title: Comprehensive imaging of stroke - Looking for the gold standard.
abstract: OBJECTIVE
  Stroke is the third cause of death worldwide. In recent decade there has been a marked progress in treatment and prevention of stroke, which was possible largely due to modern neuroimaging techniques. Early radiological confirmation of the diagnosis allows for introduction of fibrinolytic therapy and evaluation of ischaemic penumbra.
  
  
  METHODS
  We have analysed clinical and imaging data of 92 patients with early stages of stroke. The sensitivity, specificity and possible influence on the choice of treatment were assessed for different neuroimaging techniques, including diffusion weighted and perfusion imaging in patients with hyperacute and acute stroke.
  
  
  RESULTS
  A non-contrast computed tomography (CT) allowed for the detection of early ischaemic changes with an overall sensitivity of 38% and 42% in patients in hyperacute phase. In a perfusion CT study the perfusion abnormalities in the area corresponding to the clinical symptoms were present in 79% of patients. The sensitivity of diffusion weighted imaging (DWI) alone was 95% and in conjunction with perfusion MR reached 100%.
  
  
  CONCLUSIONS
  Our study proves that advanced neuroimaging modalities allow for a substantial increase of sensitivity when detecting changes in patients with acute ischaemic strokes and confirming the clinical diagnosis. We believe that MR in combination with DWI should be the imaging methods of choice in diagnosing acute stroke patients. Perfusion adds significant diagnostic value to structural techniques, particularly in clinically ambiguous cases. In cases with a clear clinical picture the data provided by a non-contrast CT study is sufficient for therapeutic decision making.
authors.affiliation: Diagnostic Radiology Department, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland. Electronic address: agnieszka.piliszek@gmai.com.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Piliszek
authors.affiliation: 1st Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Witkowski
authors.affiliation: Diagnostic Radiology Department, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Sklinda
authors.affiliation: Diagnostic Radiology Department, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
authors.forename: Cezary
authors.initials: C
authors.lastname: Szary
authors.affiliation: 1st Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.
authors.forename: Danuta
authors.initials: D
authors.lastname: Ryglewicz
authors.affiliation: Department of Neurology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Dorobek
authors.affiliation: Mossakowski Medical Research Centre, Polish Academy of Science, Warsaw, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Walecki
mesh_terms: D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D020521:Stroke / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
keywords: Acute stroke; Diffusion; Imaging; Perfusion