CT stroke window settings: an unfortunate misleading misnomer?

Turner, Paul J.; Holdsworth, Gill

doi:10.1259/bjr/99730184

Cited by 21 publications

(14 citation statements)

References 5 publications

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“…[1, 2, 8, 12, 14, 20] As opposed to magnetic resonance imaging (MRI), CT is relatively rapid, cheap, and widely available. [21, 22] In addition, CT is able to identify most significant intracranial pathologies. Though its resolution is lower than that of MRI, specifically in soft tissue contrast, the use of narrow window width helps to increase the detection of more subtle lesions.…”

Section: Commentmentioning

confidence: 99%

“…Though its resolution is lower than that of MRI, specifically in soft tissue contrast, the use of narrow window width helps to increase the detection of more subtle lesions. [22] Non-contrast CT is primarily used to determine the presence of hemorrhagic stroke while simultaneously ruling out neoplasms or other space occupying lesions that may mimic stroke symptoms. [21, 23–25] Although the appearance of the ischemic core after infarction is quite specific on non-contrast CT, this modality has only a 45%–70% sensitivity in the hyper-acute period (<6 h), as the associated early changes can be very subtle.…”

Section: Commentmentioning

confidence: 99%

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The Role of Head Computed Tomography Imaging in the Evaluation of Postoperative Neurologic Deficits in Cardiac Surgery Patients

Beaty

Arnaoutakis

Grega

et al. 2013

The Annals of Thoracic Surgery

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Background Computed tomography(CT) scans of the head without contrast are routinely obtained to evaluate neurologic deficits after cardiac surgery(CS), but their utility is unknown. We evaluated our experience with this imaging modality to determine its value. Methods We retrospectively identified CS patients with postoperative neurologic deficits occurring during the first week after surgery between January 2000 and December 2012. Stroke was defined by neurologist’s determination, while a non-focal deficit(NFD) was defined by the presence of seizure, delirium, or cognitive impairment. We defined early non-contrast head CT as occurring within 7 days of surgery. Outcomes included positive findings on CT, in-hospital mortality and length of stay(LOS). Multivariate logistic regression identified predictors of positive findings on head CT. Results Within the population of 11,070 postoperative patients, 451 had early non-contrast head CT scans (4%). 202(44.7%) were associated with stroke and 249(55.2%) with NFD. Among stroke patients, 40/202(20%) showed acute infarction, 17/202(8%) showed sub-acute infarction, and 5/202(2%) showed hemorrhage. Among NFD patients, 1/248(0.4%) showed acute infarction, 4/248(1.6%) sub-acute infarction, and 1/248(0.4%) hemorrhage. There was no difference in in-hospital mortality(S:42/201(21%) versus NFD:41/248(16%), p=0.2) or LOS (S:24d versus NFD:22d, p=0.5). On multivariable logistic regression, only focal deficits and aortic procedures predicted a positive finding on CT scan. Conclusions To our knowledge, this is the only modern study to review the utility of early postoperative non-contrast head CT in CS patients. With focal neurologic deficits, this imaging modality was positive for approximately one third of patients, but rarely positive for NFD. Its use in this setting has limited utility.

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Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

The Role of Head Computed Tomography Imaging in the Evaluation of Postoperative Neurologic Deficits in Cardiac Surgery Patients

Beaty

Arnaoutakis

Grega

et al. 2013

The Annals of Thoracic Surgery

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“…Turner and G. Holdsworth (2011) mentions the value of window width and window level used is 40 WW and WL 40 which can be used to improve the diagnosis of subacute ischemic stroke [10]. Meanwhile Charlie Chia-Tsong Hsu (2010) states that the value of the window width and windows at 8 WW and 20 WL level can increase detection sensitivity of acute ischemic stroke with the sensitivity level of 71% of 57% of the normal window settings (80 WW/20 WL).…”

Section: Discussionmentioning

confidence: 99%

“…Stroke window is a method of setting the window width and window-level narrow windows which are specifically used to diagnose ischemic stroke [9][10][11][12][13][14]. Using a particular arrangement, the main image of the acute and subacute ischemic stroke can be clearly seen [15].…”

Section: Introductionmentioning

confidence: 99%

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

Muqmiroh¹,

Setyanur²,

Maimanah³

et al. 2018

KSS

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Background: Non-enhanced head CT (NECT) was known as one of the modalities to assess subacute ischemic stroke. The values of window width (WW) and window level (WL) were influencing lesion conspicuity and diagnostic accuracy as well. The ability of physicians to detect parenchymal hypoattenuation depended on window width and window-level settings. Objective: To determine the best value of head NECT window width and window level in the subacute ischemic stroke. Material and method: Routine non-enhanced CT scanning was performed with the patient's head in a head holder with a 64 Slice MSCT Light speed (GE Medical Systems) in the hospital emergency department using the following non-helical scanning technique:120 kV, 625 mA, and 5-mm section thickness. Twenty six values of window width and window level of subacute ischemic stroke were made and assessed by 28 experienced radiologist. We found the best value of 35 WW 25 WL. This value was significantly better than brain window (p < 0.05). Conclusion: In summary, we have demonstrated that the detection of subacute ischemic stroke with non-enhanced head CT scanning was facilitated by window width and window-level settings. The 35 WW 25 WL setting was recommended to increase the diagnostic value of subacute stroke infarct.

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“…Therefore, the preparation of residents to take call needs to be extensive and focused on perceptual manifestations of neuroradiology in order to have optimal impact (Funaki et al 1997 ). One important maneuver during softcopy viewing on picture archiving and communication system (PACS) workstations would be to vary the window width and center level (for stroke, suggest 8 and 32, respectively, rather than the preset "brain" settings of 80 and 20) in order to improve contrast and detection of subtle signs (Lev et al 1999 ;Turner and Holdworth 2011 ) (Fig. 10.3a ).…”

Section: Avoiding Ct Pitfallsmentioning

confidence: 99%