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Comparison of MRI and CT for Detection of Acute Intracerebral Hemorrhage
Chelsea S. Kidwell, MD;
Julio A. Chalela, MD;
Jeffrey L. Saver, MD;
Sidney Starkman, MD;
Michael D. Hill, MD;
Andrew M. Demchuk, MD;
John A. Butman, MD, PhD;
Nicholas Patronas, MD;
Jeffry R. Alger, PhD;
Lawrence L. Latour, PhD;
Marie L. Luby, MEng, MS;
Alison E. Baird, FRACP, PhD;
Megan C. Leary, MD;
Margaret Tremwel, MD, PhD;
Bruce Ovbiagele, MD;
Andre Fredieu, MD;
Shuichi Suzuki, MD, PhD;
J. Pablo Villablanca, MD;
Stephen Davis, MD;
Billy Dunn, MD;
Jason W. Todd, MD;
Mustapha A. Ezzeddine, MD;
Joseph Haymore, MS, ACNP;
John K. Lynch, DO, MPH;
Lisa Davis, MSN, RN;
Steven Warach, MD, PhD
JAMA. 2004;292:1823-1830.
Context Noncontrast computed tomography (CT) is the standard brain imaging study for the initial evaluation of patients with acute stroke symptoms. Multimodal magnetic resonance imaging (MRI) has been proposed as an alternative to CT in the emergency stroke setting. However, the accuracy of MRI relative to CT for the detection of hyperacute intracerebral hemorrhage has not been demonstrated.
Objective To compare the accuracy of MRI and CT for detection of acute intracerebral hemorrhage in patients presenting with acute focal stroke symptoms.
Design, Setting, and Patients A prospective, multicenter study was performed at 2 stroke centers (UCLA Medical Center and Suburban Hospital, Bethesda, Md), between October 2000 and February 2003. Patients presenting with focal stroke symptoms within 6 hours of onset underwent brain MRI followed by noncontrast CT.
Main Outcome Measures Acute intracerebral hemorrhage and any intracerebral hemorrhage diagnosed on gradient recalled echo (GRE) MRI and CT scans by a consensus of 4 blinded readers.
Results The study was stopped early, after 200 patients were enrolled, when it became apparent at the time of an unplanned interim analysis that MRI was detecting cases of hemorrhagic transformation not detected by CT. For the diagnosis of any hemorrhage, MRI was positive in 71 patients with CT positive in 29 (P<.001). For the diagnosis of acute hemorrhage, MRI and CT were equivalent (96% concordance). Acute hemorrhage was diagnosed in 25 patients on both MRI and CT. In 4 other patients, acute hemorrhage was present on MRI but not on the corresponding CT—each of these 4 cases was interpreted as hemorrhagic transformation of an ischemic infarct. In 3 patients, regions interpreted as acute hemorrhage on CT were interpreted as chronic hemorrhage on MRI. In 1 patient, subarachnoid hemorrhage was diagnosed on CT but not on MRI. In 49 patients, chronic hemorrhage, most often microbleeds, was visualized on MRI but not on CT.
Conclusion MRI may be as accurate as CT for the detection of acute hemorrhage in patients presenting with acute focal stroke symptoms and is more accurate than CT for the detection of chronic intracerebral hemorrhage.
Author Affiliations: UCLA Stroke Center (Drs Kidwell, Saver, Starkman, Alger, Tremwel, Ovbiagele, Fredieu, Suzuki, and Villablanca), Department of Neurology (Drs Kidwell, Saver, Starkman, Tremwel, Ovbiagele, Fredieu, and Suzuki), Department of Emergency Medicine (Dr Starkman), Department of Radiology (Drs Fredieu, Suzuki, and Villablanca), Ahmanson-Lovelace Brain Mapping Center (Dr Alger), UCLA Medical Center, Los Angeles, Calif; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md (Drs Chalela, Butman, Patronas, Latour, Baird, Dunn, Todd, Lynch, and Warach, and Mss Luby, and Davis); Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Calgary, Alberta (Drs Hill and Demchuk); Departments of Medicine/Community Health Sciences, University of Calgary, Calgary, Alberta (Dr Hill); Diagnostic Radiology Department, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, Md (Drs Butman, Patronas, and Alger); Division of Stroke and Vascular Neurology, Beth Israel Deaconess Medical Center, Boston, Mass (Dr Leary); Sparks Neurology Center, Fort Smith, Ark (Dr Tremwel); Royal Melbourne Hospital, Victoria, Australia (Dr Davis); Department of Neurology, Emory University, Atlanta, Ga (Dr Ezzeddine); Center for Neuroscience Services, Washington Adventist Hospital, Takoma Park, Md (Mr Haymore).
Corresponding Author: Chelsea S. Kidwell, MD, Washington Hospital Center Stroke Center, 100 Irving St NW, East Bldg Room 6126, Washington, DC 20010 (ckidwell{at}ucla.edu).
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Comparison of MRI and CT for Detection of Acute Intracerebral Hemorrhage
Michael Eliasziw and Leslie Paddock-Eliasziw
JAMA. 2005;293(5):550.
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Comparison of MRI and CT for Detection of Acute Intracerebral Hemorrhage—Reply
Chelsea S. Kidwell, Julio Chalela, Jeffrey L. Saver, Michael D. Hill, Andrew Demchuk, John Butman, and Steven Warach
JAMA. 2005;293(5):550-551.
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