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Appropriateness of CT Imaging to Support the Diagnosis of Stroke: A Review of the Clinical Evidence [Internet].


Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2013 Nov.
CADTH Rapid Response Reports.


In Canada, stroke is the third most common cause of death with an estimated incidence of approximately 50,000 cases each year. The majority of strokes are ischemic (80%) and are a result of interruption of blood flow to the brain caused by a blood clot. Transient Ischemic Attack (TIA) is defined as “a transient episode of neurodysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction”. Approximately 15,000 Canadians experience a TIA each year and are five times more likely to suffer from a stroke in the following two years when compared to the general population. The need for an accurate and timely diagnostic test is therefore needed, as the risk of recurrent stroke within 90 days after a TIA is between 10% to 20%. The combination of imaging modalities, laboratory tests, and clinical features provide a comprehensive diagnosis for stroke. Advances in imaging technology such as computed tomography (CT) and magnetic resonance imaging (MRI) have allowed for the distinction between hemorrhagic and ischemic strokes, providing clinicians with greater certainty whether to administer thrombolysis. With rapid scan times and ease for detecting intracranial hemorrhage, CT has shown to be a preferred diagnostic technology. MRI has been shown to easily detect ischemia with diffusion-weighted imaging and also detects hyperacute hemorrhage with proper sequences. MRI is not as widely available as CT and is typically more costly. With no single gold standard for the diagnosis of stroke, uncertainty regarding the appropriateness of solely using CT or expert clinical assessment remains. Furthermore, current clinical practice guidelines state that CT tests must be performed, though this technology is not always available in rural or remote emergency departments. The objective of this review is to summarize recent clinical evidence of CT and expert clinical assessment to support the diagnosis of stroke and TIAs.

Copyright © 2013 Canadian Agency for Drugs and Technologies in Health.

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