CT and MR Reading Form

Acute Ischaemic Stroke CT or MR SCAN READING FORM SCAN ID: DATE OF READING: Good Moderate Poor Comment: SCAN QUALITY: READER ID: TYPE OF SCAN: CT: Without contrast: With contrast: MR: Diffusion: Perfusion Note – examples and definitions will be on a separate sheet or in drop down boxes if electronic. Please tick Yes or No. Please do not leave blanks. Thank you. Y 1. N Is the scan completely normal? If YES stop here ISCHAEMIC CHANGES 2. Y N Is there any sign of acute ischaemic change? If in doubt as to whether acute or old, code as acute. If No go to Q.10 R 3. Which side of the brain shows ischaemic change? 4. Classify signs of ischaemic change in the main lesion (if more than one recent lesion). (see examples) L Tick R and L if both Y N a) loss of grey/white matter cortex definition N/A b) loss of basal ganglia outline c) hypodensity present (i.e. more than in a or b so that the lesion appears less dense than white matter) 1 Y N d) mass effect (swelling) present If yes – sulcal effacement ventricular effacement midline shift N/A uncal herniation hyperdense artery (see Q.10) mass effect: ventricular effacement Image © J Wardlaw, Univ. of Edinburgh hypodensity loss of grey/white matter definition hyperdense artery (see Q.10) mass effect: ventricular effacement Image © J Wardlaw, Univ. of Edinburgh loss of basal ganglia outline hypodensity mass effect: sulcal effacement loss of basal ganglia outline 2 5. Classify site and size of ischaemic lesion (see examples) a) site M =MCA* AS =Infarct of up to half of ACA territory AL =Infarct of more than half of ACA territory PS =Infarct of up to half of PCA territory PL =Infarct of more than half of PCA territory MAS=M+AS* MAL=M+AL* MPS=M+PS* MPL=M+PL* MAP=Infarct of whole MCA, ACA and PCA territories L =Lacune* B =Borderzone* C =Cerebellum* S =Brainstem* CS =Cerebellum and brainstem * code sub-territory sites in b b) sub-territory sites MCA sub-territory codes 1=small cortical infarct 2=basal ganglia infarct (>2x2x2cm) 3=infarct of white matter lateral to the lateral ventricle (>2x2x2cm) 4=infarct of anterior half of peripheral MCA territory 5=infarct of the posterior half of peripheral MCA territory 6=infarct of the whole of peripheral MCA territory 7=6+infarct of lateral part of basal ganglia 8=infarct of whole of MCA territory Lacunar/Borderzone sub-territory codes 9=lacune in internal capsule/lentiform 10=lacune in internal border zone 11=lacune in centrum semiovale 12=lacune in thalamus 13=lacune in brainstem, inc. pons (not shown) 14=anterior (mainly) border zone 15=posterior (mainly) border zone Cerebellum sub-territory codes 16=small cortical (not shown) 17=<1/2 hemisphere (medium) (not shown) 18=>1/2 hemisphere (not shown) Brainstem sub-territory codes 11=small, i.e.<1/2 medulla (not shown) 12=extensive, i.e. pons + medulla (not shown) c) degree of mass effect Image © J Wardlaw, Univ. of Edinburgh Mass effect grading 0=no swelling 1=effacement of the sulci overlying the infarct 2=1+minor effacement of adjacent lateral ventricle 3=1+complete effacement of lateral ventricle 4=1+effacement of the lateral and third ventricle 5=4+shift of the midline away from the side of the ventricle 6=5+effacement of the basal cisterns Diagrams © J Wardlaw, Univ of Edinburgh 3 IF INFARCT IS IN THE MCA TERRITORY ANSWER Q.6 &Q.7 (if not go to Q.8): 6. In your opinion does the new acute ischaemic change involve more than 1/3 of the MCA territory? 7. ASPECTS for the MCA territory (see examples) Y N Norm Abnorm Y N ASPECT Score: Please indicate if each of the MCA areas shown opposite, in the hemisphere that you think is ischaemic, are normal or show some signs of an infarct (abnormal). (NB: Does not include areas A or P) Caudate (C) Lentiform (L) Insula (I) Internal Capsule (IC) MCA1 (M1) MCA2 (M2) MCA3 (M3) MCA4 (M4) MCA5 (M5) MCA6 (M6) Diagrams and score 2000;355:1670-1674 8. 9. taken from Lancet Is there a second (discrete) recent ischaemic lesion? If No go to Q.10 Describe second ischaemic lesion: HYPERDENSE VESSEL SIGN 10. Is there a hyperdense artery? (see example in question 4) 11. Name hyperdense artery: Y N If No go to Q.12 4 HAEMORRHAGIC CHANGES 12. Is there any haemorrhage anywhere? 13. Classify haemorrhage (if more than one haemorrhage, tick all present – indicate order of significance) : Y N If No go to Q.14 Order Y N (insert 1, 2, 3 to indicate your estimate of the order of importance) Size of Haematoma (max diam.): <3cm 3-5cm 5-8cm >8cm a) petechial haemorrhage (example 1 or 2 below) b) significant haemorrhagic transformation of infarct (i.e. underlying infarct still visible) (example 3 below) c) parenchymal haematoma (i.e. no infarct visible) d) parenchymal haematoma clearly remote from infarct e) subdural haematoma f) subarachnoid haemorrhage g) extradural haemorrhage h) In your opinion, is the haemorrhage a major component of the infarct which is likely to have worsened mass effect or involved more brain in the damage present and so worsened symptoms, or if remote from the infarct, likely to have contributed significantly to the burden of brain damage? Diagrams © J Wardlaw, Univ of Edinburgh Haematoma with no or only slight mass effect Haematoma with definite mass effect compressing surrounding tissue 5 Reduction in brain tissue volume Y 14. Is there any Reduction in brain tissue volume? 15. Classify atrophy (see examples and pick nearest likeness): central N If No go to Q.16 None Mod Severe cortical CENTRAL reduction in brain tissue None Modest Severe CORTICAL reduction in brain tissue None Mild Severe Approach validated in Eur Radiol 2008;19:177-183 6 PERIVENTRICULAR LUCENCIES Y 16. Are there any periventricular lucencies? 17. Classify extent of white matter lucency a. N If No go to Q.18 Anterior lucencies Ant. & Post lucencies Slice through choroid plexus Slice through cella media Posterior lucencies 0,1,2 Anterior white matter 0= no lucency 1= lucency restricted to region adjoining ventricles 2= lucency covering entire region from lateral ventricle to cortex b. 0,1,2 Posterior white matter 0= no lucency 1= lucency restricted to region adjoining ventricles 2= lucency covering entire region from lateral ventricle to cortex AWM = 1 AWM = 2 Slice through centrum semiovale (diagrams from van Swieten et al. JNNP 1990;53:10801083) PWM = 0 PWM = 1 Form, images and diagrams, except where indicated otherwise, © J Wardlaw, University of Edinburgh 7 OLD VASCULAR LESIONS 18. Are there any old vascular lesions? 19. Classify old vascular lesion(s): Y N If No go to Q.20 Y N Y N a) old cortical infarct(s) b) old striatocapsular infarct(s) c) old borderzone infarct(s) d) old lacunar infarct(s) e) old brainstem/cerebellar infarct(s) f) probable old haemorrhage NON-STROKE LESIONS 20. Is there a non-stroke lesion, which could have accounted for the patient’s stroke syndrome? 21. Classify non-stroke lesion: If No go to Q.22 Y N a) cerebral tumour b) encephalitis c) cerebral abscess d) other (e.g. contusion) 22. Specify Other: COMMENT: 8