Agreement and variability in the interpretation of early CT changes in stroke patients qualifying for intravenous rtPA therapy.

@article{Grotta1999AgreementAV,
  title={Agreement and variability in the interpretation of early CT changes in stroke patients qualifying for intravenous rtPA therapy.},
  author={James Charles Grotta and David Chiu and M J Lu and S C Patel and Steven R. Levine and Barbara C Tilley and Thomas G. Brott and E. Clarke Haley and Patrick D. Lyden and Rashmi U. Kothari and Michael Frankel and Christopher A. Lewandowski and R.B. Libman and Thomas Kwiatkowski and Joseph P. Broderick and John R. Marler and J J Corrigan and Stephen J. Huff and Panayiotis D. Mitsias and Sanjay Talati and David Tann{\'e}},
  journal={Stroke},
  year={1999},
  volume={30 8},
  pages={
          1528-33
        }
}
BACKGROUND AND PURPOSE Ischemic changes identified on CT scans performed in the first few hours after stroke onset, which are thought to possibly represent early cytotoxic edema and development of irreversible injury, may have important implications for subsequent treatment. However, insecurity and conflicting data exist over the ability of clinicians to correctly recognize and interpret these changes. We performed a detailed review of selected baseline CT scans from the NINDS rt-PA Stroke… 

Tables from this paper

Agreement in Endovascular Thrombolysis Patient Selection Based on Interpretation of Presenting CT and CT-P Changes in Ischemic Stroke Patients

There is considerable lack of agreement, even among stroke specialists, in selecting acute ischemic stroke patients for endovascular treatment based on CT-P changes, and this mandates a careful evaluation ofCT-P for patient selection before widespread adoption.

Reliability of Visual Assessment of Non-Contrast CT, CT Angiography Source Images and CT Perfusion in Patients with Suspected Ischemic Stroke

Inter-observer agreement for the 1/3 middle cerebral artery rule and the Alberta Stroke Program Early CT Score was poor to good for non-contrast CT, fair to moderate for CT angiography source images, and good to excellent for all CT perfusion maps.

Ability of Emergency Physicians to Detect Early Ischemic Changes of Acute Ischemic Stroke on Cranial Computed Tomography

The ability of EPs to recognize early ischemic changes on CT scans in acute isChemic stroke was moderate based on sensitivities, and EPs must be trained especially for recognizing early is Chemic changes in acute Ischemic stroke to improve their accuracy of interpretation.

Evidence-based neuroimaging in acute ischemic stroke.

Early CT changes of ischemia: limitations of what we know

  • J. Grotta
  • Medicine
    Journal of the Neurological Sciences
  • 2000

Hypodensity of >⅓ Middle Cerebral Artery Territory Versus Alberta Stroke Programme Early CT Score (ASPECTS): Comparison of Two Methods of Quantitative Evaluation of Early CT Changes in Hyperacute Ischemic Stroke in the Community Setting

The ⅓ MCA method was more reliable in detecting significant EIC on CT brain within 6 hours of stroke onset in routine clinical practice, whereas ASPECTS was able to detectsignificant EIC in a higher proportion of these early scans.

Detection of ischemic changes on baseline multimodal computed tomography: expert reading vs. Brainomix and RAPID software.

Influence of availability of clinical history on detection of early stroke using unenhanced CT and diffusion-weighted MR imaging.

OBJECTIVE The radiologic diagnosis of stroke requires accurate detection and appropriate interpretation of relevant imaging findings; both detection and interpretation may be influenced by knowledge

Detection of early CT signs of >1/3 middle cerebral artery infarctions : interrater reliability and sensitivity of CT interpretation by physicians involved in acute stroke care.

Neuroradiologists can achieve moderate agreement in detecting >1/3 MCA acute infarction, but their performance did not reliably identify all patients who have early CT infarct signs that place them at increased risk for cerebral hemorrhage after thrombolytic therapy.
...

References

SHOWING 1-10 OF 33 REFERENCES

Acute stroke: usefulness of early CT findings before thrombolytic therapy.

The response to rt-PA in patients with ischemic stroke can be predicted on the basis of initial CT findings of the extent of parenchymal hypoattenuation in the territory of the middle cerebral artery.

Evaluation of early computed tomographic findings in acute ischemic stroke.

D detection of MCA territory hypodensity on hyperacute CT scans is a sensitive, prognostic, and reliable indicator of the amount of M CA territory undergoing infarction.

Interobserver agreement in assessing early CT signs of middle cerebral artery infarction.

Even with no clinical information, neuroradiologists can assess subtle CT signs of cerebral infarction within the first 6 hours of symptom onset with moderate to substantial interobserver agreement.

Cranial computed tomography interpretation in acute stroke: physician accuracy in determining eligibility for thrombolytic therapy.

Physicians in this study did not uniformly achieve a level of sensitivity for identification of intracerebral hemorrhage sufficient to permit safe selection of candidates for thrombolytic therapy.

Brain and vascular imaging in acute ischemic stroke

Computed tomography and MRI/MRS are most promising for meeting the above-mentioned objectives in the clinical setting of acute stroke.

Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke. The NINDS t-PA Stroke Study Group.

Despite a higher rate of intracerebral hemorrhage, patients with severe strokes or edema or mass effect on the baseline-CT are reasonable candidates for t-PA, if it is administered within 3 hours of onset.

Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS)

Intravenous thrombolysis in acute ischemic stroke is effective in improving some functional measures and neurologic outcome in a defined subgroup of stroke patients with moderate to severe neurologic deficit and without extended infarct signs on the initial CT scan, however, the identification of this subgroup is difficult.

Generalized efficacy of t-PA for acute stroke. Subgroup analysis of the NINDS t-PA Stroke Trial.

A post hoc subgroup analysis of a randomized, double-blind, placebo-controlled clinical trial of intravenous tissue plasminogen activator (t-PA) for stroke patients presenting within 3 hours after symptom onset found that patients should be selected for t-PA thrombolysis according to the guidelines published in the report of the NINDS t- PA Stroke Trial.

Sensitivity and prognostic value of early CT in occlusion of the middle cerebral artery trunk.

Early CT in acute middle cerebral artery trunk occlusion is highly predictive for fatal clinical outcome if there is extended hypodensity or local brain swelling despite aggressive therapeutic attempts such as thrombolysis or decompressive surgery.

Early detection of regional cerebral ischemia in cats: Comparison of diffusion‐ and T2‐weighted MRI and spectroscopy

Diffusion‐weighted hyperintensity in ischemic tissues may be temperature‐related, due to rapid accumulation of diffusion‐restricted water in the intracellular space (cytotoxic edema) resulting from the breakdown of the transmembrane pump and/or to microscopic brain pulsations.