scholarly journals The Effect of Window Width and Window-level Settings in Non-enhanced Head CT to Increase the Diagnostic Value of Subacute Ischemic Stroke

2018 ◽  
Vol 3 (11) ◽  
pp. 679
Author(s):  
L Muqmiroh ◽  
A Setyanur ◽  
R Maimanah ◽  
B P Witjaksono
Keyword(s):  
Ischemic Stroke ◽  
Diagnostic Value ◽  
Head Ct ◽  
Window Width ◽  
Window Level

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Abstract WMP18: CT Work-Up of Patients Suspected of Acute Ischemic Stroke: Perfusion-CT Adds Value Compared to Clinical Evaluation, Noncontrast Head CT and CT-Angiogram in Terms of Predicting Outcome

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Guangming Zhu ◽  
Patrik Michel ◽  
Amin Aghaebrahim ◽  
James T Patrie ◽  
Wenjun Xin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Data ◽  
Multivariate Regression ◽  
Multivariate Regression Analysis ◽  
Perfusion Ct ◽  
Infarct Core ◽  
Head Ct ◽  
Ct Angiogram ◽  
Work Up

BACKGROUND AND PURPOSE: To determine whether Perfusion-CT (PCT) adds value to Noncontrast head CT (NCT), CT-Angiogram (CTA) and clinical assessment in patients suspected of acute ischemic stroke. METHODS: We retrospectively reviewed the clinical and imaging data collected in 165 patients with acute ischemic stroke. ASPECTS score was calculated from NCT. CTA was reviewed for site of occlusion and collateral flow score. PCT was used to calculate the volumes of infarct core and ischemic penumbra on admission. Recanalization status was assessed on follow-up imaging. Clinical data included age, time from onset to baseline imaging, time from baseline imaging to reperfusion therapy, time from baseline imaging to recanalization imaging, NIHSS at baseline, treatment type and modified Rankin score (mRS) at 90 days. In a first multivariate regression analysis, we used volume of PCT penumbra and infarct core as outcome, and assessed whether they could be predicted from clinical variables, NCT and/or CTA. In a second multivariate regression analysis, we used mRS at 90 days as outcome, and determined which imaging and clinical variables predicted it best. RESULTS: 165 patients were identified. Mean±SD time from onset to baseline imaging was 6.7±8.7 hrs. 76 had a good outcome (90-day mRS 0-2), 89 had a poor outcome. Mean±SD PCT infarct was 44.8±46.5 ml. Mean±SD PCT penumbra was 47.0±33.9 ml. PCT infarct could be predicted by clinical data, NCT, CTA, and combinations of this data (P<0.05); the best predictive model included the clinical data, plus NCT and CTA. PCT Penumbra could NOT be predicted by clinical data, NCT, and CTA. In terms of predicting mRS at 90 days, all of variables but NCT and CTA were significantly associated with 90-day mRS outcome. The single most important predictor was recanalization status (P<0.001). PCT penumbra volume (P=0.001) was also a predictor of clinical outcome, especially when considered in conjunction with recanalization through an interaction term (P<0.001). CONCLUSION: PCT penumbra represents independent information, which cannot be predicted by clinical, NCT, and CTA data. PCT penumbra is an important determinant of clinical outcome, and adds relevant clinical information compared to a stroke CT work-up including NCT and CTA.

Window width/window level

2018 ◽  
pp. 107-114
Author(s):  
Gert Tempelman
Keyword(s):  
Window Width ◽  
Window Level

scholarly journals Multiphasic Computed Tomography Angiography Findings for Identifying Pseudo-Occlusion of the Internal Carotid Artery

Stroke ◽  
2020 ◽  
Vol 51 (8) ◽  
pp. 2558-2562
Author(s):  
Jai Ho Choi ◽  
Jinhee Jang ◽  
Jaseong Koo ◽  
Kook-Jin Ahn ◽  
Yong Sam Shin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Computed Tomography Angiography ◽  
Internal Carotid ◽  
Diagnostic Value ◽  
Fisher Exact Test ◽  
Anterior Circulation

Background and Purpose: Differentiation between pseudo-occlusion and true occlusion of internal carotid artery (ICA) is important in treatment planning for acute ischemic stroke patients. We compared the findings of multiphasic computed tomography angiography between cervical ICA pseudo-occlusion and true occlusion at the cervical ICA in patients with anterior circulation acute ischemic stroke to determine their diagnostic value. Methods: Thirty patients with nonvisualization of the proximal ICA were included. Diagnosis of pseudo- or true occlusion of the ICA was made based on digital subtraction angiography. Diagnostic performances of multiphasic computed tomography angiography findings—(1) a flame-shaped stump and (2) delayed contrast filling at the cervical ICA— were evaluated and compared. The Fisher exact test, χ 2 test, or Wilcoxon rank-sum test and McNemar test were used in the data analysis. Results: Twelve patients had true proximal ICA occlusion and 18 had pseudo-occlusion. Delayed contrast filling at the cervical ICA on multiphasic computed tomography angiography was found in all patients with pseudo-occlusion of the ICA, while 1 case of true occlusion showed delayed contrast filling ( P <0.001). The presence of a flame-shaped stump was not significantly different between the pseudo- and true occlusion groups. The sensitivity of delayed contrast filling (0.94 [95% CI, 0.73–1]) was significantly higher than that of flame-shaped stump (0.75 [95% CI, 0.36–0.83]). Conclusions: We demonstrated that the delayed filling sign on multiphasic computed tomography angiography could be a useful and readily available finding for differentiating proximal ICA pseudo-occlusion from true occlusion.

