• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • 2MM Podcast
  • Write for us
  • Contact Us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • All Specialties, All Recent Reports
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Pharma
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • AI Roundup
  • Pharma
  • The Scan+
  • Classics™+
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Podcasts
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • All Specialties, All Recent Reports
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Pharma
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • AI Roundup
  • Pharma
  • The Scan+
  • Classics™+
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Podcasts
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home The Classics Emergency Classics

Diffusion-weighted MRI highly sensitive, specific vs. CT in acute ischemic stroke [Classics Series]

byAaron Maxwell, MDandMarc Succi, MD
February 20, 2015
in Emergency Classics, General Medicine Classics, The Classics
Reading Time: 3 mins read
0
Share on FacebookShare on Twitter

1. Among patients with acute neurologic deficits presenting within six hours of symptoms onset, diffusion-weight magnetic resonance imaging (DWI) was shown to be significantly more sensitive and specific for the diagnosis of ischemic stroke than non-contrast computed tomography (NCCT).

Original Date of Publication: September 2002

Study Rundown: Thrombolysis is a widely accepted method for the management of acute ischemic stroke, with the goal of opening blocked vessels to restore blood flow to at-risk brain tissue. One of the primary requirements for the administration of intravenous thrombolytic drugs is the exclusion of intracranial hemorrhage as an explanation for a patient’s acute neurologic symptoms. NCCT is the method of choice for fast and accurate detection of intracranial bleeding. Its performance in the detection of early acute ischemic stroke, however, is generally poor, with a reported sensitivity of approximately 40-60% within the first six hours from symptom onset. DWI is an attractive alternative magnetic resonance imaging sequence that allows for the high-resolution depiction of areas of reduced blood flow in the brain much earlier than is generally possible with NCCT. In this comparative trial, patients presenting to the emergency department with symptoms concerning for acute ischemic stroke were assigned to undergo both NCCT and DWI in a randomized order. For each patient and for each imaging study, the presence or absence of stroke was determined alongside other parameters to determine the diagnostic utility of both methods. Imaging was obtained a mean of 180 and 189 minutes after symptoms onset, for CT and DWI respectively. The results revealed that DWI is significantly more sensitive and specific than NCCT for the diagnosis of acute ischemic stroke. Additionally, researchers found that interreader reliability differed greatly between the two imaging modalities, with almost perfect agreement when using DWI and only modest agreement when using NCCT, suggesting that DWI is less susceptible to interpretive errors than NCCT. This was the first trial to provide a randomized, head-to-head comparison of the two diagnostic imaging methods for stroke, and it served to significantly strengthen the evidence base in support of DWI that had been built in prior trials.

Click to read the study in Stroke

In-Depth [randomized controlled trial]: In this study, 54 consecutive patients presenting to a single academic medical center emergency department with symptoms concerning for acute ischemic stroke were prospectively enrolled to undergo both NCCT and DWI in a randomized order. Primary inclusion criteria included presentation for evaluation within six hours of symptom onset and a National Institute of Health Stroke Scale (NIHSS) greater than three, with higher values indicating greater stroke severity. All images were read by expert neuroradiologists and stroke neurologists and categorized according to the presence or absence of ischemic stroke, the vascular distribution of the stroke, the stroke subtype (none, lacunar, territorial, or hemodynamic), and other parameters. Readers were blinded to the specific details of each case.

Overall, NCCT demonstrated a sensitivity and specificity of 61% and 65%, respectively, for the diagnosis of acute ischemic stroke, and interreader reliability was moderate. DWI significantly outperformed NCCT, with a sensitivity and specificity of 91% and 95%, respectively, and almost perfect interreader reliability. Notably, no acute lacunar infarcts were visible on NCCT while four were diagnosed using DWI, suggesting that DWI may also be superior for the identification of specific stroke subtypes. All infarcts in this study were within the middle cerebral artery distribution, and the mean NIHSS of enrolled patients was 11 (range 3-27). The mean time from initial evaluation to the receipt of diagnostic imaging was comparable for both modalities (NCCT=180 minutes, DWI=189 minutes).

RELATED REPORTS

Impaired lipoprotein cholesterol ratio is associated with cognitive impairment in patients with stroke

Personalized visual perceptual learning digital therapy may improve vision post-stroke

Delayed alteplase has clinical benefits in posterior circulation stroke outcomes

Image: PD

©2015 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.

Tags: mristroke
Previous Post

Long-acting opioid use linked to higher risk of overdose

Next Post

Postmenopausal hormone replacement therapy use associated with increased ovarian cancer risk

RelatedReports

Quick Take: Functional Outcome of Intravenous Thrombolysis in Patients With Lacunar Infarcts in the WAKE-UP Trial
Chronic Disease

Impaired lipoprotein cholesterol ratio is associated with cognitive impairment in patients with stroke

June 4, 2025
Non-alcoholic fatty liver disease and risk of incident acute myocardial infarction and stroke: findings from matched cohort study of 18 million European adults
Chronic Disease

Personalized visual perceptual learning digital therapy may improve vision post-stroke

May 30, 2025
Stroke expansion following intra-arterial therapy may explain worse outcomes
Emergency

Delayed alteplase has clinical benefits in posterior circulation stroke outcomes

May 30, 2025
Quick Take: Functional Outcome of Intravenous Thrombolysis in Patients With Lacunar Infarcts in the WAKE-UP Trial
Chronic Disease

Low-frequency electrical stimulation effective for stimulation of the wrist extensors in patients after stroke

May 24, 2025
Next Post
Conjugated equine estrogens may elevate risk of venous thrombosis

Postmenopausal hormone replacement therapy use associated with increased ovarian cancer risk

Increased risk of subsequent melanoma after first melanoma diagnosis

Increased risk of subsequent melanoma after first melanoma diagnosis

Napping associated with poor sleep behavior and quality in children above 2 years

Napping associated with poor sleep behavior and quality in children above 2 years

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • Sacituzumab tirumotecan may have a role in the treatment of metastatic non-small cell lung cancer
  • Obicetrapib and ezetimibe combination therapy lowers LDL cholesterol in high-risk patients
  • Rectoscopy alone may be sufficient to evaluate for remission of ulcerative colitis
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • All Specialties, All Recent Reports
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Pharma
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • AI Roundup
  • Pharma
  • The Scan
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Podcasts
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account
No Result
View All Result

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.