Bethesda -. Computed tomography (CT) can in stroke patients, but as reliable as magnetic resonance imaging (MRI) to exclude a cerebral hemorrhage, the sensitivity of the diagnosis, that is the question whether in fact there is an ischemic stroke is, in a prospective comparative study in the Lancet (2007 , 369: 293-298) with MRI to answer much better than with CT, which is why the U.S. National Institutes of Health, the MRI would like to raise a new standard for stroke diagnosis.
Patients who reached within 3 hours of symptom onset to hospital can be treated with thrombolysis. The most important contraindication is a cerebral hemorrhage, which are excluded, if possible, since it would worsen by the administration of fibrinolytic drugs still. The imaging technique of choice is a CT today. An alternative is to an MRI, because the devices now in many hospitals are also available.
Julio Chalela and colleagues at the U.S. National Institute of Neurological Disorders and Stroke in Bethesda / Maryland have undergone both imaging techniques now a prospective comparison. They rated the recordings of 356 patients who had stroke-like symptoms appeared for examination in the emergency department at Bethesda: 217 of them were ultimately the clinical diagnosis of acute stroke.
How to tell the researchers were CT and MRI in the exclusion of a cerebral hemorrhage equivalent: Of the 27 patients with the final diagnosis, the CT detected 25 cases, 23 cases, the MRI, a statistically insignificant difference.
The superiority of MRI is reflected in the sensitivity with which the diagnosis of ischemic stroke were. Important here is the result only in the subgroup of patients who reached the hospital within three hours. The MRI detected 41 of 90 cases of ischemic stroke (46 percent, 95 percent CI 35-56 percent), the CT contrast, only 6 of 90 cases (7 percent, 3-14 percent).
Based on the total group of patients (including those for thrombolysis arriving too late), the MRI had a sensitivity of 83 percent (181 of 217 cases, 78 to 88 percent). The CT had a sensitivity of 26 percent (56 of 217 cases, 20 to 32 percent).
These numbers are clearly in the opinion of the U.S. National Institute of Neurological Disorders and Stroke. Whenever a magnetic resonance imaging in the clinic is available, it should be favored, urge the U.S. neurologists. You hold the results for directly transferable to clinical practice, since the study was conducted at a clinic of the normal supply and therefore representative of the entire spectrum of disease, whether the emergency situations will be encountered in a suspected stroke.
The MRI, according to experts could also increase the confidence of physicians in the diagnosis. Because in many cases remain under thrombolytic therapy, because physicians are uncertain in their judgments. The caution is understandable, because the fibrinolytic therapy is obviously associated with risks, but their effect is itself limited. However, the guidelines lay down clear, that the therapy should be made when the patient reaches the hospital in time, but this is still far too rare. © rme
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