Management

Ken Butcher, MD, on Multimodal CT Scanning for Acute Stroke

A new review highlights the power and importance of multimodal computed tomography (CT) scanning for the care of patients with current ischemic stroke.1 Lead author Ken Butcher, MD, answered our questions about his latest research and the clinical implications of his findings.

Ken Butcher, MD, is a professor in the Division of Neurology at the University of Alberta in Edmonton, Canada, and a professor at the Prince of Wales Clinical School at the University of New South Wales in Randwick, Australia.

NEUROLOGY CONSULTANT: For your study, you and your colleagues reviewed the purpose and interpretation of each component of multimodal CT scanning and examined the evidence for use in routine care. Which components did you examine?

Ken Butcher: We reviewed the 3 components of multimodal CT, which are non-contrast CT, CT angiography, and CT perfusion.

NEURO CON: What other findings did your study highlight? How do they add to the current literature?

KB: We summarized the current evidence for using all 3 components of multimodal CT, as well as each individual component. Essentially, each component adds additional information. While stroke can be treated with the most basic scan, diagnostic and prognostic accuracy increases with each additional component.

NEURO CON: How might these findings change clinical practice or how acute stroke is managed?

KB: We summarized the evidence for using each component to select patients for reperfusion therapies. We also summarized the current controversy surrounding the need for CT perfusion and attempts to replace this with additional alterations to the CT angiography protocol.

NEURO CON: What is your key take-home message for neurologists?

KB: Our take-home message is that multimodal CT is the diagnostic tool of choice in suspected acute ischemic stroke. The strongest evidence for late-window intervention is based on a full multimodal CT workup. In addition, this approach provides diagnostic information to clinicians that permits a definitive diagnosis of stroke. We conclude that full multimodal CT should be standard in patients with an acute ischemic stroke presentation.

Reference:

  1. Wannamaker R, Buck B, Butcher K. Multimodal CT in acute stroke. Curr Neurol Neurosci Rep. 2019;19(9):63. https://doi.org/10.1007/s11910-019-0978-z.