CT of the head in stroke - Revision history

Mikael Häggström: /* Reporting */ Template

2019-07-30T06:49:15Z

Reporting: Template

Mikael Häggström: /* Subsequent MRI */ Report

2019-07-28T12:17:54Z

Subsequent MRI: Report

Mikael Häggström: /* Quantification of ischemic involvement - ASPECTS */ Cleanup

2018-12-25T17:07:28Z

Quantification of ischemic involvement - ASPECTS: Cleanup

Mikael Häggström: /* Quantification of ischemic involvement - ASPECTS */ Related to thrombolysis contraindications

2018-12-25T16:55:26Z

Quantification of ischemic involvement - ASPECTS: Related to thrombolysis contraindications

Mikael Häggström: /* Non-contrast CT */ Redundant

2018-12-24T19:09:35Z

Non-contrast CT: Redundant

Mikael Häggström: /* Subsequent MRI */ Seldom

2018-12-24T18:57:43Z

Subsequent MRI: Seldom

Mikael Häggström: Linked to MRI

2018-12-24T18:26:56Z

Linked to MRI

Mikael Häggström: /* Computed tomography angiography (CTA) */ better

2018-12-24T18:10:52Z

Computed tomography angiography (CTA): better

Mikael Häggström: /* Computed tomography angiography (CTA) */ Formatting

2018-12-24T18:08:37Z

Computed tomography angiography (CTA): Formatting

Mikael Häggström: Defined

2018-12-24T17:55:44Z

Defined

@@ Line 158: / Line 158: @@
 In case of angiography, report:
 *Normal/Unremarkable contrast filling of larger vessels of the cerebrum and cerebellum (or pathology thereof).
+{{Reporting}}
 {{Bottom}}

← Older revision		Revision as of 12:17, 28 July 2019
Line 150:		Line 150:

	{{Main\|MRI of the head in stroke}}		{{Main\|MRI of the head in stroke}}
		+
		+	==Reporting==
		+	Report even the absence of:
		+	*Intracranial hemorrhage
		+	*Delineable infarction
		+
		+	In case of angiography, report:
		+	*Normal/Unremarkable contrast filling of larger vessels of the cerebrum and cerebellum (or pathology thereof).
		+
	{{Bottom}}		{{Bottom}}

@@ Line 77: / Line 77: @@
 |+ CT findings that generally contraindicate thrombolysis<ref name="FrankGrotta2013">{{cite journal|last1=Frank|first1=Benedikt|last2=Grotta|first2=James C.|last3=Alexandrov|first3=Andrei V.|last4=Bluhmki|first4=Erich|last5=Lyden|first5=Patrick|last6=Meretoja|first6=Atte|last7=Mishra|first7=Nishant K.|last8=Shuaib|first8=Ashfaq|last9=Wahlgren|first9=Nils G.|last10=Weimar|first10=Christian|last11=Lees|first11=Kennedy R.|title=Thrombolysis in Stroke Despite Contraindications or Warnings?|journal=Stroke|volume=44|issue=3|year=2013|pages=727–733|issn=0039-2499|doi=10.1161/STROKEAHA.112.674622}}</ref>
 |-
-| Edema, dense middle cerebral artery sign, loss of insular ribbon, lenticular hypodensity, acute infarction, sulcal effacement, or ASPECT-score of 8 or 9§
+| Edema, dense middle cerebral artery sign, loss of insular ribbon, lenticular hypodensity, acute infarction, sulcal effacement, or ASPECT-score of 8 or 9
 |-
-| Mass effect, infarction of >1/3 of the middle cerebral artery territory, midline shift, or ASPECT-score of ≤7§
+| Mass effect, infarction of >1/3 of the middle cerebral artery territory, midline shift, or ASPECT-score of ≤7
 |-
 | ASPECT-score of ≤7

@@ Line 62: / Line 62: @@
 At cut near top of the lateral ventricles: M4 - anterior third of cortex; M5 - middle third of
 cortex; M6 - posterior third of cortex.<ref name=Mirza2016/>]]
 Alberta Stroke Program Early CT score (ASPECTS) is a 10-point quantitative topographic CT
-scan score developed in 2001 offering a reproducible grading system to score early ischemia in
+scan score offering a reproducible grading system to score early ischemia in
-anterior circulation strokes to better direct treatment and reduce the variability of observations
+anterior circulation strokes to better direct treatment and reduce the variability of observations. Using two standard axial CT slices; one at the level of the thalamus and basal ganglia, and
-. Using two standard axial CT slices; one at the level of the thalamus and basal ganglia, and
+one just rostral to the basal ganglia, the MCA territory is divided into 10 regions, each accounting
 for one point in the total score, for each involved area, a point is subtracted. This score correlated
 inversely with the NIHSS (National Institutes of Health Stroke Score) with clinicians agreeing it
 superior and more systematic compared to the conventional 1/3 MCA rule to exclude thrombolytic
-treatment . The ASPECTS method is not without its limitations; such as difficulty in scoring
+treatment. The ASPECTS method is not without its limitations; such as difficulty in scoring
 due to age related periventricular white matter changes or streak artifacts in the base of the skull
-or tilt and motion artifacts. (ASPECTS diagram).<ref name=Mirza2016/>
+or tilt and motion artifacts..<ref name=Mirza2016/>
 ==Computed tomography angiography (CTA)==

