Early Diagnosis of Acute Ischemic Stroke by Using 16 row Multi-slice Computed Tomography

ABSTRACT

PURPOSE: Conventional spiral computed tomography (CT) has a limitation in the diagnosis of the early phase of cerebral ischemia because ischemic signs may be subtle or even not detectable. The authors carried out this study in order to determine the value of 16 row multi-slice CT (MSCT) in the clinical study of patients with acute stroke. METHODS: Between June 2002 and May 2003, we performed MSCT on 18 consecutive patients who presented within 6 hours of onset of signs and symptoms suggesting stroke. We used an imaging protocol with 3 components, noncontrast CT, perfusion CT, and CT angiography, to evaluate hyperacute stroke patients. In order to evaluate it' s validity, we compared MSCT with MRI. RESULTS: Perfusion parameter maps such as cerebral blood flow, cerebral blood volume, and time to peak showed perfusion deficits in 14 of 18 patients. Perfusion deficits in two patients with brain stem infarcts and in one patient with a lacunar infarct were missed. Hemispheric territorial infarcts were diagnosed with a sensitivity of 93% (14 of 15 patients). MSCT has a significantly shorter interval between the patient's arrival and taking an image (23.1+/-13.3 vs 52.7+/-21.8 minutes, p=0.0001) and a significantly shorter scanning time (13.7+/-2.5 vs 26.8+/-11.2 minutes, p=0.0003) than MRI does. CONCLUSION: In hyperacute stroke, MSCT not only allows early detection of cerebral ischemia but also yields valuable information about the extent of perfusion disturbances. Compared with MRI, MSCT is a more readily available, less time consuming procedure. MSCT may help in therapeutic decision-making if perfusion and diffusion-weighted MRI are not available or cannot be performed on specific patients.