Neuroradiology: Plain scan CT predicts the time of onset, maybe it will greatly change clinical practice?

In the first few hours and days after the onset of an ischemic stroke , the CT attenuation of the affected brain decreases with time

Preclinical experimental data show that the gradual decrease of CT attenuation represents the worsening of edema, which is secondary to the increase of intracellular and extracellular water

Up to 20% of ischemic strokes do not know the time of onset, and 36% of patients visit a doctor later than the treatment window

In June 2021, Grant Mair and others from the United Kingdom announced their research results in Neuroradiology.

The researchers used well-defined stroke test data to measure the CT attenuation of the ischemic injury and the contralateral normal brain to obtain the attenuation rate

Figure 1.

The study included 200 patients and 342 scans (41% males, median age 83 years)

In the end, the author believes that it is feasible to use this simple method of cerebral ischemia CT attenuation to accurately estimate the onset time of stroke

Translator's note: humble research may completely change current clinical practice

Literature source: Neuroradiology.

Source of pictures and texts | Introduction to cerebrovascular diseases and critical illness literature

In the first few hours and days after the onset of an ischemic stroke , the CT attenuation of the affected brain decreases with time

Preclinical experimental data show that the gradual decrease of CT attenuation represents the worsening of edema, which is secondary to the increase of intracellular and extracellular water

Up to 20% of ischemic strokes do not know the time of onset, and 36% of patients visit a doctor later than the treatment window

Figure 1.

The study included 200 patients and 342 scans (41% males, median age 83 years)
.
The elapsed time (translator's note: I understand it is the time of onset) range: from 22 minutes to 36 days
.
The estimated error of onset time is at least in the early elapsed time (r=0.
82, p<0.
0001): the onset distance CT scan time is <=3h, >3-9, >9-30 and >30h, and the average absolute error is 23, respectively , 106, 1030 and 1933min
.
AUROC is as high as 0.
955
.

In the end, the author believes that it is feasible to use this simple method of cerebral ischemia CT attenuation to accurately estimate the onset time of stroke
.
When the onset is 0-9 hours, the estimated time of onset is the most accurate, which can be used to screen patients, especially when imaging resources are scarce
.

Translator's note: humble research may completely change current clinical practice
.

Literature source: Neuroradiology.
2021 Jun;63(6):869-878.
doi: 10.
1007/s00234-020-02591-w.
Epub 2020 Oct 30.
Feasibility and diagnostic accuracy of using brain attenuation changes on CT to estimate time of ischemic stroke onset

Source of pictures and texts | Introduction to cerebrovascular diseases and critical illness literature