@@ Line 11: / Line 11: @@
 ==Non-contrast CT==
-NCCT is performed as a first line in neuroimaging as it is usually considered gold standard in
+Non-contrast CT in early infarction has a variable detection rate of about 65% in cases imaged within 6 hours. A description of these signs is below.<ref name=Mirza2016/>
 ;Hyperdense artery/MCA sign

@@ Line 142: / Line 142: @@
 ==Subsequent MRI==
-Where available, MRI provides further diagnostics of a stroke.
+MRI is seldom performed after CT of stroke in Swedish practice,<ref>{{NU Hospital Group}}</ref> but can offer additional diagnostics:
 [[File:Stroke imaging algorithm.png|thumb|350px|center|Algorithm.]]
 {{Main|MRI of the head in stroke}}
 {{Bottom}}

@@ Line 141: / Line 141: @@
 </gallery>
-MRI is more sensitive than CT in detecting ischemic changes, similar to CT with respect to
+==Subsequent MRI==
-diagnosing hemorrhage, and it remains the gold standard for imaging in acute focal neurological
+Where available, MRI provides further diagnostics of a stroke.
-deficits . Multimodal MRI (different imaging sequences) provides detailed visualization of
+[[File:Stroke imaging algorithm.png|thumb|350px|center|Algorithm.]]
-brain and vessel anatomy, including perfusion data with a higher sensitivity and specificity than
-CT to detect stroke mimics . The complete MR imaging protocol requires approximately 15
+{{Main|MRI of the head in stroke}}
 {{Bottom}}

@@ Line 96: / Line 96: @@
 File:Volume rendered CT angiography of anterior communicating artery aneurysm.png|Figure 5C: Volume rendering of cerebal computed tomography angiogram (CTA) with
 skull surface overlay demonstrates an anterior communicating artery aneurysm (1). Dedicated images from CTA of the Circle of Willis isolate the aneurysm (arrow) (2).<ref name=Mirza2016/>
-File:Volume rendered CT angiography of posterior communicating artery aneurysm.png|Figure 5D: This patient had subarachnoid hemorrhage on non-contrast CT scan. Left image is a maximum intensity projection and right is a volume rendering CTA (to identify source of hemorrhage) which show aneurysm like pouching (red arrows) in the PCOM (2).<ref name=Mirza2016/>
+File:Volume rendered CT angiography of posterior communicating artery aneurysm.png|Figure 5D: This patient had subarachnoid hemorrhage on non-contrast CT scan. Left image is a maximum intensity projection and right is a volume rendering CTA (to identify source of hemorrhage) which show aneurysm like pouching (red arrows) in the PCOM (2). On conventional angiography, these aneurysms were proved to be the infundibulum of vessels. The diagnosis of aneurysms <3 mm on CTA is often tenuous and requires angiographic confirmation.<ref name=Mirza2016/>
-File:Volume rendered CT angiography of subtle anterior communicating artery aneurysm.png|Two more volume renderings of the same case, also showing an aneurysm-like pouching in the ACOM. On conventional angiography, these aneurysms were proved to be the infundibulum of vessels. The diagnosis of aneurysms <3 mm on CTA is often tenuous and requires angiographic confirmation.<ref name=Mirza2016/>
+File:Volume rendered CT angiography of subtle anterior communicating artery aneurysm.png|Two more volume renderings of the same case, also showing an aneurysm-like pouching in the ACOM.<ref name=Mirza2016/>
 </gallery>

@@ Line 94: / Line 94: @@
 File:CT angiography of a vascular malformation with intraventricular hemorrhage.png|Figure 5A: Sagital reformatted images from CT angiogram identify an enhancing vascular malformation (arrow), which was the etiology of the intraventricular hemorrhage.<ref name=Mirza2016/>
 File:CT angiography of basilar tip aneurysm.png|Figure 5B: Computed tomography angiogram in the axial projection demonstrates a focal basilar tip artery aneurysm (arrow).<ref name=Mirza2016/>
-File:Volume rendered CT angiography of anterior communicating artery aneurysm.png|Figure 5C: [[Volume rendering]] of cerebal computed tomography angiogram (CTA) with
+File:Volume rendered CT angiography of anterior communicating artery aneurysm.png|Figure 5C: Volume rendering of cerebal computed tomography angiogram (CTA) with
 skull surface overlay demonstrates an anterior communicating artery aneurysm (1). Dedicated images from CTA of the Circle of Willis isolate the aneurysm (arrow) (2).<ref name=Mirza2016/>
 </gallery>
 CTA Source Images: CTA SI using the images in a CTA, cerebral perfusion can be assessed as

@@ Line 1: / Line 1: @@
 {{Top
 |author1=[[User:Mikael Häggström|Mikael Häggström]]
-|author2=Authors if integrated Creative Commons article<ref name=Mirza2016/>
+|author2=Authors if integrated Creative Commons article<ref name=Mirza2016>{{cite web|url=http://www.smgebooks.com/neuroimaging/chapters/NI-16-06.pdf|title=Neuroimaging in Acute Stroke|author=Shazia Mirza and Sankalp Gokhale|date=2016-07-25}}<br>[https://creativecommons.org/licenses/by/4.0/ Attribution 4.0 International (CC BY 4.0)]</ref>
 |author3=
 }}