Comparison of MRI and CT for detection of acute intracerebral hemorrhage

Stella Kidwell, Julio A. Chalela, Jeffrey L. Saver, Sidney Starkman, Michael D. Hill, Andrew M. Demchuk, John A. Butman, Nicholas Patronas, Jeffry R. Alger, Lawrence L. Latour, Marie L. Luby, Alison E. Baird, Megan C. Leary, Margaret Tremwel, Bruce Ovbiagele, Andre Fredieu, Shuichi Suzuki, J. Pablo Villabianca, Stephen Davis, Billy DunnJason W. Todd, Mustapha A. Ezzeddine, Joseph Haymore, John K. Lynch, Lisa Davis, Steven Warach

Research output: Contribution to journalArticle

469 Citations (Scopus)

Abstract

Context: Noncontrast computed tomography (CT) is the standard brain imaging study for the initial evaluation of patients with acute stroke symptoms. Multimodal magnetic resonance imaging (MRI) has been proposed as an alternative to CT in the emergency stroke setting. However, the accuracy of MRI relative to CT for the detection of hyperacute intracerebral hemorrhage has not been demonstrated. Objective: To compare the accuracy of MRI and CT for detection of acute intracerebral hemorrhage in patients presenting with acute focal stroke symptoms. Design, Setting, and Patients: A prospective, multicenter study was performed at 2 stroke centers (UCLA Medical Center and Suburban Hospital, Bethesda, Md), between October 2000 and February 2003. Patients presenting with focal stroke symptoms within 6 hours of onset underwent brain MRI followed by non-contrast CT. Main Outcome Measures: Acute intracerebral hemorrhage and any intracerebral hemorrhage diagnosed on gradient recalled echo (GRE) MRI and CT scans by a consensus of 4 blinded readers. Results: The study was stopped early, after 200 patients were enrolled, when it became apparent at the time of an unplanned interim analysis that MRI was detecting cases of hemorrhagic transformation not detected by CT. For the diagnosis of any hemorrhage, MRI was positive in 71 patients with CT positive in 29 (P<.001). For the diagnosis of acute hemorrhage, MRI and CT were equivalent (96% concordance). Acute hemorrhage was diagnosed in 25 patients on both MRI and CT. In 4 other patients, acute hemorrhage was present on MRI but not on the corresponding CT - each of these 4 cases was interpreted as hemorrhagic transformation of an ischemic infarct. In 3 patients, regions interpreted as acute hemorrhage on CT were interpreted as chronic hemorrhage on MRI. In 1 patient, subarachnoid hemorrhage was diagnosed on CT but not on MRI. In 49 patients, chronic hemorrhage, most often microbleeds, was visualized on MRI but not on CT. Conclusion: MRI may be as accurate as CT for the detection of acute hemorrhage in patients presenting with acute focal stroke symptoms and is more accurate than CT for the detection of chronic intracerebral hemorrhage.

Original languageEnglish (US)
Pages (from-to)1823-1830
Number of pages8
JournalJournal of the American Medical Association
Volume292
Issue number15
DOIs
StatePublished - Oct 20 2004
Externally publishedYes

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Cerebral Hemorrhage
Tomography
Magnetic Resonance Imaging
Hemorrhage
Stroke
Subarachnoid Hemorrhage
Neuroimaging
Multicenter Studies

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Kidwell, S., Chalela, J. A., Saver, J. L., Starkman, S., Hill, M. D., Demchuk, A. M., ... Warach, S. (2004). Comparison of MRI and CT for detection of acute intracerebral hemorrhage. Journal of the American Medical Association, 292(15), 1823-1830. https://doi.org/10.1001/jama.292.15.1823

Comparison of MRI and CT for detection of acute intracerebral hemorrhage. / Kidwell, Stella; Chalela, Julio A.; Saver, Jeffrey L.; Starkman, Sidney; Hill, Michael D.; Demchuk, Andrew M.; Butman, John A.; Patronas, Nicholas; Alger, Jeffry R.; Latour, Lawrence L.; Luby, Marie L.; Baird, Alison E.; Leary, Megan C.; Tremwel, Margaret; Ovbiagele, Bruce; Fredieu, Andre; Suzuki, Shuichi; Villabianca, J. Pablo; Davis, Stephen; Dunn, Billy; Todd, Jason W.; Ezzeddine, Mustapha A.; Haymore, Joseph; Lynch, John K.; Davis, Lisa; Warach, Steven.

