Can stroke physicians and neuroradiologists identify signs of early cerebral infarction on CT?

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 67; no. 5; pp. 651 - 653
• Main Authors: Wardlaw, J M, Dorman, P J, Lewis, S C, Sandercock, P A G
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.11.1999; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Biological and medical sciences; cerebral infarction; Cerebral Infarction - diagnostic imaging; computed tomography; Diagnosis, Differential; Family physicians; Fibrinolytic Agents - therapeutic use; Humans; Medical imaging; Medical sciences; Medicine; Neurology; observer reliability; Observer Variation; Patient Selection; Patients; Personnel, Hospital; Physicians; Professional Competence; Reproducibility of Results; Short Report; Signs; Specialization; Stroke; Stroke - diagnosis; Time Factors; Tomography, X-Ray Computed; Vascular diseases and vascular malformations of the nervous system; Human; Professional experience; Cerebral infarction; Nervous system diseases; Radiodiagnosis; Image interpretation; Decision making; Early phase; Physician; Cardiovascular disease; Cerebral disorder; Vascular disease; Radiologist; Central nervous system disease; Medical imagery; Computerized axial tomography; Diagnosis; Reliability; Cerebrovascular disease
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.67.5.651

Doctors managing acute stroke are expected to recognise signs of early infarction on CT before choosing thrombolytic treatment, according to recent trials and guidelines. The ability of 13 physicians and two neuroradiologists to recognise early infarct signs and decide whether patients should be randomised in a hypothetical stroke treatment trial was tested. Only 65% of the CT scans from 14 stroke patients were correctly identified as normal or abnormal (95% CI 60–69%). Neither observer experience nor knowledge of symptoms significantly improved recognition of abnormality, although experience did significantly improve the observers’ ability to reproduce their results. Parenchymal hypodensity was the least well recognised sign. Only 45% (95% CI 40%–50%) of patients were identified correctly for the hypothetical acute stroke treatment trial. Early infarction on CT is not well recognised even by experienced doctors. Part of the problem may be in understanding the definitions of the extent of infarction. These difficulties should be considered in the design of acute stroke treatment trials and in the introduction of any new acute stroke treatments.