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- Title
Diffusion-weighted imaging determinants for acute ischemic stroke diagnosis in the emergency room.
- Authors
Brunser, Alejandro M.; Cavada, Gabriel; Venturelli, Paula Muñoz; Olavarría, Verónica; Rojo, Alexis; Almeida, Juan; Díaz, Violeta; Hoppe, Arnold; Lavados, Pablo
- Abstract
Purpose: The aim of this study was to investigate the clinical-radiological determinants of diffusion-weighted image (DWI) abnormalities in patients with suspected acute ischemic stroke (AIS) seen at the emergency room (ER).Methods: During the study period, 882 consecutive patients were screened at Clínica Alemana de Santiago, Chile; 786 had AIS and 711 (90.4%) were included.Results: DWI demonstrated 87.3% sensitivity and 99.0% specificity, with a positive likelihood ratio of 79 and a negative likelihood ratio of 0.13 for the detection of AIS. In the univariate analysis, a positive DWI in AIS was associated with admission National Institute of Health Stroke Scale (NIHSS) score (OR 1.09, 95% CI 1.04-1.1%), time from symptom onset to DWI (OR 1.03, 95% CI 1.01-1.05), presence of a relevant intracranial artery occlusion (OR 3.18, 95% CI 1.75-5.76), posterior circulation ischemia (OR 0.44, 95% CI 0.28-0.7), brainstem location of the AIS (OR 0.16, 95% CI 0.093-0.27), infratentorial location of AIS (OR 0.44, 95% CI 0.28-0.70), and lacunar (OR 0.27, 95% CI 0.11-0.68) or undetermined stroke etiology (OR 0.12, 95% CI 0.3-0.31). In multivariate analysis, only admission NIHSS score (OR 1.07, 95% CI 1.01-1.13), time from symptom onset to DWI (OR 1.04, 95% CI 1.01-1.13), brainstem location (OR 0.13, 95% CI 0.051-0.37), and lacunar (OR: 0.4, 95% CI 0.21-0.78) or undetermined etiology (OR: 0.4, 95% CI 0.22-0.78) remained independently associated.Conclusion: DWI detects AIS accurately; the positivity of these evaluations in the ER is associated only with NIHSS on admission, time to DWI, brainstem location, and AIS etiology.
- Subjects
CHILE; BRAIN stem anatomy; STROKE diagnosis; AGE factors in disease; ARTERIAL occlusions; BRAIN stem; CEREBRAL arteries; CEREBRAL ischemia; CONFIDENCE intervals; HEALTH facilities; HOSPITAL admission &; discharge; HOSPITAL emergency services; MAGNETIC resonance imaging; MEDICAL screening; MULTIVARIATE analysis; PATIENTS; STATISTICS; ACUTE diseases; LACUNAR stroke; ODDS ratio; DIAGNOSIS
- Publication
Neuroradiology, 2018, Vol 60, Issue 7, p687
- ISSN
0028-3940
- Publication type
Article
- DOI
10.1007/s00234-018-2029-x