Article · Clinical
Stroke CT Interpretation Guide
Stroke CT interpretation involves a systematic read of non-contrast CT (NCCT) to exclude haemorrhage and detect early ischaemic signs, followed by CT angiography (CTA) to identify large-vessel occlusion (LVO) and inform thrombectomy decisions.
Step-by-step NCCT + CTA approach for acute stroke.
Step 1 — exclude haemorrhage on NCCT
Look for hyperdense intra-axial blood, subarachnoid blood in basal cisterns, subdural collections, and mass effect with midline shift.
Step 2 — early ischaemic signs
Loss of grey-white differentiation, sulcal effacement, insular ribbon sign, hyperdense MCA sign. Use ASPECTS scoring for MCA territory.
Step 3 — CTA for LVO
Scan from arch to vertex. Look for filling defects in ICA, M1, M2, basilar. LVO patients are candidates for mechanical thrombectomy up to 24 hours from onset (DAWN/DEFUSE-3).
Quick facts
- Always rule out blood before treating ischaemia
- ASPECTS ≥6 favours intervention
- Thrombectomy window: up to 24 h in select patients