Detection of Early Ischemic Changes in Noncontrast CT Head Improved with "Stroke Windows"

Abstract

Introduction. Noncontrast head CT (NCCT) is the standard radiologic test for patients presenting with acute stroke. Early ischemic changes (EIC) are often overlooked on initial NCCT. We determine the sensitivity and specificity of improved EIC detection by a standardized method of image evaluation (Stroke Windows). Methods. We performed a retrospective chart review to identify patients with acute ischemic stroke who had NCCT at presentation. EIC was defined by the presence of hyperdense MCA/basilar artery sign; sulcal effacement; basal ganglia/subcortical hypodensity; and loss of cortical gray-white differentiation. NCCT was reviewed with standard window settings and with specialized Stroke Windows. Results. Fifty patients (42% females, 58% males) with a mean NIHSS of 13.4 were identified. EIC was detected in 9 patients with standard windows, while EIC was detected using Stroke Windows in 35 patients (18% versus 70%; P < 0.0001). Hyperdense MCA sign was the most commonly reported EIC; it was better detected with Stroke Windows (14% and 36%; P < 0.0198). Detection of the remaining EIC also improved with Stroke Windows (6% and 46%; P < 0.0001). Conclusions. Detection of EIC has important implications in diagnosis and treatment of acute ischemic stroke. Utilization of Stroke Windows significantly improved detection of EIC.

Figure 1

Noncontrast head CTs (NCCTs). (a) NCCT of head viewed on standard windows (35/100). (b) NCCT of head viewed on Stroke Windows (35/30) demonstrating left sulcal effacement of the insular ribbon and hypodensity of left basal ganglia. (c) NCCT of head viewed on standard windows (35/100). (d) NCCT of head viewed on Stroke Windows (35/30) demonstrating right MCA sign. (e) NCCT of head viewed on standard windows (35/100). (f) NCCT of head viewed on Stroke Windows (35/30) demonstrating hypodensity of left basal ganglia.