BACKGROUND: Although the use of magnetic resonance imaging (MRI) for the diagnosis of acute stroke is increasing, this method has not proved more effective than computed tomography (CT) in the emergency setting. We aimed to prospectively compare CT and MRI for emergency diagnosis of acute stroke. METHODS: We did a single-centre, prospective, blind comparison of non-contrast CT and MRI (with diffusion-weighted and susceptibility weighted images) in a consecutive series of patients referred for emergency assessment of suspected acute stroke. Scans were independently interpreted by four experts, who were unaware of clinical information, MRI-CT pairings, and follow-up imaging. RESULTS: 356 patients, 217 of whom had a final clinical diagnosis of acute stroke, were assessed. MRI detected acute stroke (ischaemic or haemorrhagic), acute ischaemic stroke, and chronic haemorrhage more frequently than did CT (p<0.0001, for all comparisons). MRI was similar to CT for the detection of acute intracranial haemorrhage. MRI detected acute ischaemic stroke in 164 of 356 patients (46%; 95% CI 41-51%), compared with CT in 35 of 356 patients (10%; 7-14%). In the subset of patients scanned within 3 h of symptom onset, MRI detected acute ischaemic stroke in 41 of 90 patients (46%; 35-56%); CT in 6 of 90 (7%; 3-14%). Relative to the final clinical diagnosis, MRI had a sensitivity of 83% (181 of 217; 78-88%) and CT of 26% (56 of 217; 20-32%) for the diagnosis of any acute stroke. INTERPRETATION: MRI is better than CT for detection of acute ischaemia, and can detect acute and chronic haemorrhage; therefore it should be the preferred test for accurate diagnosis of patients with suspected acute stroke. Because our patient sample encompassed the range of disease that is likely to be encountered in emergency cases of suspected stroke, our results are directly applicable to clinical practice.
BACKGROUND: Although the use of magnetic resonance imaging (MRI) for the diagnosis of acute stroke is increasing, this method has not proved more effective than computed tomography (CT) in the emergency setting. We aimed to prospectively compare CT and MRI for emergency diagnosis of acute stroke. METHODS: We did a single-centre, prospective, blind comparison of non-contrast CT and MRI (with diffusion-weighted and susceptibility weighted images) in a consecutive series of patients referred for emergency assessment of suspected acute stroke. Scans were independently interpreted by four experts, who were unaware of clinical information, MRI-CT pairings, and follow-up imaging. RESULTS: 356 patients, 217 of whom had a final clinical diagnosis of acute stroke, were assessed. MRI detected acute stroke (ischaemic or haemorrhagic), acute ischaemic stroke, and chronic haemorrhage more frequently than did CT (p<0.0001, for all comparisons). MRI was similar to CT for the detection of acute intracranial haemorrhage. MRI detected acute ischaemic stroke in 164 of 356 patients (46%; 95% CI 41-51%), compared with CT in 35 of 356 patients (10%; 7-14%). In the subset of patients scanned within 3 h of symptom onset, MRI detected acute ischaemic stroke in 41 of 90 patients (46%; 35-56%); CT in 6 of 90 (7%; 3-14%). Relative to the final clinical diagnosis, MRI had a sensitivity of 83% (181 of 217; 78-88%) and CT of 26% (56 of 217; 20-32%) for the diagnosis of any acute stroke. INTERPRETATION: MRI is better than CT for detection of acute ischaemia, and can detect acute and chronic haemorrhage; therefore it should be the preferred test for accurate diagnosis of patients with suspected acute stroke. Because our patient sample encompassed the range of disease that is likely to be encountered in emergency cases of suspected stroke, our results are directly applicable to clinical practice.
Authors: P A Barber; M D Hill; M Eliasziw; A M Demchuk; J H W Pexman; M E Hudon; A Tomanek; R Frayne; A M Buchan Journal: J Neurol Neurosurg Psychiatry Date: 2005-11 Impact factor: 10.154
Authors: Azlisham Mohd Nor; John Davis; Bas Sen; Dean Shipsey; Stephen J Louw; Alexander G Dyker; Michelle Davis; Gary A Ford Journal: Lancet Neurol Date: 2005-11 Impact factor: 44.182
Authors: R G González; P W Schaefer; F S Buonanno; L H Schwamm; R F Budzik; G Rordorf; B Wang; A G Sorensen; W J Koroshetz Journal: Radiology Date: 1999-01 Impact factor: 11.105
Authors: K O Lövblad; H J Laubach; A E Baird; F Curtin; G Schlaug; R R Edelman; S Warach Journal: AJNR Am J Neuroradiol Date: 1998 Jun-Jul Impact factor: 3.825
Authors: J P Mohr; J Biller; S K Hilal; W T Yuh; T K Tatemichi; S Hedges; E Tali; H Nguyen; I Mun; H P Adams Journal: Stroke Date: 1995-05 Impact factor: 7.914
Authors: Stephen J Phillips; Dingwei Dai; Arnold Mitnitski; Gordon J Gubitz; Karen C Johnston; Walter J Koroshetz; Karen L Furie; Sandra Black; Darell E Heiselman Journal: Stroke Date: 2007-08-23 Impact factor: 7.914