Imaging

Stroke

Preliminary Diagnosis: Stroke

I. What imaging technique is first-line for this diagnosis

  • Non-contrast CT of the brain.

II. Describe the advantages and disadvantages of this technique for diagnosis of stroke.

Advantages

  • Relatively fast, inexpensive imaging modality.

  • Highly specific and sensitive to evaluate and rule out intracranial hemorrhage.

Disadvantages

  • Exposes patients to ionizing radiation.

  • Less sensitive for detecting ischemia or infarction compared with MR imaging.

III. What are the contraindications for the first-line imaging technique?

  • CT imaging may be contraindicated in pregnant patients.

IV. What alternative imaging techniques are available?

  • Non-contrast MR of the brain (Stroke Protocol)

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of stroke.

Non-contrast MR of the brain (Stroke Protocol)

Advantages

  • Imaging is more sensitive and specific in detecting early signs of ischemia and infarction.

  • Better able to distinguish chronicity of infarct than CT

  • Does not expose the patient to ionizing radiation.

  • Sensitive in detecting subtle microhemorrhage.

Disadvantages

  • Expensive

  • Time-consuming

  • Requires significant patient cooperation to minimize artifact

VI. What are the contraindications for the alternative imaging techniques?

Non-contrast MR of the brain (Stroke Protocol)

  • Contraindicated in patients with non-MR compatible hardware.

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