Informasi Citra Anatomi CT Scan Kepala pada Kasus Stroke Iskemik dengan Variasi Windowing

Authors

DOI:

https://doi.org/10.31983/jimed.v11i2.13190

Keywords:

CT Scan Head, Ischemic Stroke, Windowing

Abstract

Background: Ischemic stroke is a critical condition detectable through head CT scans, where windowing techniques significantly enhance brain tissue visualization. At Bethesda Hospital Yogyakarta, differing windowing protocols are used in the Emergency and Main Radiology Departments, yet no standardized stroke-specific window has been established. This study aims to identify the differences in anatomical information in head CT scans with various windowing settings and to determine the most optimal windowing protocol.

Methods: This research is a quantitative-experimental study conducted at Bethesda Hospital Yogyakarta involving 10 patients with ischemic stroke, using variations of windowing settings: WW 120 HU WL 60 HU, WW 100 HU WL 35 HU, and WW 40 HU WL 40 HU. The image results were evaluated by two respondents based on the anatomical information of brain parenchyma, insular cortex, internal capsule, left and right cerebral hemispheres, and brain sulci. The data analysis was performed using the Friedman statistical test.

Results: The results of the study showed that the WW 100 HU WL 35 HU setting provided the most informative anatomical visualization across all evaluated brain structures. In contrast, WW 120 HU WL 60 HU was the least informative for the brain parenchyma and insular cortex, while WW 40 HU WL 40 HU offered moderate clarity for most structures but was suboptimal for the brain parenchyma. These differences were confirmed by the Friedman test, with a p-value < 0.05.

Conclusions: There were differences in anatomical information across the various windowing settings in head CT scan examinations for ischemic stroke cases. In addition, the highest overall and individual anatomical mean rank was found in the WW 100 HU WL 35 HU windowing setting, with a value of 2.95.

References

Arsava, E. M., Saarinen, J. T., Unal, A., Akpinar, E., Oguz, K. K., & Topcuoglu, M. A. (2014). Impact of window setting optimization on accuracy of computed tomography and computed tomography angiography source image-based alberta stroke program early computed tomography score. Journal of Stroke and Cerebrovascular Diseases, 23(1), 12–16. https://doi.org/10.1016/j.jstrokecerebrovasdis.2012.05.012

Chau, S., & Hayre, C. (2023). Computed tomography: A Primer for Radiograhers. In CRC Press (1 ed., Vol. 94, Nomor 20–21).

El-Koussy, M., Schroth, G., Brekenfeld, C., & Arnold, M. (2014). Imaging of Acute Ischemic Stroke. European Neurology, 72(5–6), 309–316. https://doi.org/10.1159/000362719

Feske, S. K. (2021). Ischemic Stroke. American Journal of Medicine, 134(12), 1457–1464. https://doi.org/10.1016/j.amjmed.2021.07.027

Haussen, D. C., Lima, A., Frankel, M., Anderson, A., Belagaje, S., Nahab, F., Rangaraju, S., & Nogueira, R. G. (2015). Sulcal Effacement with Preserved Gray-White Junction: A Sign of Reversible Ischemia. Stroke, 46(6), 1704–1706. https://doi.org/10.1161/STROKEAHA.115.009304

Hu, X., Michael De Silva, T., Chen, J., & Faraci, F. M. (2017). Cerebral Vascular Disease and Neurovascular Injury in Ischemic Stroke. Circulation Research, 120(3), 449–471. https://doi.org/10.1161/CIRCRESAHA.116.308427

Izzudin, M., Sukmaningtyas, H., & Sulaksono, N. (2021). Analisis Variasi Window Width Terhadap Informasi Citra Anatomi MSCT Stonografi. Jurnal Radiografer Indonesia, 4(2), 99–105. https://doi.org/10.55451/jri.v4i2.98

