Document Detail


Evidence-based guideline: The role of diffusion and perfusion MRI for the diagnosis of acute ischemic stroke: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.
MedLine Citation:
PMID:  20625171     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To assess the evidence for the use of diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) in the diagnosis of patients with acute ischemic stroke. METHODS: We systematically analyzed the literature from 1966 to January 2008 to address the diagnostic and prognostic value of DWI and PWI. RESULTS AND RECOMMENDATIONS: DWI is established as useful and should be considered more useful than noncontrast CT for the diagnosis of acute ischemic stroke within 12 hours of symptom onset. DWI should be performed for the most accurate diagnosis of acute ischemic stroke (Level A); however, the sensitivity of DWI for the diagnosis of ischemic stroke in a general sample of patients with possible acute stroke is not perfect. The diagnostic accuracy of DWI in evaluating cerebral hemorrhage is outside the scope of this guideline. On the basis of Class II and III evidence, baseline DWI volumes probably predict baseline stroke severity in anterior territory stroke (Level B) but possibly do not in vertebrobasilar artery territory stroke (Level C). Baseline DWI lesion volumes probably predict (final) infarct volumes (Level B) and possibly predict early and late clinical outcome measures (Level C). Baseline PWI volumes predict to a lesser degree the baseline stroke severity compared with DWI (Level C). There is insufficient evidence to support or refute the value of PWI in diagnosing acute ischemic stroke (Level U).
Authors:
P D Schellinger; R N Bryan; L R Caplan; J A Detre; R R Edelman; C Jaigobin; C S Kidwell; J P Mohr; M Sloan; A G Sorensen; S Warach;
Publication Detail:
Type:  Journal Article; Practice Guideline; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Neurology     Volume:  75     ISSN:  1526-632X     ISO Abbreviation:  Neurology     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-13     Completed Date:  2010-07-30     Revised Date:  2011-08-01    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  177-85     Citation Subset:  AIM; IM    
Affiliation:
National Institutes of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA.
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MeSH Terms
Descriptor/Qualifier:
Brain Ischemia / diagnosis*
Evidence-Based Medicine
Humans
Magnetic Resonance Imaging / methods*
Stroke / diagnosis*
Grant Support
ID/Acronym/Agency:
CA137254/CA/NCI NIH HHS; K24 NS058386/NS/NINDS NIH HHS; N01-HC-95178/HC/NHLBI NIH HHS; P30 NS045839/NS/NINDS NIH HHS; P41RR002305/RR/NCRR NIH HHS; R01 DK085615/DK/NIDDK NIH HHS; R01 HL102119/HL/NHLBI NIH HHS; R01 NS060653/NS/NINDS NIH HHS; R01 NS061572/NS/NINDS NIH HHS; R01AG034682/AG/NIA NIH HHS; R01MH080729/MH/NIMH NIH HHS; R01NS057400/NS/NINDS NIH HHS; R01NS063925/NS/NINDS NIH HHS; R01NS38477/NS/NINDS NIH HHS; R03 DA027098/DA/NIDA NIH HHS; R21DA025882/DA/NIDA NIH HHS; R21NS061119/NS/NINDS NIH HHS; R24 HD050836/HD/NICHD NIH HHS; R24 HD050838/HD/NICHD NIH HHS; R24HD050836/HD/NICHD NIH HHS; T32NS054575/NS/NINDS NIH HHS
Comments/Corrections
Comment In:
Neurology. 2011 Jun 7;76(23):2036-7; author reply 2038   [PMID:  21646634 ]
Neurology. 2011 Jun 7;76(23):2036; author reply 2038   [PMID:  21793246 ]
Erratum In:
Neurology. 2010 Sep 7;75(10):938

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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