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Diffusion-weighted imaging determinants for acute ischemic stroke diagnosis in the emergency room

  • Diagnostic Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to investigate the clinical-radiological determinants of diffusion-weighted image (DWI) abnormalities in patients with suspected acute ischemic stroke (AIS) seen at the emergency room (ER).

Methods

During the study period, 882 consecutive patients were screened at Clínica Alemana de Santiago, Chile; 786 had AIS and 711 (90.4%) were included.

Results

DWI demonstrated 87.3% sensitivity and 99.0% specificity, with a positive likelihood ratio of 79 and a negative likelihood ratio of 0.13 for the detection of AIS. In the univariate analysis, a positive DWI in AIS was associated with admission National Institute of Health Stroke Scale (NIHSS) score (OR 1.09, 95% CI 1.04–1.1%), time from symptom onset to DWI (OR 1.03, 95% CI 1.01–1.05), presence of a relevant intracranial artery occlusion (OR 3.18, 95% CI 1.75–5.76), posterior circulation ischemia (OR 0.44, 95% CI 0.28–0.7), brainstem location of the AIS (OR 0.16, 95% CI 0.093–0.27), infratentorial location of AIS (OR 0.44, 95% CI 0.28–0.70), and lacunar (OR 0.27, 95% CI 0.11–0.68) or undetermined stroke etiology (OR 0.12, 95% CI 0.3–0.31). In multivariate analysis, only admission NIHSS score (OR 1.07, 95% CI 1.01–1.13), time from symptom onset to DWI (OR 1.04, 95% CI 1.01–1.13), brainstem location (OR 0.13, 95% CI 0.051–0.37), and lacunar (OR: 0.4, 95% CI 0.21–0.78) or undetermined etiology (OR: 0.4, 95% CI 0.22–0.78) remained independently associated.

Conclusion

DWI detects AIS accurately; the positivity of these evaluations in the ER is associated only with NIHSS on admission, time to DWI, brainstem location, and AIS etiology.

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Authors and Affiliations

  1. Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile

    Alejandro M. Brunser, Paula Muñoz Venturelli, Verónica Olavarría, Alexis Rojo, Juan Almeida, Violeta Díaz, Arnold Hoppe & Pablo Lavados

  2. Departamento de Urgencia General, Clínica Alemana de Santiago, Facultad de Medicina, Clinica Alemana, Universidad del Desarrollo, Santiago, Chile

    Alejandro M. Brunser, Juan Almeida & Violeta Díaz

  3. Unidad de Investigación y Ensayos Clínicos, Departamento Científico Docente, Clínica Alemana de Santiago, Santiago, Chile

    Gabriel Cavada

  4. Departamento de Paciente Crítico, Clínica Alemana de Santiago, Facultad de Medicina, Clinica Alemana, Universidad del Desarrollo, Santiago, Chile

    Paula Muñoz Venturelli & Verónica Olavarría

  5. Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile

    Pablo Lavados

Authors
  1. Alejandro M. Brunser
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  2. Gabriel Cavada
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  3. Paula Muñoz Venturelli
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  4. Verónica Olavarría
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  5. Alexis Rojo
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  6. Juan Almeida
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  7. Violeta Díaz
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  8. Arnold Hoppe
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  9. Pablo Lavados
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Corresponding author

Correspondence to Alejandro M. Brunser.

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Funding

No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Cite this article

Brunser, A.M., Cavada, G., Venturelli, P.M. et al. Diffusion-weighted imaging determinants for acute ischemic stroke diagnosis in the emergency room. Neuroradiology 60, 687–692 (2018). https://doi.org/10.1007/s00234-018-2029-x

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  • DOI: https://doi.org/10.1007/s00234-018-2029-x

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