Karki, M., Cho, J., Lee, E., Hahm, M. H., Yoon, S. Y., Kim, M., Ahn, J. Y., Son, J., Park, S. H., Kim, K. H., & Park, S. (2020). CT window trainable neural network for improving intracranial hemorrhage detection by combining multiple settings. Artificial Intelligence in Medicine, 106, 101850. https://doi.org/10.1016/j.artmed.2020.101850

KEMENKES. (2018). Laporan Riskesdas 2018 Nasional. In Lembaga Penerbit Balitbangkes. Lembaga Penerbit BALITBANGKES. https://repository.badankebijakan.kemkes.go.id/id/eprint/3514/1/Laporan Riskesdas 2018 Nasional.pdf

Lo, C. M., Hung, P. H., & Lin, D. T. (2021). Rapid Assessment of Acute Ischemic Stroke by Computed Tomography Using Deep Convolutional Neural Networks. Journal of Digital Imaging, 34(3), 637–646. https://doi.org/10.1007/s10278-021-00457-y

Mair, G., & Wardlaw, J. M. (2014). Imaging of acute stroke prior to treatment: Current practice and evolving techniques. British Journal of Radiology, 87(1040). https://doi.org/10.1259/bjr.20140216

Mela, A., Murniawaty, I., Pendidikan Ekonomi, J., & Ekonomi, F. (2019). Pengaruh Lokasi Usaha, Pengalaman Usaha Dan Pengelolaan Pasar Terhadap Omzet Penjualan Pedagang Setelah Revitalisasi. Economic Education Analysis Journal, 8(2), 588–604. https://doi.org/10.15294/eeaj.v8i2.31490

Povlow, M. R., Cloran, F. J., & Bui-Mansfield, L. T. (2021). From Outside to Inside: A Systematic Approach to the Head CT from the Emergency Department. Contemporary Diagnostic Radiology, 44(1), 1–8. https://doi.org/10.1097/01.CDR.0000724332.12197.4d

Puig, J., Shankar, J., Liebeskind, D., Terceño, M., Nael, K., Demchuk, A. M., Menon, B., Dowlatshahi, D., Leiva-Salinas, C., Wintermark, M., Thomalla, G., Silva, Y., Serena, J., Pedraza, S., & Essig, M. (2020). From “Time is Brain†to “Imaging is Brainâ€: A Paradigm Shift in the Management of Acute Ischemic Stroke. Journal of Neuroimaging, 30(5), 562–571. https://doi.org/10.1111/jon.12693

Salazar, A. J., Useche, N., Granja, M., Morillo, A. J., & Bermúdez, S. (2017). Ruling Out Brain CT Contraindications prior to Intravenous Thrombolysis: Diagnostic Equivalence between a Primary Interpretation Workstation and a Mobile Tablet Computer. International Journal of Telemedicine and Applications, 2017. https://doi.org/10.1155/2017/6869145

Seeram, E. (2016). Computed tomography : physical principles, clinical applications, and quality control. In Elsevier. Elsevier. https://doi.org/10.1002/9781119720553.ch3

Smith, A., & Hill, C. (2017). Imaging assessment of acute ischaemic stroke: A review of radiological methods. British Journal of Radiology, 91(1083), 1–11. https://doi.org/10.1259/bjr.20170573

Srivatsan, A., Christensen, S., & Lansberg, M. G. (2019). A Relative Noncontrast CT Map to Detect Early Ischemic Changes in Acute Stroke. Journal of Neuroimaging, 29(2), 182–186. https://doi.org/10.1111/jon.12593

Tortora, G., & Derrickson, B. (2019). Principles of Human Anatomy & Physiology (15 ed.). John Wiley & Sons.

Turner, P. J., & Holdsworth, G. (2011). CT stroke window settings: An unfortunate misleading misnomer? British Journal of Radiology, 84(1008), 1061–1066. https://doi.org/10.1259/bjr/99730184

Vilela, P., & Rowley, H. A. (2017). Brain ischemia: CT and MRI techniques in acute ischemic stroke. European Journal of Radiology, 96(August), 162–172. https://doi.org/10.1016/j.ejrad.2017.08.014

Downloads

Published

2025-07-31

Issue

Section

Articles