Non-Contrast CT in Place of MRI Mismatch in the Imaging Triage of Acute Ischemic Stroke Patients

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Main Article Content

Emmad Qazi http://orcid.org/0000-0003-0222-3884 Fahad S Al-Ajlan Akash Mahajan Sung Il Sohn Sachin Mishra Hyuk Won Chang Mohamed Najm Christopher d’Esterre Andrew M Demchuk Mayank Goyal Ting Yim Lee Michael D Hill Bijoy K Menon http://orcid.org/0000-0002-3466-496X

Abstract

Purpose: We test if assessment of attenuation on NCCT identifies similar patients with acute ischemic stroke as the MRI DWI-FLAIR mismatch paradigm.

Methods: Data are from the Keimyung Stroke Registry. Patients with anterior circulation occlusion on baseline CT-angiography, known symptom onset time and MRI within 60 minutes of baseline CT were included. All patients received revascularization therapy. Baseline MRI DWI-FLAIR mismatch, hypoattenuation on baseline NCCT and parenchymal hemorrhage (PH) on follow-up imaging were assessed by consensus. Ratio of ipsilateral/contralateral NCCT Hounsfield Unit (HU) (rCT) within baseline DWI lesion was calculated. Statistical methods were used to assess if CT hypoattenuation was a reliable biomarker of time from stroke symptom onset and if it compared well with DWI-FLAIR mismatch in  predicting PH at 24 hours.

Results: Of 127 patients included [median age 68 (IQR-15), 53.5% male, median onset to MR time 158 (94) minutes], DWI-FLAIR mismatch was seen in 85/127 (67%). NCCT hypo-attenuation was seen in 111/127 (87%). A statistically significant negative correlation was noted between rCT and stroke symptom onset to MRI time (Spearman’s r = -0.33, p<0.001). A rCT > 0.87 best predicted the presence of DWI-FLAIR mismatch [c statistic = 0.84 (95% CI 0.77-0.91), sensitivity 73.75% (95%CI 62.71%-82.95%); specificity 76.92% (95%CI 60.67-88.87%)]. Models with CT hypoattenuation were similar to a model with DWI-FLAIR mismatch in ability to discriminate PH (p>0.5).

Conclusion: Degree of hypoattenuation on NCCT can be used in place of DWI-FLAIR mismatch to identify patients with wake up strokes or unknown time of onset.

Article Details

How to Cite
QAZI, Emmad et al. Non-Contrast CT in Place of MRI Mismatch in the Imaging Triage of Acute Ischemic Stroke Patients. Medical Research Archives, [S.l.], v. 4, n. 6, oct. 2016. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/608>. Date accessed: 17 nov. 2024.
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Keywords
Non contrast CT hypoattenuation, MRI DWI-FLAIR mismatch, acute ischemic stroke
Issue
Vol 4 No 6 (2016): Vol. 4 issue 6, October,2016
Section
Research Articles

The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.

 

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