Diagnosis of lacunar infarcts within 6 hours of onset by clinical and CT criteria versus MRI

Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging
Venkatakrishna RajajeeUCLA MRI Acute Stroke Investigators

Abstract

The diagnosis of small deep infarcts (SDIs) based on clinical and noncontrast CT findings is often employed to triage stroke patients for emergent endovascular interventions. Few studies have evaluated the accuracy of <6 hours presentation with lacunar clinical syndromes in predicting the presence of a SDI and the absence of large vessel occlusion. Consecutive patients were identified with symptoms suggestive of acute stroke, diffusion-weighted magnetic resonance imaging (DW-MRI) and CT performed within 6 hours of onset, and absence of hemorrhage on imaging. Patients were given a diagnosis of SDI if they met the defined clinical and CT criteria. Diagnoses of large vessel occlusion absent (LVOA) and final diagnoses of SDI versus non-SDI incorporated hyperacute multimodal MRI data. Of 64 patients, 15 were diagnosed as SDI at <6 hours based on clinical/CT criteria. Fourteen of 15 patients (93%) had a final diagnosis of LVOA. Ten of 15 (67%) had a final MR-DWI-confirmed diagnosis of SDI. Clinical/CT diagnosis of SDI showed sensitivity of 44%, specificity 97%, positive predictive value (PPV) 93%, and negative predictive value (NPV) of 61% in predicting LVOA and sensitivity 83%, specificity 90%, PPV 67%, and NPV 96% compared to the f...Continue Reading

References

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Citations

May 29, 2010·Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology·Eberhard SiebertRandolf Klingebiel
Jul 9, 2008·Current Opinion in Neurology·Carolina CiumasPhilippe Ryvlin
Jul 22, 2009·Journal of the Neurological Sciences·Raf BrounsPeter P De Deyn
May 2, 2009·Magnetic Resonance Imaging Clinics of North America·Ashley D HarrisRichard Frayne
Jan 8, 2015·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Edward A MichelsonLeslie S Prichep
Nov 14, 2015·European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies·K D KurzM W Kurz
Mar 5, 2011·Journal of Vascular Surgery·Jean BismuthMark G Davies
Apr 27, 2010·Journal of the Neurological Sciences·Junya AokiTakeshi Iwanaga
Aug 6, 2015·Stroke; a Journal of Cerebral Circulation·Matthew TraylorHugh S Markus
Mar 29, 2021·Lancet Neurology·Matthew TraylorUNKNOWN International Stroke Genetics Consortium

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