients with wake-up stroke to enable thrombolytic therapy. However, MRI has a limited availability and feasibility, and is more time-consuming in the acute situation. As ischemic changes of the cerebral parenchyma can be detected on non-contrast enhanced computed tomography (NECT), we hypothesized that in direct comparison of the two modalities, NECT is equally sensitive and specific than MRI in identifying patients with lesion age <4.5 hours from symptom onset. Methoden: 41 patients with acute anterior circulation stroke were analyzed with both imaging modalities at admission. Mismatch between diffusion-weighted MRI (DWI) and fluid-attenuated inversion recovery (FLAIR) was diagnosed by consensus reading according to the criteria of the WAKE-UP trial. NECT were analyzed for signs of ischemic parenchymal changes (loss of grey-white matter differentiation, hypoattenuation of deep nuclei, cortical hypodensity with associated parenchymal swelling and gyral effacement), in a blinded approach by two experienced neuroradiologists. If ischemic parenchymal changes were detected, the patients were assigned to the group of >4.5 hours from onset and vice versa. Ergebnisse: In 17 patients, the time from symptom onset to CT imaging was <4.5 h and 24 patients presented >4.5 h (range: 0.5-7.6 h). The median time from CT to MRI was 36 minutes (IQR: 24-55). DWIFLAIR mismatch correctly assigned 28/41 patients (68%) with a sensitivity of 70% (95%CI: 51-85%) and specificity of 72% (95%CI: 4790%). NECT analysis correctly assigned 30/41 (75%) with a sensitivity of 72% (95%CI: 69-91%) and specificity of 79% (95%CI: 53-90%). Fazit: In this cohort, analysis of NECT was comparable to DWIFLAIR mismatch in identifying patients within thrombolysis time window. Thus, future trials and a larger patient cohort are needed to investigate if NECT can be used to stratify wake-up stroke instead of MRI.
Publisher
Springer
