Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison

Julio A. Chalela, Stella Kidwell, Lauren M. Nentwich, Marie Luby, John A. Butman, Andrew M. Demchuk, Michael D. Hill, Nicholas Patronas, Lawrence Latour, Steven Warach

Research output: Contribution to journalArticle

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Abstract

Background: Although the use of magnetic resonance imaging (MRI) for the diagnosis of acute stroke is increasing, this method has not proved more effective than computed tomography (CT) in the emergency setting. We aimed to prospectively compare CT and MRI for emergency diagnosis of acute stroke. Methods: We did a single-centre, prospective, blind comparison of non-contrast CT and MRI (with diffusion-weighted and susceptibility weighted images) in a consecutive series of patients referred for emergency assessment of suspected acute stroke. Scans were independently interpreted by four experts, who were unaware of clinical information, MRI-CT pairings, and follow-up imaging. Results: 356 patients, 217 of whom had a final clinical diagnosis of acute stroke, were assessed. MRI detected acute stroke (ischaemic or haemorrhagic), acute ischaemic stroke, and chronic haemorrhage more frequently than did CT (p<0·0001, for all comparisons). MRI was similar to CT for the detection of acute intracranial haemorrhage. MRI detected acute ischaemic stroke in 164 of 356 patients (46%; 95% CI 41-51%), compared with CT in 35 of 356 patients (10%; 7-14%). In the subset of patients scanned within 3 h of symptom onset, MRI detected acute ischaemic stroke in 41 of 90 patients (46%; 35-56%); CT in 6 of 90 (7%; 3-14%). Relative to the final clinical diagnosis, MRI had a sensitivity of 83% (181 of 217; 78-88%) and CT of 26% (56 of 217; 20-32%) for the diagnosis of any acute stroke. Interpretation: MRI is better than CT for detection of acute ischaemia, and can detect acute and chronic haemorrhage; therefore it should be the preferred test for accurate diagnosis of patients with suspected acute stroke. Because our patient sample encompassed the range of disease that is likely to be encountered in emergency cases of suspected stroke, our results are directly applicable to clinical practice.

Original languageEnglish (US)
Pages (from-to)293-298
Number of pages6
JournalThe Lancet
Volume369
Issue number9558
DOIs
StatePublished - Jan 27 2007
Externally publishedYes

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Emergencies
Stroke
Tomography
Magnetic Resonance Imaging
Hemorrhage
Diffusion Magnetic Resonance Imaging
Intracranial Hemorrhages
Ischemia

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke : a prospective comparison. / Chalela, Julio A.; Kidwell, Stella; Nentwich, Lauren M.; Luby, Marie; Butman, John A.; Demchuk, Andrew M.; Hill, Michael D.; Patronas, Nicholas; Latour, Lawrence; Warach, Steven.

In: The Lancet, Vol. 369, No. 9558, 27.01.2007, p. 293-298.

Research output: Contribution to journalArticle

Chalela, JA, Kidwell, S, Nentwich, LM, Luby, M, Butman, JA, Demchuk, AM, Hill, MD, Patronas, N, Latour, L & Warach, S 2007, 'Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison', The Lancet, vol. 369, no. 9558, pp. 293-298. https://doi.org/10.1016/S0140-6736(07)60151-2
Chalela, Julio A. ; Kidwell, Stella ; Nentwich, Lauren M. ; Luby, Marie ; Butman, John A. ; Demchuk, Andrew M. ; Hill, Michael D. ; Patronas, Nicholas ; Latour, Lawrence ; Warach, Steven. / Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke : a prospective comparison. In: The Lancet. 2007 ; Vol. 369, No. 9558. pp. 293-298.
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abstract = "Background: Although the use of magnetic resonance imaging (MRI) for the diagnosis of acute stroke is increasing, this method has not proved more effective than computed tomography (CT) in the emergency setting. We aimed to prospectively compare CT and MRI for emergency diagnosis of acute stroke. Methods: We did a single-centre, prospective, blind comparison of non-contrast CT and MRI (with diffusion-weighted and susceptibility weighted images) in a consecutive series of patients referred for emergency assessment of suspected acute stroke. Scans were independently interpreted by four experts, who were unaware of clinical information, MRI-CT pairings, and follow-up imaging. Results: 356 patients, 217 of whom had a final clinical diagnosis of acute stroke, were assessed. MRI detected acute stroke (ischaemic or haemorrhagic), acute ischaemic stroke, and chronic haemorrhage more frequently than did CT (p<0·0001, for all comparisons). MRI was similar to CT for the detection of acute intracranial haemorrhage. MRI detected acute ischaemic stroke in 164 of 356 patients (46{\%}; 95{\%} CI 41-51{\%}), compared with CT in 35 of 356 patients (10{\%}; 7-14{\%}). In the subset of patients scanned within 3 h of symptom onset, MRI detected acute ischaemic stroke in 41 of 90 patients (46{\%}; 35-56{\%}); CT in 6 of 90 (7{\%}; 3-14{\%}). Relative to the final clinical diagnosis, MRI had a sensitivity of 83{\%} (181 of 217; 78-88{\%}) and CT of 26{\%} (56 of 217; 20-32{\%}) for the diagnosis of any acute stroke. Interpretation: MRI is better than CT for detection of acute ischaemia, and can detect acute and chronic haemorrhage; therefore it should be the preferred test for accurate diagnosis of patients with suspected acute stroke. Because our patient sample encompassed the range of disease that is likely to be encountered in emergency cases of suspected stroke, our results are directly applicable to clinical practice.",
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AU - Chalela, Julio A.

AU - Kidwell, Stella

AU - Nentwich, Lauren M.

AU - Luby, Marie

AU - Butman, John A.

AU - Demchuk, Andrew M.

AU - Hill, Michael D.

AU - Patronas, Nicholas

AU - Latour, Lawrence

AU - Warach, Steven

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