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AJNR - American Journal of Neuroradiology

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Sensitivity and Interrater Agreement of CT and Diffusion-Weighted MR Imaging in Hyperacute Stroke

Dorothee Saur^a, Thomas Kucinski^b, Ulrich Grzyska^b, Bernd Eckert^b, Christian Eggers^a, Wolf Niesen^a, Volker Schoder^c, Hermann Zeumer^b, Cornelius Weiller^a and Joachim Röther^a

^a Department of Neurology, University Hospital Hamburg-Eppendorf, Germany
^b Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany
^c the Institute for Mathematics and Data Science in Medicine, University Hospital Hamburg-Eppendorf, Germany

View larger version (135K): [in a new window]   FIG 1. Case of a 62-year-old patient with aphasia and right hemiparesis. (A) CT scans obtained 100 minutes after symptom onset, (B) DW images obtained 120 minutes after symptom onset, and (C) follow-up FLAIR images. DW images were rated positive by all raters and show hyperintensity in the left MCA territory. CT scans were rated normal by five of the six raters. With the knowledge of the DW images, there might be a subtle hypoattenuation in the left insular ribbon region on CT scans. However, the follow-up FLAIR images reveal only small ischemic leasons of the left insular ribbon and parietal regions, with normalization of large parts of the former diffusion-restricted area.

View larger version (135K): [in a new window]   FIG 2. Case of a 35-year-old patient with left hemiparesis and neglect. (A) CT scans obtained 80 minutes after symptom onset, (B) DW images obtained 115 minutes after symptom onset, and (C) follow-up FLAIR images. Five of the six raters recognized parenchymal hypoattenuation of the right insular ribbon and frontotemporal regions on the CT scans. DW images and follow-up FLAIR images after 7 days illustrate a right MCA stroke caused by an MCA trunk occlusion.