Letter to the editor: "Diagnostic accuracy of major stroke types in Chinese adults: A clinical adjudication study involving 40,000 stroke cases".

Letter to the editor,

We have read with interest the study by Turnbull et al. However, we raise the following concerns. The author states that the current study was limited in its ability to differentiate silent small vessel diseases due to the low use of diffusion-weighted imaging (DW-MR). Although not stated in the paper, I would like to know what percentage of silent lacunar infarcts are diagnosed by CT. If the MRI penetration rate in China during that study period was considerably low, it is possible that the number and rate of true cerebral infarcts, especially silent lacunar infarcts, may have been underestimated., WebTable 7 also shows an increase in the proportion of lacunar infarcts toward the end of the study period. This may be due to the widespread use and accessibility of MRI, besides the change in the ICD-10, 11 classification that the author mentions. If so, is there a societal factor that has increased the number of testing opportunities, e.g., brain examination for healthy adults not using the health insurance system, that can detect silent lacunar infarcts by chance,?

Contributors

Tatsuya Fujikawa and Masashi Nishiyama contributed to writing the manuscript.

Declaration of interests

The authors do not have any conflict of interest to declare.