Mullins Mark E, Lev Michael H, Schellingerhout Dawid, Koroshetz Walter J, Gonzalez R Gilberto
Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA.
AJR Am J Roentgenol. 2002 Jul;179(1):223-8. doi: 10.2214/ajr.179.1.1790223.
The radiologic diagnosis of stroke requires accurate detection and appropriate interpretation of relevant imaging findings; both detection and interpretation may be influenced by knowledge of the patient's presentation. In our study, we evaluated the effect of the availability of clinical history on the sensitivity for stroke detection using unenhanced CT and diffusion-weighted MR imaging.
The records of 733 consecutive patients with a clinically based admission diagnosis of early stroke were reviewed. Among the criteria for inclusion in our study were the availability of an unenhanced CT scan (561 cases) or diffusion-weighted MR imaging examination (409 cases) obtained at admission and a discharge diagnosis indicating whether a patient had actually had a stroke. The radiology requisition forms, available at the time of image interpretation, were classified as either indicating or not indicating a clinical suspicion of early stroke. Sensitivity, specificity, and accuracy of stroke detection were computed, stratified by the presence or absence of an available history indicating suspicion of stroke. Results were compared using the Fisher's exact two-tailed test.
Unenhanced CT sensitivity was 52% (specificity, 95%) for the suspicion-of-stroke group and 38% (specificity, 89%) for the no-suspicion-of-stroke group (p = 0.008). Diffusion-weighted MR imaging sensitivity was 95% (specificity, 94%) for the suspicion-of-stroke group and 94% (specificity, 98%) for the no-suspicion-of-stroke group (p = 0.822).
Availability of a clinical history indicating that early stroke is suspected significantly improves the sensitivity for detecting strokes on unenhanced CT without reducing specificity. In contradistinction, the availability of such a history did not significantly improve the sensitivity for detecting stroke using diffusion-weighted MR imaging. Whenever possible, relevant clinical history should be made available to physicians interpreting emergency CT scans of the head.
中风的放射学诊断需要准确检测并恰当解读相关影像学表现；检测和解读均可能受到患者临床表现信息的影响。在我们的研究中，我们评估了临床病史信息的可得性对使用平扫CT和扩散加权磁共振成像检测中风的敏感性的影响。
回顾了733例连续入院且临床诊断为早期中风的患者记录。纳入我们研究的标准包括：入院时获得的平扫CT扫描（561例）或扩散加权磁共振成像检查（409例），以及出院诊断以表明患者是否实际发生了中风。在影像解读时可获取的放射学申请单被分类为提示或未提示临床怀疑早期中风。计算中风检测的敏感性、特异性和准确性，并根据是否有提示中风怀疑的病史进行分层。使用Fisher精确双侧检验比较结果。
对于怀疑中风组，平扫CT的敏感性为52%（特异性为95%），对于未怀疑中风组，敏感性为38%（特异性为89%）（p = 0.008）。对于怀疑中风组，扩散加权磁共振成像的敏感性为95%（特异性为94%），对于未怀疑中风组，敏感性为94%（特异性为98%）（p = 0.822）。
提示怀疑早期中风的临床病史的可得性显著提高了平扫CT检测中风的敏感性，且不降低特异性。相反，此类病史的可得性并未显著提高使用扩散加权磁共振成像检测中风的敏感性。只要有可能，应向解读头部急诊CT扫描的医生提供相关临床病史。
