Recommendations from others
In 2003, the Stroke Council, appointed by the American Heart Association, stated: “For most cases and at most institutions, CT remains the most important brain imaging test. A physician skilled in assessing CT studies should be available to interpret the scan (strength of recommendation grade B).” The Stroke Council further recommends that “[i]n patients seen within 6 hours of onset, CT currently may be preferred as the first imaging study because MRI detection of acute intracerebral hemorrhage has not been fully validated (strength of recommendation grade A).”4
The British National Health Service HTA Programme advises “scan all immediately” for diagnosing new neurological deficits with the understanding that CT scans were most available and cost-effective.2
CLINICAL COMMENTARY
CT without contrast still the best choice for assessing suspected acute stroke
Fred Grover, Jr, MD
Department of Family Medicine, University of Colorado
CT without contrast remains the best choice when assessing a patient for suspected stroke. For patients who are candidates for rtPA, this should be performed and read within 45 minutes of entering the emergency department. Remember that IV thrombolytics must be administered within 3 hours of stroke onset to be effective.
As Xenon-enhanced CT (XeCT) and Single Photon Emission CT (SPECT) become more available, these may be considered an adjunct to help risk-stratify patients prior to revascularization with a thrombolytic.1 After 48 hours, an MRI shows greater sensitivity in detecting both hemorrhagic and ischemic strokes.