Accuracy and Reliability of the Recommendation for IV Thrombolysis in Acute Ischemic Stroke Based on Interpretation of Head CT on a Smartphone or a Laptop

2020 ◽  
Vol 214 (4) ◽  
pp. 877-884
Author(s):  
Antonio J. Salazar ◽  
Nicolás Useche ◽  
Sonia Bermúdez ◽  
Aníbal J. Morillo ◽  
Oscar Tórres ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Head Ct

Effect of MRI Images Based on Semi-Automatic Volume Segmentation in Patients with Acute Ischemic Stroke

2021 ◽  
Vol 11 (1) ◽  
pp. 223-229
Author(s):  
Peng Ji ◽  
Limin Jiang ◽  
Xiangdong Guo ◽  
Yajing Sun ◽  
Xueping Qu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Automatic Segmentation ◽  
Diagnostic Value ◽  
Processing Method ◽  
Segmentation Method ◽  
Adc Value ◽  
Conventional Mri ◽  
Infarct Area ◽  
Signal Characteristics

Objective: To study the MRI and CT characteristics of different periods of acute ischemic stroke and evaluate its diagnostic value by using semi-automatic mention segmentation method. Methods: CT, conventional MRI and DWI were performed in 64 patients with acute ischemic stroke. The average ADC value and average relative ADC (rADC) value of infarct lesions were measured and statistically analyzed. Results: There were no significant differences in CT, conventional MRI, and DWI signal characteristics between 1 and 7 days after the onset of acute ischemic stroke. The average ADC value and the average rADC value decreased, but the average rADC in the infarct area increased with time. The rADC value was statistically significant with the onset of 1d, 2d, 3d, and 4d (P < 0.05), but not statistically significant with the onset of 5d and 6d (P > 0.05). Conclusion: In the image processing method of semi-automatic segmentation method, the characteristics of CT, conventional MRI, and DWI signals combined with the evolution of rADC values over time can help to judge the pathophysiological changes of acute ischemic stroke, which is ischemic. Stroke staging and treatment guidance are provided.

The Diagnostic Value of N-terminal Pro-brain Natriuretic Peptide in Differentiating Cardioembolic Ischemic Stroke

2013 ◽  
Vol 22 (4) ◽  
pp. 554-560 ◽  
Author(s):  
Shokoufeh Hajsadeghi ◽  
Ladan Kashani Amin ◽  
Hooman Bakhshandeh ◽  
Mohammad Rohani ◽  
Amir Reza Azizian ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Diagnostic Value

scholarly journals The Risk of Developing Ischemic Stroke in Patients After Exacerbation of Ischemic Heart Disease

Kardiologiia ◽  
2020 ◽  
Vol 60 (8) ◽  
pp. 46-53
Author(s):  
V. A. Brazhnik ◽  
L. O. Minushkina ◽  
N. R. Khasanov ◽  
E. D. Kosmacheva ◽  
M. A. Chichkova ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischemic Stroke ◽  
Ischemic Heart Disease ◽  
Roc Curve ◽  
Prognostic Model ◽  
External Validation ◽  
Diagnostic Value ◽  
Ischemic Heart ◽  
Blood Pressure Goal ◽  
Coronary Syndrome

Aim      To develop a model for evaluating the risk of stroke in patients after exacerbation of ischemic heart disease who were admitted to the hospitals included into a vascular program.Materials and methods This study included 1803 patients with acute coronary syndrome (ACS) from four institutions of Moscow, Kazan, Astrakhan, and Krasnodar where the vascular program was established. Mean age of patients was 64.9±12.78 years, 62,1 % of them were men. The patients were followed up for one year after the discharge from the hospital. External validation of the developed prognostic model was performed on a cohort of patients with ACS included into the RECORD-3 study.Results During the follow-up period, 42 cases of ischemic stroke were observed. The risk of ischemic stroke was associated with the presence of atrial fibrillation (odd ratio (OR) 2.640; р=0.037), diabetes mellitus (OR 2.718; р=0.041), and chronic heart failure (OR 7.049; р=0.011). Protective factors were high-density lipoprotein cholesterol >1 mmol/l (OR 0.629; р=0.041), percutaneous coronary intervention during an index hospitalization (OR 0.412; р=0.042), anticoagulant treatment (OR 0.670; р=0.049), and achieving the blood pressure goal (OR 0.604; р=0.023). The prognostic model developed on the basis of regression analysis showed a good predictive value (area under the ROC curve, 0.780), sensitivity of 80 %, and specificity of 64.6 %. The diagnostic value of other scales for risk assessment was somewhat lower. The area under the ROC curve was 0.692±0.0245 for the GRACE scale and 0.708±0.0334 for CHA2DS2‑VASc. In the external validation of the scale based on data of the RECORD-3 study, the diagnostic value was lower although satisfactory as well (area under the ROC curve, 0.651); sensitivity was 78.9 %, and specificity was 52.3 %.Conclusion      The study resulted in development of a simple clinical scale, which will probably allow identifying groups at risk of stroke more precisely than with standard scales. 

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