Magnetic resonance imaging versus computed tomography for detection of acute vascular lesions in patients presenting with stroke symptoms

Miriam Giovanna Brazzelli, Peter A. G. Sandercock, Francesca M. Chappell, Maria Grazia Celani, Enrico Righetti, Nicholas Arestis, Joanna M. Wardlaw, Jonathan J. Deeks

Research output: Contribution to journalLiterature review

66 Citations (Scopus)

Abstract

Background

Magnetic resonance imaging (MRI) is increasingly used for the diagnosis of acute ischaemic stroke but its sensitivity for the early detection of intracerebral haemorrhage has been debated. Computed tomography (CT) is extensively used in the clinical management of acute stroke, especially for the rapid exclusion of intracerebral haemorrhage.

Objectives

To compare the diagnostic accuracy of diffusion-weighted MRI (DWI) and CT for acute ischaemic stroke, and to estimate the diagnostic accuracy of MRI for acute haemorrhagic stroke.

Search strategy

We searched MEDLINE and EMBASE (January 1995 to March 2009) and perused bibliographies of relevant studies for additional references.

Selection criteria

We selected studies that either compared DWI and CT in the same patients for detection of ischaemic stroke or examined the utility of MRI for detection of haemorrhagic stroke, had imaging performed within 12 hours of stroke onset, and presented sufficient data to allow construction of contingency tables.

Data collection and analysis

Three authors independently extracted data on study characteristics and measures of accuracy. We assessed data on ischaemic stroke using random-effects and fixed-effect meta-analyses.

Main results

Eight studies with a total of 308 participants met our inclusion criteria. Seven studies contributed to the assessment of ischaemic stroke and two studies to the assessment of haemorrhagic stroke. The spectrum of patients was relatively narrow in all studies, sample sizes were small, there was substantial incorporation bias, and blinding procedures were often incomplete. Amongst the patients subsequently confirmed to have acute ischaemic stroke (161/226), the summary estimates for DWI were: sensitivity 0.99 (95% CI 0.23 to 1.00), specificity 0.92 (95% CI 0.83 to 0.97). The summary estimates for CT were: sensitivity 0.39 (95% CI 0.16 to 0.69), specificity 1.00 (95% CI 0.94 to 1.00). The two studies on haemorrhagic stroke reported high estimates for diffusion-weighted and gradient-echo sequences but had inconsistent reference standards. We did not calculate overall estimates for these two studies. We were not able to assess practicality or cost-effectiveness issues.

Authors' conclusions

DWI appears to be more sensitive than CT for the early detection of ischaemic stroke in highly selected patients. However, the variability in the quality of included studies and the presence of spectrum and incorporation biases render the reliability and generalisability of observed results questionable. Further well-designed studies without methodological biases, in more representative patient samples, with practicality and cost estimates are now needed to determine which patients should undergo MRI and which CT in suspected acute stroke.

Original languageEnglish
Article numberCD007424
Number of pages56
JournalCochrane Database of Systematic Reviews
Issue number4
DOIs
Publication statusPublished - 7 Oct 2009

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Blood Vessels
Stroke
Tomography
Magnetic Resonance Imaging
Diffusion Magnetic Resonance Imaging
Cerebral Hemorrhage
Patient Advocacy
Bibliography
MEDLINE
Sample Size
Cost-Benefit Analysis
Meta-Analysis
Costs and Cost Analysis

Keywords

  • echo-planar sequences
  • attenuated inversion-recovery
  • dynamic CT perfusion
  • middle cerebral-artery
  • suspected acute stroke
  • tissue-plasminogen activator
  • acute ischemic-stroke
  • diffusion-weighted MRI
  • acute hemispheric stroke
  • hyperacute intracerebral hemorrhage

Cite this

Magnetic resonance imaging versus computed tomography for detection of acute vascular lesions in patients presenting with stroke symptoms. / Brazzelli, Miriam Giovanna; Sandercock, Peter A. G.; Chappell, Francesca M.; Celani, Maria Grazia; Righetti, Enrico; Arestis, Nicholas; Wardlaw, Joanna M.; Deeks, Jonathan J.

In: Cochrane Database of Systematic Reviews, No. 4, CD007424, 07.10.2009.

