Imaging of the brain in acute ischaemic stroke: comparison of computed tomography and magnetic resonance diffusion-weighted imaging
Imaging of the brain in acute ischaemic stroke: comparison of computed tomography and magnetic resonance diffusion-weighted imaging
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DOI：
10.1136/jnnp.2004.059261
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发表时间：
2005-11-01
影响因子：
11
通讯作者：
Buchan, AM
中科院分区：
文献类型：
--
作者：
Barber, PA;Hill, MD;Buchan, AM
背景和目的：关于急性卒中的最佳成像技术存在争议。有人假设，CT是与DWI相媲美，当两者都读系统使用定量scoring.Methods：缺血性中风患者谁有CT在6小时内和DWI在7小时内发病。5名阅片人使用定量评分系统（ASPECTS）读取基线（B）并随访CT和DWI。还通过前瞻性记录排除原因，在接受组织纤溶酶原激活剂（tPA）治疗的患者中评估了MRI在急性卒中中的应用。临床随访3个月，结果：连续100例患者（入院中位数NIHSS = 9）的bDWI和bCT。平均bDWI和bCT ASPECTS呈正相关（p < 0.001）。在所有模式和时间段内，评定者间一致性水平从良好到优秀不等。Bland-Altman图显示bCT和bDWI之间的变异性大于24小时。bCT和bDWI之间的差异为（2个方面）分。在ASPECTS 8-10的bCT扫描中，81%的DWI ASPECTS 8-10。bCT ASPECTS评分为8-10的患者在90天时获得有利结局的可能性是评分为0-7的患者的1.9倍（95% CI 1.1 - 3.1，p = 0.002）。bDWI方面8-10的有利结局的相对可能性为1.4（95% CI 1.0 - 1.9，p = 0.10）。接受tPA的患者45%的禁忌症，以紧急MRI.Conclusion：CT和DWI之间的差异，在可视化早期梗死是小的，当使用ASPECTS。CT比MRI更快，更容易获得，因此是治疗急性卒中的更好的神经影像学方式。
Background and objectives: Controversy exists about the optimal imaging technique in acute stroke. It was hypothesised that CT is comparable with DWI, when both are read systematically using quantitative scoring.Methods: Ischaemic stroke patients who had CT within six hours and DWI within seven hours of onset were included. Five readers used a quantitative scoring system ( ASPECTS) to read the baseline (b) and follow up CT and DWI. Use of MRI in acute stroke was also assessed in patients treated with tissue plasminogen activator (tPA) by prospectively recording reasons for exclusion. Patients were followed clinically at three months.Results: bDWI and bCT were available for 100 consecutive patients (admission median NIHSS = 9). The mean bDWI and bCT ASPECTS were positively related (p < 0.001). The level of interrater agreement ranged from good to excellent across all modalities and time periods. Bland-Altman plots showed more variability between bCT and bDWI than at 24 hours. The difference between bCT and bDWI was (2 ASPECTS points. Of bCT scans with ASPECTS 8-10, 81% had DWI ASPECTS 8-10. Patients with bCT ASPECTS of 8-10 were 1.9 times more likely to have a favourable outcome at 90 days than those with a score of 0-7 (95% CI 1.1 to 3.1, p = 0.002). The relative likelihood of favourable outcome with a bDWI ASPECTS 8-10 was 1.4 (95% CI 1.0 to 1.9, p = 0.10). Of patients receiving tPA 45% had contraindications to urgent MRI.Conclusion: The differences between CT and DWI in visualising early infarction are small when using ASPECTS. CT is faster and more accessible than MRI, and therefore is the better neuroimaging modality for the treatment of acute stroke.