J Korean Soc Radiol.  2019 Nov;80(6):1075-1090. 10.3348/jksr.2019.80.6.1075.

Neuroimaging in Acute Ischemic Stroke: Role and Recent Advances

• Cho SJ
• Jung SC
• Suh CH
• Kim KW
• Woo DC
• Oh WY
• Lee JG
• Kim BJ

• KMID: 2464908
• DOI: http://doi.org/10.3348/jksr.2019.80.6.1075

Abstract

Neuroimaging plays a key role in assessing the detection of acute hemorrhage, diagnosis of infarct core, detection of steno-occlusive arteries, mismatch between infarct core and penumbra, and collateral circulation in patients with acute cerebral ischemic stroke. The recent announcement of randomized clinical trials that demonstrated the usefulness of intra-arterial mechanical thrombectomy and the guidelines of 2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke from American Heart Association/American Stroke Association led to a larger role of neuroimaging and required new neuroimaging strategy for acute cerebral ischemic stroke. In this review, we summarize the recommendation on neuroimaging from the 2018 Guidelines, and review pros and cons between CT and MR and fast scanned stroke MR. Based on the new guidelines and recent research, we discuss the appropriate neuroimaging strategy for acute cerebral ischemic stroke patients.

MeSH Terms

Arteries
Collateral Circulation
Diagnosis
Heart
Hemorrhage
Humans
Magnetic Resonance Imaging
Neuroimaging*
Stroke*
Thrombectomy
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. Acute ischemic hyperintensity on fast and conventional FLAIR. Acute ischemic hyperintensity (left column, arrows) in a diffusion-restricted area is well demonstrated in both conventional FLAIR (middle column, scan time: 128 s) and fast FLAIR [right column: (EPI-FLAIR, top, scan time: 45 s), (ETL-FLAIR, middle row, scan time: 74 s), and (TR-FLAIR, bottom, scan time: 79 s)]. DWI = diffusion-weighted imaging, EPI = echo planar imaging, ETL = echo train length, FLAIR = fluid-attenuated inversion recovery imaging, TR = repetition time

• 

  Fig. 2. Fast and conventional GRE. A microbleed in the right thalmus (arrows) is well-demonstrated on both conventional GRE (right, scan time: 141 s) and fast GRE [EPI-GRE (middle, scan time: 29 s) and parallel-GRE (left, scan time: 54 s)]. EPI = echo planar imaging, GRE = Gradient echo

• 

  Fig. 3. Fast CE-MRA and TOF-MRA. Both TOF-MRA (left, scan time: 274 s) and fast CE-MRA (right, scan time: 39 s) demonstrate an occlusion in the right middle cerebral artery (arrows). CE = contrast-enhanced, MRA = magnetic resonance angiography, TOF = time-of-flight

Reference

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