Research output: Contribution to journalLiterature review

Brazzelli, Miriam Giovanna ; Sandercock, Peter A. G. ; Chappell, Francesca M. ; Celani, Maria Grazia ; Righetti, Enrico ; Arestis, Nicholas ; Wardlaw, Joanna M. ; Deeks, Jonathan J. / Magnetic resonance imaging versus computed tomography for detection of acute vascular lesions in patients presenting with stroke symptoms. In: Cochrane Database of Systematic Reviews. 2009 ; No. 4.
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abstract = "BackgroundMagnetic resonance imaging (MRI) is increasingly used for the diagnosis of acute ischaemic stroke but its sensitivity for the early detection of intracerebral haemorrhage has been debated. Computed tomography (CT) is extensively used in the clinical management of acute stroke, especially for the rapid exclusion of intracerebral haemorrhage.ObjectivesTo compare the diagnostic accuracy of diffusion-weighted MRI (DWI) and CT for acute ischaemic stroke, and to estimate the diagnostic accuracy of MRI for acute haemorrhagic stroke.Search strategyWe searched MEDLINE and EMBASE (January 1995 to March 2009) and perused bibliographies of relevant studies for additional references.Selection criteriaWe selected studies that either compared DWI and CT in the same patients for detection of ischaemic stroke or examined the utility of MRI for detection of haemorrhagic stroke, had imaging performed within 12 hours of stroke onset, and presented sufficient data to allow construction of contingency tables.Data collection and analysisThree authors independently extracted data on study characteristics and measures of accuracy. We assessed data on ischaemic stroke using random-effects and fixed-effect meta-analyses.Main resultsEight studies with a total of 308 participants met our inclusion criteria. Seven studies contributed to the assessment of ischaemic stroke and two studies to the assessment of haemorrhagic stroke. The spectrum of patients was relatively narrow in all studies, sample sizes were small, there was substantial incorporation bias, and blinding procedures were often incomplete. Amongst the patients subsequently confirmed to have acute ischaemic stroke (161/226), the summary estimates for DWI were: sensitivity 0.99 (95{\%} CI 0.23 to 1.00), specificity 0.92 (95{\%} CI 0.83 to 0.97). The summary estimates for CT were: sensitivity 0.39 (95{\%} CI 0.16 to 0.69), specificity 1.00 (95{\%} CI 0.94 to 1.00). The two studies on haemorrhagic stroke reported high estimates for diffusion-weighted and gradient-echo sequences but had inconsistent reference standards. We did not calculate overall estimates for these two studies. We were not able to assess practicality or cost-effectiveness issues.Authors' conclusionsDWI appears to be more sensitive than CT for the early detection of ischaemic stroke in highly selected patients. However, the variability in the quality of included studies and the presence of spectrum and incorporation biases render the reliability and generalisability of observed results questionable. Further well-designed studies without methodological biases, in more representative patient samples, with practicality and cost estimates are now needed to determine which patients should undergo MRI and which CT in suspected acute stroke.",
keywords = "echo-planar sequences, attenuated inversion-recovery, dynamic CT perfusion, middle cerebral-artery, suspected acute stroke, tissue-plasminogen activator, acute ischemic-stroke, diffusion-weighted MRI, acute hemispheric stroke, hyperacute intracerebral hemorrhage",
author = "Brazzelli, {Miriam Giovanna} and Sandercock, {Peter A. G.} and Chappell, {Francesca M.} and Celani, {Maria Grazia} and Enrico Righetti and Nicholas Arestis and Wardlaw, {Joanna M.} and Deeks, {Jonathan J.}",
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TY - JOUR

T1 - Magnetic resonance imaging versus computed tomography for detection of acute vascular lesions in patients presenting with stroke symptoms

AU - Brazzelli, Miriam Giovanna

AU - Sandercock, Peter A. G.

AU - Chappell, Francesca M.

AU - Celani, Maria Grazia

AU - Righetti, Enrico

AU - Arestis, Nicholas

AU - Wardlaw, Joanna M.

AU - Deeks, Jonathan J.

