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References and appendices; two Word documents.
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Copyright © 2011 by AAN Enterprises, Inc.
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Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology
- P.D. Schellinger, MD, PhD,
- R.N. Bryan, MD, PhD,
- L.R. Caplan, MD,
- J.A. Detre, MD,
- R.R. Edelman, MD,
- C. Jaigobin, MD,
- C.S. Kidwell, MD,
- J.P. Mohr, MD,
- M. Sloan, MD, MS,
- A.G. Sorensen, MD and
- S. Warach, MD, PhD
- From the National Institutes of Neurological Disorders and Stroke (P.D.S., S.W.), NIH, Bethesda, MD; Department of Neurology (P.D.S.), University of Erlangen, Germany; Departments of Radiology (R.N.B.) and Neurology (J.A.D.), University of Pennsylvania, Philadelphia; Department of Neurology (L.R.C.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Radiology (R.R.E.), Northwestern University, Evanston, IL; Division of Neurology (C.J.), Toronto General Hospital, Canada; Department of Neurology (C.S.K.), Georgetown University, Washington, DC; Columbia University (J.P.M.), New York, NY; Department of Neurology (M.S.), University of South Florida, Tampa; and Department of Radiology (A.G.S.), MGH, Boston, MA.
- Address correspondence and reprint requests to the American Academy of Neurology, 1080 Montreal Avenue, St. Paul, MN 55116 guidelines{at}aan.com
Abstract
Objective: To assess the evidence for the use of diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) in the diagnosis of patients with acute ischemic stroke.
Methods: We systematically analyzed the literature from 1966 to January 2008 to address the diagnostic and prognostic value of DWI and PWI.
Results and Recommendations: DWI is established as useful and should be considered more useful than noncontrast CT for the diagnosis of acute ischemic stroke within 12 hours of symptom onset. DWI should be performed for the most accurate diagnosis of acute ischemic stroke (Level A); however, the sensitivity of DWI for the diagnosis of ischemic stroke in a general sample of patients with possible acute stroke is not perfect. The diagnostic accuracy of DWI in evaluating cerebral hemorrhage is outside the scope of this guideline. On the basis of Class II and III evidence, baseline DWI volumes probably predict baseline stroke severity in anterior territory stroke (Level B) but possibly do not in vertebrobasilar artery territory stroke (Level C). Baseline DWI lesion volumes probably predict (final) infarct volumes (Level B) and possibly predict early and late clinical outcome measures (Level C). Baseline PWI volumes predict to a lesser degree the baseline stroke severity compared with DWI (Level C). There is insufficient evidence to support or refute the value of PWI in diagnosing acute ischemic stroke (Level U).
This guideline is retired. The recommendations and conclusions are no longer considered valid and no longer supported by the AAN. Retired guidelines should be used for historical reference only. Please see AAN current guidelines here: https://www.aan.com/policy-and-guidelines/guidelines/.
Footnotes
Disputes & Debates: Rapid online correspondence
- Evidence-based guideline: The role of diffusion and perfusion MRI for the diagnosis of acute ischemi
- Evidence-based guideline: The role of diffusion and perfusion MRI for the diagnosis of acute
- Reply from the authors
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