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Neuroradiology

E1126. A Beginner's Guide to Reading Brain CT After Acute Stroke

MUBARAK F. Aga Khan University Hospital, karachi, pakistan

Address correspondence to F. Mubarak (Fatima.mubarak@aku.edu)

Background Information: The estimated annual incidence of stroke in Pakistan is 250/100,000, which is projected to an estimate of 350,000 new cases each year. The role of imaging in triage of acute stroke is to rule out hemorrhage or ischemic infarction and selection of ischemic stroke patients for available reperfusion therapies. The imaging modality of choice for stroke triage should enable patient selection for thrombolytic therapy in terms of both safety and efficacy. Routine IV tissue plasminogen activator treatment within the 3-hour window is still typically administered according to the protocol of the 1995 National Institute of Neurological Disorders and Stroke trial, which focused on exclusion of hemorrhage with unenhanced CT. However, infarct core and penumbra are desired for selection of reperfusion options as well as prognostication. Options for penumbra detection are being used, but several controversies remain with respect to CT or MRI with perfusion. These are particularly advised when mechanical thrombectomy is being considered.

Educational Goals/Teaching Points: Radiologists need to use a systematic approach in evaluating brain CT, to be able to recognize and describe the early signs of acute ischemic stroke, and to know how to exclude lesions that mimic acute ischemic stroke.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: We designed a systematic approach to read CT scans of the brain: obtain a scout image, quickly review the scan to assess for hemorrhage, apply a system that we designed that examines asymmetry, blood, brain, and CSF spaces (ABBC), and finally extend the search for mimics.

Conclusion: We found the ABBC system to be very appropriate and time-saving approach in these patients.