PY - 2009/10/7

Y1 - 2009/10/7

N2 - BackgroundMagnetic resonance imaging (MRI) is increasingly used for the diagnosis of acute ischaemic stroke but its sensitivity for the early detection of intracerebral haemorrhage has been debated. Computed tomography (CT) is extensively used in the clinical management of acute stroke, especially for the rapid exclusion of intracerebral haemorrhage.ObjectivesTo compare the diagnostic accuracy of diffusion-weighted MRI (DWI) and CT for acute ischaemic stroke, and to estimate the diagnostic accuracy of MRI for acute haemorrhagic stroke.Search strategyWe searched MEDLINE and EMBASE (January 1995 to March 2009) and perused bibliographies of relevant studies for additional references.Selection criteriaWe selected studies that either compared DWI and CT in the same patients for detection of ischaemic stroke or examined the utility of MRI for detection of haemorrhagic stroke, had imaging performed within 12 hours of stroke onset, and presented sufficient data to allow construction of contingency tables.Data collection and analysisThree authors independently extracted data on study characteristics and measures of accuracy. We assessed data on ischaemic stroke using random-effects and fixed-effect meta-analyses.Main resultsEight studies with a total of 308 participants met our inclusion criteria. Seven studies contributed to the assessment of ischaemic stroke and two studies to the assessment of haemorrhagic stroke. The spectrum of patients was relatively narrow in all studies, sample sizes were small, there was substantial incorporation bias, and blinding procedures were often incomplete. Amongst the patients subsequently confirmed to have acute ischaemic stroke (161/226), the summary estimates for DWI were: sensitivity 0.99 (95% CI 0.23 to 1.00), specificity 0.92 (95% CI 0.83 to 0.97). The summary estimates for CT were: sensitivity 0.39 (95% CI 0.16 to 0.69), specificity 1.00 (95% CI 0.94 to 1.00). The two studies on haemorrhagic stroke reported high estimates for diffusion-weighted and gradient-echo sequences but had inconsistent reference standards. We did not calculate overall estimates for these two studies. We were not able to assess practicality or cost-effectiveness issues.Authors' conclusionsDWI appears to be more sensitive than CT for the early detection of ischaemic stroke in highly selected patients. However, the variability in the quality of included studies and the presence of spectrum and incorporation biases render the reliability and generalisability of observed results questionable. Further well-designed studies without methodological biases, in more representative patient samples, with practicality and cost estimates are now needed to determine which patients should undergo MRI and which CT in suspected acute stroke.

AB - BackgroundMagnetic resonance imaging (MRI) is increasingly used for the diagnosis of acute ischaemic stroke but its sensitivity for the early detection of intracerebral haemorrhage has been debated. Computed tomography (CT) is extensively used in the clinical management of acute stroke, especially for the rapid exclusion of intracerebral haemorrhage.ObjectivesTo compare the diagnostic accuracy of diffusion-weighted MRI (DWI) and CT for acute ischaemic stroke, and to estimate the diagnostic accuracy of MRI for acute haemorrhagic stroke.Search strategyWe searched MEDLINE and EMBASE (January 1995 to March 2009) and perused bibliographies of relevant studies for additional references.Selection criteriaWe selected studies that either compared DWI and CT in the same patients for detection of ischaemic stroke or examined the utility of MRI for detection of haemorrhagic stroke, had imaging performed within 12 hours of stroke onset, and presented sufficient data to allow construction of contingency tables.Data collection and analysisThree authors independently extracted data on study characteristics and measures of accuracy. We assessed data on ischaemic stroke using random-effects and fixed-effect meta-analyses.Main resultsEight studies with a total of 308 participants met our inclusion criteria. Seven studies contributed to the assessment of ischaemic stroke and two studies to the assessment of haemorrhagic stroke. The spectrum of patients was relatively narrow in all studies, sample sizes were small, there was substantial incorporation bias, and blinding procedures were often incomplete. Amongst the patients subsequently confirmed to have acute ischaemic stroke (161/226), the summary estimates for DWI were: sensitivity 0.99 (95% CI 0.23 to 1.00), specificity 0.92 (95% CI 0.83 to 0.97). The summary estimates for CT were: sensitivity 0.39 (95% CI 0.16 to 0.69), specificity 1.00 (95% CI 0.94 to 1.00). The two studies on haemorrhagic stroke reported high estimates for diffusion-weighted and gradient-echo sequences but had inconsistent reference standards. We did not calculate overall estimates for these two studies. We were not able to assess practicality or cost-effectiveness issues.Authors' conclusionsDWI appears to be more sensitive than CT for the early detection of ischaemic stroke in highly selected patients. However, the variability in the quality of included studies and the presence of spectrum and incorporation biases render the reliability and generalisability of observed results questionable. Further well-designed studies without methodological biases, in more representative patient samples, with practicality and cost estimates are now needed to determine which patients should undergo MRI and which CT in suspected acute stroke.

KW - echo-planar sequences

KW - attenuated inversion-recovery

KW - dynamic CT perfusion

KW - middle cerebral-artery

KW - suspected acute stroke

KW - tissue-plasminogen activator

KW - acute ischemic-stroke

KW - diffusion-weighted MRI

KW - acute hemispheric stroke

KW - hyperacute intracerebral hemorrhage

U2 - 10.1002/14651858.CD007424.pub2

DO - 10.1002/14651858.CD007424.pub2

M3 - Literature review

JO - Cochrane Database of Systematic Reviews

JF - Cochrane Database of Systematic Reviews

SN - 1469-493X

IS - 4

M1 - CD007424

ER -