From the Departments of Neuroradiology (E.Prodi, L.D., E.Pravatà, A.C.)
From the Departments of Neuroradiology (E.Prodi, L.D., E.Pravatà, A.C.).
AJNR Am J Neuroradiol. 2022 Feb;43(2):216-222. doi: 10.3174/ajnr.A7379. Epub 2021 Dec 30.
Ischemic stroke can be mimicked by nonischemic conditions. Due to emphasis on the rapid treatment of acute ischemic stroke, it is crucial to identify these conditions to avoid unnecessary therapies and potential complications. We investigated the performance of the multimodal CT protocol (unenhanced brain CT, CTA, and CTP) to discriminate stroke mimics from acute ischemic stroke.
We retrospectively selected multimodal CT studies performed for clinical suspicion of acute ischemic stroke in our center in a 24-month period, including patients with at least 1 follow-up imaging study (brain CT or MR imaging). Hemorrhagic strokes were excluded. We measured the performance of multimodal CT, comparing the original diagnostic results with the final clinical diagnosis at discharge.
Among 401 patients, a stroke mimic condition was diagnosed in 89 (22%), including seizures (34.8%), migraine with aura attack (12.4%), conversion disorder (12.4%), infection (7.9%), brain tumor (7.9%), acute metabolic condition (6.7%), peripheral vertigo (5.6%), syncope (5.6%), transient global amnesia (3.4%), subdural hematoma (1.1%), cervical epidural hematoma (1.1%), and dural AVF (1.1%). Multimodal CT sensitivity, specificity, and accuracy were 24.7%, 99.7%, and 83%. Multimodal CT revealed peri-ictal changes in 13/31 seizures and diagnosed 7/7 brain tumors, 1/1 dural AVF, and 1/1 subdural hematoma. CT perfusion played a pivotal diagnostic role.
Multimodal CT demonstrated low sensitivity but high specificity in the diagnosis of stroke mimics in the acute setting. The high specificity of multimodal CT allows ruling out stroke and thereby avoiding unnecessary revascularization treatment in patients with diagnosis of a stroke mimic.
缺血性卒中可由非缺血性疾病引起。由于强调对急性缺血性卒中的快速治疗，因此识别这些疾病以避免不必要的治疗和潜在的并发症至关重要。我们研究了多模态 CT 方案（未增强脑 CT、CTA 和 CTP）在鉴别卒中模拟与急性缺血性卒中方面的性能。
我们回顾性选择了在 24 个月期间因临床怀疑急性缺血性卒中在我们中心进行的多模态 CT 研究，包括至少有 1 次随访成像研究（脑 CT 或磁共振成像）的患者。排除出血性卒中。我们测量了多模态 CT 的性能，将原始诊断结果与出院时的最终临床诊断进行比较。
在 401 例患者中，诊断为卒中模拟疾病 89 例（22%），包括癫痫发作（34.8%）、有先兆偏头痛发作（12.4%）、转换障碍（12.4%）、感染（7.9%）、脑肿瘤（7.9%）、急性代谢性疾病（6.7%）、周围性眩晕（5.6%）、晕厥（5.6%）、短暂性全面遗忘症（3.4%）、硬膜下血肿（1.1%）、颈椎硬膜外血肿（1.1%）和硬脑膜动静脉瘘（1.1%）。多模态 CT 的敏感性、特异性和准确性分别为 24.7%、99.7%和 83%。多模态 CT 在 13/31 例癫痫发作中显示出发作期变化，并诊断出 7/7 例脑肿瘤、1/1 例硬脑膜动静脉瘘和 1/1 例硬膜下血肿。CT 灌注在诊断中发挥了关键作用。
多模态 CT 在急性情况下诊断卒中模拟疾病的敏感性低，但特异性高。多模态 CT 的高特异性允许排除卒中，并因此避免对诊断为卒中模拟的患者进行不必要的血管再通治疗。
