Noncontrast Computed Tomography for Differentiating Between Nonhemorrhagic Stroke Mimics and Acute Ischemic Stroke
Abstract
Objective: To determine the efficacy of noncontrast computed tomography (NCCT) for diagnosing stroke mimics in acute settings to promote confident decision-making and avoid unnecessary treatments and procedures.
Material and Methods: We enrolled patients presenting with clinical stroke-like symptoms within 6 hours who underwent NCCT at our institution between 2020 and 2021. Each NCCT scan was independently reviewed by 2 radiologists with consensus. Scans were classified as either stroke or stroke mimic patterns. Our study compared demographic data, clinical characteristics, and CT imaging patterns between the 2 groups. We used statistics to assess the performance of NCCT in diagnosing stroke mimics, in comparison with diagnosed ischemic strokes.
Results: The study cohort comprised 559 patients. The results demonstrated excellent interobserver reliability in imaging interpretation. Stroke mimics were identified in approximately 57% of patients, predominantly in older adults (median age: 64.1 years, p-value=0.002), females (51.6%, p-value=0.038), and patients with malignancies (17.9%, p-value<0.001). The most prevalent clinical presentation among stroke mimics was seizures (33.5%). Major etiologies of stroke mimics included idiopathic seizures (20.3%). The most common NCCT finding in stroke mimics was a negative scan (79.7%), with positive findings in only 20.3% of cases. NCCT exhibited a high specificity of 95% and a high positive predictive value of 97% in diagnosing stroke mimics.
Conclusion: NCCT is a reliable adjunctive diagnostic tool for differentiating stroke mimics, especially in acute settings. Its high specificity and positive predictive value enhance the accurate distinction between ischemic stroke and other conditions with similar presentations, facilitating appropriate treatment.
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