Evidence map›Paper›PMID 29720033›Full record

ArticleThe neuroradiology journal2018

Diagnostic accuracy of whole-brain computed tomography perfusion for detection of ischemic stroke in patients with mild neurological symptoms.

Robert A Frank, Santanu Chakraborty, Trevor McGrath, Alexander Mungham, James Ross, Dar Dowlatshahi, Michel Shamy, Grant Stotts

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The neuroradiology journal, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.2field-weighted citation impact, top 47% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 3 citations in OpenAlex.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 2 institutions in 1 country.

Robert A Frank1 Department of Medical Imaging, Division of Neuroradiology, Ottawa Hospital Research Institute, ,University of Ottawa, Canada.
Santanu Chakraborty2 Department of Diagnostic Imaging, Division of Neuroradiology, Ottawa Hospital Research Institute, University of Ottawa, Canada.
Trevor McGrath1 Department of Medical Imaging, Division of Neuroradiology, Ottawa Hospital Research Institute, ,University of Ottawa, Canada.
Alexander Mungham2 Department of Diagnostic Imaging, Division of Neuroradiology, Ottawa Hospital Research Institute, University of Ottawa, Canada.
James Ross2 Department of Diagnostic Imaging, Division of Neuroradiology, Ottawa Hospital Research Institute, University of Ottawa, Canada.
Dar Dowlatshahi3 Department of Neurology, Ottawa Hospital Research Institute, University of Ottawa, Canada.
Michel Shamy3 Department of Neurology, Ottawa Hospital Research Institute, University of Ottawa, Canada.
Grant Stotts4 Department of Neurology, The Ottawa Hospital, Canada.
Ottawa Hospital · CAUniversity of Ottawa · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Mild and minor acute neurological symptoms may lead to diagnostic uncertainty, resulting in a heterogeneous group of patients with true ischemic events and stroke mimics with a potential for poor outcomes. More than half of ischemic stroke patients present as minor strokes (National Institutes of Health Stroke Scale score <6). Whole-brain computed tomography perfusion can be used as a diagnostic test for minor stroke, offering a potential method of reducing diagnostic uncertainty in these patients. We hypothesize that whole-brain computed tomography perfusion imaging features could accurately predict infarction in patients with minor neurological deficits. This retrospective chart review enrolled consecutive patients suspected of acute ischemic stroke with a National Institutes of Health Stroke Scale score <6, who underwent whole-brain computed tomography perfusion and follow-up diffusion-weighted magnetic resonance imaging at our institution. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated for whole-brain computed tomography perfusion, using follow-up diffusion-weighted magnetic resonance imaging as a reference standard. A total of 524 patients (mean age: 67 years; range: 17-96 years; 56% men) met the inclusion criteria. Patients were excluded for non-diagnostic ( n = 25) or missing maps ( n = 8) scans, non-ischemic findings ( n = 7), and lack of follow-up magnetic resonance imaging ( n = 336). The final analysis included 148 patients who underwent diffusion-weighted magnetic resonance imaging. Whole-brain computed tomography perfusion has a sensitivity of 0.57 (95% CI: 0.45-0.69) and a specificity of 0.82 (95% CI: 0.71-0.90). The positive and negative predictive values and positive and negative likelihood ratios were 75%, 67%, 3.09, and 0.53, respectively. Our analysis suggests that although whole-brain computed tomography perfusion may offer some value as an adjunctive test for improving confidence in offering stroke treatment, it is not sufficiently sensitive or specific to accurately predict cerebral infarcts in patients with minor neurological symptoms.

Indexed as

Perfusion ImagingTomography, X-Ray ComputedAdolescentAdultAgedAged, 80 and overBrainBrain IschemiaContrast MediaDiffusion Magnetic Resonance ImagingFemaleFollow-Up StudiesHumansMaleMiddle AgedRetrospective StudiesContrast Mediacerebral infarctioncomputed tomography perfusiondiagnosisStroke

Identifiers

PMID29720033
PMCPMC6136141
OpenAlexW2799769128

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.