Cerebrovascular Disease

Article Figures & Data

Table 1:

Clinical condition—Cerebrovascular disease: Ischemia

	MRI, brain, with or without contrast	CT, head, with or without contrast	MRA, head and neck, with or without contrast	CTA, head and neck	Arterio-graphy, neck	Arterio-graphy, head and neck	US, carotid, duplex	US, trans cranial, Doppler
Asymptomatic: positive physical exam (cervical bruit) and/or risk factors.	5^a	5^a ^k	8ⁱ	8^j	2	2	8^h	3
TIA: carotid territory or vertebrobaslar TIA, initial screening survey	8^a ^b ^c	8^a ^b ^c ^d	8^b ^c	8^b ^c	3	3	6	3
Less than 3 hours: new focal neurologic defect, fixed or worsening.	8^a ^b ^c	8^a ^b ^c	8^b ^c	8^b ^c	5^e	5^e	2	2
Three to 24 hours: new focal neurologic defect, fixed or worsening.	8^b ^c ^f	8^b ^c ^g	8^b ^c	8^b ^c	6^e	6^e	2	2
Greater than 24 hours: new focal neurologic defect, fixed or worsening.	8^b ^c ^f	8^b ^c ^g	8^b ^c	8^b ^c	6^e	6^e	2	2

Note: —Appropriateness criteria scale from 1 to 9, 1 = least appropriate, 9 = most appropriate;
a , consider perfusion if stenosis found;
b , combined vascular and cerebral evaluation should be considered;
c , MR preferred if treatment not unreasonably delayed;
d , primarily to rule out hemorrhage;
e , if intra-arterial therapy is considered;
f , diffusion especially valuable;
g , for perfusion according to institutional protocols;
h , may need to confirm with second non-invasive study;
i , MRA of neck only, with or without contrast. MRA head = 3 but recommended if neck stenosis or occlusion found;
j , CTA of neck only. CTA head = 3 but recommended if neck stenosis or occlusion found;
k , CT head without contrast = 3

Table 2:

Clinical condition—Cerebrovascular disease: Hemorrhage

	MRI, brain, with or without contrast	CT, head, without contrast	CT, head, without and with contrast	MRA, head, with or without contrast	MRA, neck, with or without contrast	CTA, neck	CTA, head	Arterio-graphy, head and neck	Arterio-graphy, neck	US, trans cranial, Doppler
Aneurysm: Risk for unruptured aneurysm. Positive family history	6	3	3	8^b	3	2	8^b ^c	1	1	1
SAH: clinically suspected subarachnoid hemorrhage, not yet confirmed	4	9	5	4	2	2^d	2	2	2	1
SAH: proven by lumbar puncture or imaging	6	8	5	7	6^d	6^d	8	8	8^d ^e	5^f
SAH: proven but negative angiogram, follow-up	8^a ^b	5	4	8^a ^b	5	5	8^b	8	5	5^f
Hematoma: clinically suspected parenchymal hemorrhage, not yet confirmed	7	8	7	4	3	3	4	3	2	1
Hematoma: proven parenchymal hemorrhage	8^a ^b	8^a ^b	7	8^a ^b	5	5	8^a ^b	7^g	7	1

Note:—Appropriateness criteria scale from 1 to 9, 1 = least appropriate, 9 = most appropriate;
a , combined vascular and cerebral evaluation;
b , MR preferred if treatment not unreasonably delayed should be considered;
c , noncontrast CT obtained routinely at the same time;
d , for treatment planning;
e , as part of cerebral angiography;
f , for vasospasm;
g , if suspect AVM