COMPARATIVE SENSITIVITY OF COMPUTED TOMOGRAPHY VS. MAGNETIC RESONANCE IMAGING FOR DETECTING ACUTE POSTERIOR FOSSA INFARCT
COMPARATIVE SENSITIVITY OF COMPUTED TOMOGRAPHY VS. MAGNETIC RESONANCE IMAGING FOR DETECTING ACUTE POSTERIOR FOSSA INFARCT
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DOI：
10.1016/j.jemermed.2011.05.101
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发表时间：
2012-05-01
影响因子：
1.5
通讯作者：
Greer, David M.
中科院分区：
文献类型：
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作者：
Hwang, David Y.;Silva, Gisele S.;Greer, David M.
背景：后窝卒中，特别是与基底动脉闭塞相关的卒中，具有较高的进展风险和较差的神经预后。临床病史和检查往往不够敏感或特异性检测。研究目的：由于这一人群将受益于急性干预，如静脉注射和动脉内组织纤溶酶原激活剂、机械取栓和神经系统恶化的强化监测，本研究检验了非对比头部计算机断层扫描（NCCT）在急诊科诊断后窝卒中的敏感性。方法：本研究分析了前瞻性收集的急性缺血性卒中患者数据库，这些患者在症状出现30小时内进行了头部NCCT，随后在NCCT后6小时内进行脑磁共振成像（MRI）发现后颅窝梗死。结果：67例患者在MRI上发现后颅窝弥散受限。美国国立卫生研究院卒中量表（NIHSS）评分范围从0到36，中位数为3。只有28例患者在初始NCCT扫描中有梗死的证据。NCCT扫描的时间范围为症状出现后1.2至28.9小时。NCCT的敏感性为41.8%（95%置信区间为30.1-54.4）。从症状出现到NCCT阴性和随后的弥散加权成像MRI阳性之间的最长时间为26.7小时。结论：头部NCCT成像通常对检测后窝梗死不敏感。这种分布中中风的时间演变，加上波束硬化伪影，可能导致这种限制。当怀疑后颅窝卒中且NCCT不能诊断时，MRI是排除后颅窝梗死的首选成像方式。(C) 2012爱思唯尔公司
Background: Posterior fossa strokes, particularly those related to basilar occlusion, pose a high risk for progression and poor neurological outcomes. The clinical history and examination are often not adequately sensitive or specific for detection. Study Objectives: Because this population stands to benefit from acute interventions such as intravenous and intra-arterial tissue plasminogen activator, mechanical thrombectomy, and intensive monitoring for neurologic deterioration, this study examined the sensitivity of non-contrast head computed tomography (NCCT) for diagnosing posterior fossa strokes in the emergency department. Methods: This study analyzed a prospectively collected database of acute ischemic stroke patients who underwent head NCCT within 30 h of symptom onset and who were subsequently found to have a posterior fossa infarct on brain magnetic resonance imaging (MRI) performed within 6 h of the NCCT. Results: There were 67 patients identified who had restricted diffusion on MRI in the posterior fossa. The National Institutes of Health Stroke Scale (NIHSS) scores ranged from 0 to 36, median 3. Only 28 patients had evidence of infarction on the initial NCCT scan. The timing of NCCT scans ranged from 1.2 to 28.9 h after symptom onset. The sensitivity of NCCT was 41.8% (95% confidence interval 30.1-54.4). The longest period of time between symptom onset and a negative NCCT with a subsequent positive diffusion-weighted imaging MRI was 26.7 h. Conclusions: Head NCCT imaging is frequently insensitive for detecting posterior fossa infarction. Temporal evolution of strokes in this distribution, coupled with beam-hardening artifact, may contribute to this limitation. When a posterior fossa stroke is suspected and the NCCT is non-diagnostic, MRI is the preferred imaging modality to exclude posterior fossa infarction. (C) 2012 Elsevier Inc.