In: Journal of the American Medical Association, Vol. 292, No. 15, 20.10.2004, p. 1823-1830.

Research output: Contribution to journalArticle

Kidwell, S, Chalela, JA, Saver, JL, Starkman, S, Hill, MD, Demchuk, AM, Butman, JA, Patronas, N, Alger, JR, Latour, LL, Luby, ML, Baird, AE, Leary, MC, Tremwel, M, Ovbiagele, B, Fredieu, A, Suzuki, S, Villabianca, JP, Davis, S, Dunn, B, Todd, JW, Ezzeddine, MA, Haymore, J, Lynch, JK, Davis, L & Warach, S 2004, 'Comparison of MRI and CT for detection of acute intracerebral hemorrhage', Journal of the American Medical Association, vol. 292, no. 15, pp. 1823-1830. https://doi.org/10.1001/jama.292.15.1823
Kidwell, Stella ; Chalela, Julio A. ; Saver, Jeffrey L. ; Starkman, Sidney ; Hill, Michael D. ; Demchuk, Andrew M. ; Butman, John A. ; Patronas, Nicholas ; Alger, Jeffry R. ; Latour, Lawrence L. ; Luby, Marie L. ; Baird, Alison E. ; Leary, Megan C. ; Tremwel, Margaret ; Ovbiagele, Bruce ; Fredieu, Andre ; Suzuki, Shuichi ; Villabianca, J. Pablo ; Davis, Stephen ; Dunn, Billy ; Todd, Jason W. ; Ezzeddine, Mustapha A. ; Haymore, Joseph ; Lynch, John K. ; Davis, Lisa ; Warach, Steven. / Comparison of MRI and CT for detection of acute intracerebral hemorrhage. In: Journal of the American Medical Association. 2004 ; Vol. 292, No. 15. pp. 1823-1830.
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abstract = "Context: Noncontrast computed tomography (CT) is the standard brain imaging study for the initial evaluation of patients with acute stroke symptoms. Multimodal magnetic resonance imaging (MRI) has been proposed as an alternative to CT in the emergency stroke setting. However, the accuracy of MRI relative to CT for the detection of hyperacute intracerebral hemorrhage has not been demonstrated. Objective: To compare the accuracy of MRI and CT for detection of acute intracerebral hemorrhage in patients presenting with acute focal stroke symptoms. Design, Setting, and Patients: A prospective, multicenter study was performed at 2 stroke centers (UCLA Medical Center and Suburban Hospital, Bethesda, Md), between October 2000 and February 2003. Patients presenting with focal stroke symptoms within 6 hours of onset underwent brain MRI followed by non-contrast CT. Main Outcome Measures: Acute intracerebral hemorrhage and any intracerebral hemorrhage diagnosed on gradient recalled echo (GRE) MRI and CT scans by a consensus of 4 blinded readers. Results: The study was stopped early, after 200 patients were enrolled, when it became apparent at the time of an unplanned interim analysis that MRI was detecting cases of hemorrhagic transformation not detected by CT. For the diagnosis of any hemorrhage, MRI was positive in 71 patients with CT positive in 29 (P<.001). For the diagnosis of acute hemorrhage, MRI and CT were equivalent (96{\%} concordance). Acute hemorrhage was diagnosed in 25 patients on both MRI and CT. In 4 other patients, acute hemorrhage was present on MRI but not on the corresponding CT - each of these 4 cases was interpreted as hemorrhagic transformation of an ischemic infarct. In 3 patients, regions interpreted as acute hemorrhage on CT were interpreted as chronic hemorrhage on MRI. In 1 patient, subarachnoid hemorrhage was diagnosed on CT but not on MRI. In 49 patients, chronic hemorrhage, most often microbleeds, was visualized on MRI but not on CT. Conclusion: MRI may be as accurate as CT for the detection of acute hemorrhage in patients presenting with acute focal stroke symptoms and is more accurate than CT for the detection of chronic intracerebral hemorrhage.",
author = "Stella Kidwell and Chalela, {Julio A.} and Saver, {Jeffrey L.} and Sidney Starkman and Hill, {Michael D.} and Demchuk, {Andrew M.} and Butman, {John A.} and Nicholas Patronas and Alger, {Jeffry R.} and Latour, {Lawrence L.} and Luby, {Marie L.} and Baird, {Alison E.} and Leary, {Megan C.} and Margaret Tremwel and Bruce Ovbiagele and Andre Fredieu and Shuichi Suzuki and Villabianca, {J. Pablo} and Stephen Davis and Billy Dunn and Todd, {Jason W.} and Ezzeddine, {Mustapha A.} and Joseph Haymore and Lynch, {John K.} and Lisa Davis and Steven Warach",
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T1 - Comparison of MRI and CT for detection of acute intracerebral hemorrhage

