Brain ischemia: CT and MRI techniques in acute ischemic stroke

Eur J Radiol. 2017 Nov;96:162-172. doi: 10.1016/j.ejrad.2017.08.014. Epub 2017 Aug 24.

Abstract

Imaging plays a central role for intravenous and intra-arterial arterial ischemic stroke treatment patient selection. Computed tomography (CT) / CT angiography or magnetic resonance (MR) / MR angiography imaging are used to exclude stroke mimics and haemorrhage, to determine the cause and mechanism of stroke, to define the extension of brain infarct and to identify the arterial occlusion. Imaging may identify the patients that will be benefit more from revascularization therapies independently of the conventional therapeutic time window allowing individualized treatment decisions and improving individual patient outcome. Multiparametric CT/MR imaging may be used to identify the extension of potential viable brain tissue (penumbra) and of irreversible brain lesion (core) using CT perfusion and/or diffusion weighed and perfusion weighted MR imaging. The status of the arterial collateral circulation and the type and extension of the clot may be assessed by imaging. The accuracy and the clinical significance for treatment and patient clinical outcome of different imaging techniques are reviewed.

Keywords: Acute ischemic stroke; CT angiography; CT perfusion; Collateral circulation; Core; MR angiography; MR perfusion; Penumbra.

Publication types

  • Review

MeSH terms

  • Brain Ischemia / diagnostic imaging*
  • Brain Ischemia / pathology
  • Cerebrovascular Circulation / physiology*
  • Computed Tomography Angiography*
  • Humans
  • Magnetic Resonance Angiography*
  • Patient Selection
  • Perfusion
  • Reproducibility of Results
  • Stroke / diagnostic imaging*
  • Stroke / pathology
  • Time Factors