Multiparametric multidetector computed tomography scanning on suspicion of hyperacute ischemic stroke: validating a standardized protocol

Abstract

Multidetector computed tomography (MDCT) scanning has enabled the early diagnosis of hyperacute brain ischemia. We aimed at validating a standardized protocol to read and report MDCT techniques in a series of adult patients. The inter-observer agreement among the trained examiners was tested, and their results were compared with a standard reading. No false positives were observed, and an almost perfect agreement (Kappa>0.81) was documented when the CT angiography (CTA) and cerebral perfusion CT (CPCT) map data were added to the noncontrast CT (NCCT) analysis. The inter-observer agreement was higher for highly trained readers, corroborating the need for specific training to interpret these modern techniques. The authors recommend adding CTA and CPCT to the NCCT analysis in order to clarify the global analysis of structural and hemodynamic brain abnormalities. Our structured report is suitable as a script for the reproducible analysis of the MDCT of patients on suspicion of ischemic stroke.

Multidetector computed tomography angiography in clinically suspected hyperacute ischemic stroke in the anterior circulation: an etiological workup in a cohort of Brazilian patients

“…All examinations were conducted with a previously reported institutional protocol 14 with a minimum dose of ionizing radiation and intravenous iodinated contrast in a Philips Brilliance 64-slice CT scanner (Brilliance CT 64 Channel, Philips Medical, Eindhoven, The Netherlands). The examinations included non-contrast computed tomography and cervical and intracranial MDCTA, which required up to 5 min.…”

“…In addition, it is an accurate and powerful noninvasive tool for assessing carotid artery disease in the setting of hyperacute ischemic stroke, including the detection of atherosclerosis involvement in extra-and intra-cranial vessels. However, only a few studies have reported the use of MDCTA to define stroke etiology in our population 14 . To the best of our knowledge, MDCTA has not yet been used to study the etiology of stroke in a Latin American population.…”

Multimodal multidetector computed tomography scanning and the validation of a standardized protocol

“…The interobserver agreement between Neuroradiology fellows was higher than between the general Radiology residents 5 . The paper also presents an important point to be discussed: the need of an adequate post-processing of CT perfusion and CT-angio.…”

“…In the paper from Pacheco et al 5 , there was no false negative diagnoses of acute ischemic stroke when the different CT techniques using a standardized reading protocol were associated. The definition of a standardized step-by-step interpretation in multiparametric multidetector CT in the evaluation of the signs of hyperacute stroke can aid in the detection of subtle signs of this type of lesion.…”

“…However, MRI is not always available in all emergency units and it has higher costs than CT. Multimodal CT has also been increasingly used for this purpose, being a very fast and reliable imaging examination, very adequate for an emergency situation 4 . The paper in this issue of Arquivos de Neuropsiquiatria: "Multiparametric multidetector computed tomography scanning of hyperacute ischemic stroke: validating a standardized protocol" by Pacheco et al 5 suggests a multimodal protocol for hyperacute ischemic stroke including non-contrast CT, CT-perfusion and CT-angiography (CT-angio). This paper also presents an interesting step-by-step orientation for the interpretation of these exams, as well as the role of the reader experience in the final detection of ischemic stroke.…”