AU - Kidwell, Stella

AU - Chalela, Julio A.

AU - Saver, Jeffrey L.

AU - Starkman, Sidney

AU - Hill, Michael D.

AU - Demchuk, Andrew M.

AU - Butman, John A.

AU - Patronas, Nicholas

AU - Alger, Jeffry R.

AU - Latour, Lawrence L.

AU - Luby, Marie L.

AU - Baird, Alison E.

AU - Leary, Megan C.

AU - Tremwel, Margaret

AU - Ovbiagele, Bruce

AU - Fredieu, Andre

AU - Suzuki, Shuichi

AU - Villabianca, J. Pablo

AU - Davis, Stephen

AU - Dunn, Billy

AU - Todd, Jason W.

AU - Ezzeddine, Mustapha A.

AU - Haymore, Joseph

AU - Lynch, John K.

AU - Davis, Lisa

AU - Warach, Steven

PY - 2004/10/20

Y1 - 2004/10/20

N2 - Context: Noncontrast computed tomography (CT) is the standard brain imaging study for the initial evaluation of patients with acute stroke symptoms. Multimodal magnetic resonance imaging (MRI) has been proposed as an alternative to CT in the emergency stroke setting. However, the accuracy of MRI relative to CT for the detection of hyperacute intracerebral hemorrhage has not been demonstrated. Objective: To compare the accuracy of MRI and CT for detection of acute intracerebral hemorrhage in patients presenting with acute focal stroke symptoms. Design, Setting, and Patients: A prospective, multicenter study was performed at 2 stroke centers (UCLA Medical Center and Suburban Hospital, Bethesda, Md), between October 2000 and February 2003. Patients presenting with focal stroke symptoms within 6 hours of onset underwent brain MRI followed by non-contrast CT. Main Outcome Measures: Acute intracerebral hemorrhage and any intracerebral hemorrhage diagnosed on gradient recalled echo (GRE) MRI and CT scans by a consensus of 4 blinded readers. Results: The study was stopped early, after 200 patients were enrolled, when it became apparent at the time of an unplanned interim analysis that MRI was detecting cases of hemorrhagic transformation not detected by CT. For the diagnosis of any hemorrhage, MRI was positive in 71 patients with CT positive in 29 (P<.001). For the diagnosis of acute hemorrhage, MRI and CT were equivalent (96% concordance). Acute hemorrhage was diagnosed in 25 patients on both MRI and CT. In 4 other patients, acute hemorrhage was present on MRI but not on the corresponding CT - each of these 4 cases was interpreted as hemorrhagic transformation of an ischemic infarct. In 3 patients, regions interpreted as acute hemorrhage on CT were interpreted as chronic hemorrhage on MRI. In 1 patient, subarachnoid hemorrhage was diagnosed on CT but not on MRI. In 49 patients, chronic hemorrhage, most often microbleeds, was visualized on MRI but not on CT. Conclusion: MRI may be as accurate as CT for the detection of acute hemorrhage in patients presenting with acute focal stroke symptoms and is more accurate than CT for the detection of chronic intracerebral hemorrhage.

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