EFNS guideline on neuroimaging in acute stroke. Report of an EFNS task force

Authors: Masdeu, J. C.¹; Irimia, P.¹; Asenbaum, S.²; Bogousslavsky, J.³; Brainin, M.⁴; Chabriat, H.⁵; Herholz, K.⁶; Markus, H. S.⁷; Martínez-Vila, E.¹; Niederkorn, K.⁸; Schellinger, P. D.⁹; Seitz, R. J.¹⁰

Source: European Journal of Neurology, Volume 13, Number 12, December 2006 , pp. 1271-1283(13)

Publisher: Blackwell Publishing

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Abstract:

Neuroimaging techniques are necessary for the evaluation of stroke, one of the leading causes of death and neurological impairment in developed countries. The multiplicity of techniques available has increased the complexity of decision making for physicians. We performed a comprehensive review of the literature in English for the period 1965-2005 and critically assessed the relevant publications. The members of the panel reviewed and corrected an initial draft, until a consensus was reached on recommendations stratified according to the European Federation of Neurological Societies (EFNS) criteria. Non-contrast computed tomography (CT) scan is the established imaging procedure for the initial evaluation of stroke patients. However, magnetic resonance imaging (MRI) has a higher sensitivity than CT for the demonstration of infarcted or ischemic areas and depicts well acute and chronic intracerebral hemorrhage. Perfusion and diffusion MRI together with MR angiography (MRA) are very helpful for the acute evaluation of patients with ischemic stroke. MRI and MRA are the recommended techniques for screening cerebral aneurysms and for the diagnosis of cerebral venous thrombosis and arterial dissection. For the non-invasive study of extracranial vessels, MRA is less portable and more expensive than ultrasonography but it has higher sensitivity and specificity for carotid stenosis. Transcranial Doppler is very useful for monitoring arterial reperfusion after thrombolysis, for the diagnosis of intracranial stenosis and of right-to-left shunts, and for monitoring vasospasm after subarachnoid hemorrhage. Currently, single photon emission computed tomography and positron emission tomography have a more limited role in the evaluation of the acute stroke patient.

Keywords: computed tomography (CT); CT angiography; diffusion; magnetic resonance imaging (MRI); MR angiography; perfusion; stroke; ultrasound

Document Type: Research article

DOI: 10.1111/j.1468-1331.2006.01507.x

Affiliations: 1: Department of Neurology and Neurosurgery, University of Navarra, Pamplona, Spain 2: Department of Neurology, Medical University of Vienna, Vienna, Austria 3: Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland 4: Department of Neurology, Donauklinikum and Donau-Universität, Maria Gugging, Austria 5: Department of Neurology, Lariboisiere Hospital, University of Paris, Paris, France 6: Wolfson Molecular Imaging Centre, University of Manchester, Manchester 7: Department of Neurology and Clinical Neuroscience, St George's Hospital Medical School, London, UK 8: Department of Neurology, Karl Franzens University, Graz, Austria 9: Department of Neurology, University Clinic at Heidelberg, Germany 10: Department of Neurology, University Hospital Düsseldorf, Düsseldorf, Germany

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