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Neuroimaging Clin N Am. 2003 May;13(2):167-83.

Evidence-based neuroimaging in acute ischemic stroke.

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Neuroradiology Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Campus Box 8131, Saint Louis, MO 63110, USA.


The imaging work-up of patients with acute neurologic deficits should begin with noncontrast CT to exclude intracerebral hemorrhage. Based on positive results from the NINDS t-PA trial, the overriding objectives of imaging in the selection of patients for t-PA treatment are the detection of hemorrhage and rapid evaluation (speed of imaging). Despite its limited sensitivity for the identification of an ischemic stroke lesion, CT has multiple advantages over MR imaging in the initial diagnostic work-up. Advanced MR techniques promise to provide anatomic, physiologic, and vascular information in a single examination, and the ability to increase treatment specificity and improve outcome. Clinical outcome data are lacking; therefore, the routine use of screening MR imaging before t-PA therapy is not supported. Rigorous validation and correlation to clinical outcomes will be required.

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