Clinical Study Detection of Early Ischemic Changes in Noncontrast CT Head Improved with ‘‘Stroke Windows’’ Shraddha Mainali, 1 Mervat Wahba, 1 and Lucas Elijovich 1,2,3 1 Department of Neurology, University of Tennessee, Memphis, TN 38163, USA 2 Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, University of Tennessee, Memphis, TN 38120, USA 3 Semmes-Murphey Clinic, 6325 Humphreys Boulevard, Memphis, TN 38120-2300, USA Correspondence should be addressed to Lucas Elijovich; lelijovich@semmes-murphey.com Received 2 December 2013; Accepted 8 January 2014; Published 9 March 2014 Academic Editors: M. Jan, A. J. Nelson, and S. Rosahl Copyright © 2014 Shraddha Mainali et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Noncontrast head CT (NCCT) is the standard radiologic test for patients presenting with acute stroke. Early ischemic changes (EIC) are oten overlooked on initial NCCT. We determine the sensitivity and speciicity of improved EIC detection by a standardized method of image evaluation (Stroke Windows). Methods. We performed a retrospective chart review to identify patients with acute ischemic stroke who had NCCT at presentation. EIC was deined by the presence of hyperdense MCA/basilar artery sign; sulcal efacement; basal ganglia/subcortical hypodensity; and loss of cortical gray-white diferentiation. NCCT was reviewed with standard window settings and with specialized Stroke Windows. Results. Fity patients (42% females, 58% males) with a mean NIHSS of 13.4 were identiied. EIC was detected in 9 patients with standard windows, while EIC was detected using Stroke Windows in 35 patients (18% versus 70%;  < 0.0001). Hyperdense MCA sign was the most commonly reported EIC; it was better detected with Stroke Windows (14% and 36%;  < 0.0198). Detection of the remaining EIC also improved with Stroke Windows (6% and 46%;  < 0.0001). Conclusions. Detection of EIC has important implications in diagnosis and treatment of acute ischemic stroke. Utilization of Stroke Windows signiicantly improved detection of EIC. 1. Introduction Noncontrast head CT (NCCT) is the irst-line diagnostic test for emergency evaluation of acute stroke due to its speed of imaging, widespread availability, and low cost. he window width and center level settings—measured in Hounsield units: HUs—used for computed tomographic (CT) scan review are known to inluence both lesion conspicuity and diagnostic accuracy [1]. Numerous studies suggest that detection of early ischemic change (EIC) on NCCT can predict both functional outcome and the risk of intracranial hemorrhage (ICH) [2–4]. Speciic features relevant to stroke assessment include hyperdense middle cerebral artery (MCA)/basilar signs, focal parenchymal hypoattenuation (notably of the insular ribbon or lenticular nuclei for MCA infarcts), and cerebral swelling manifested by sulcal or ventricular efacement or loss of cortical grey-white diferentiation [5–7]. Decreases in CT attenuation accompanying early stroke are small; therefore, their conspicuity may be increased by using narrow window settings centered at approximately the mean attenuation in HUs of gray and white matter. We believe that the increase in lesion conspicuity achieved with this method can improve the accuracy of nonenhanced CT stroke detection [1]. In most academic stroke centers, on-call residents, radiologists, and ED physicians are the irst providers to interpret NCCT in the setting of suspected acute ischemic stroke. We hypothesize that detection of EIC can be improved by a standardized method of image evaluation that can be implemented by the treating physicians (including trainees). Hindawi Publishing Corporation ISRN Neuroscience Volume 2014, Article ID 654980, 4 pages http://dx.doi.org/10.1155/2014/654980