Imaging in acute stroke

Eswaradass, Prasanna Venkatesan; Appireddy, Ramana; Evans, James; Tham, Carol Huilian; Dey, Sadanand; Najm, Mohamed; Menon, Bijoy K

doi:10.1080/14779072.2016.1196134

Cited by 7 publications

(3 citation statements)

References 104 publications

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“…CT of the brain is still the most widely used imaging method in the assessment of acute stroke (18). Whilst ischemic changes appear as hypodense areas in the affected territories, proximal occlusion of the middle cerebral artery can be detected with CT angiography (19). In cases of middle cerebral artery occlusion, ischemic changes on plain CT in more than 50% of the corresponding territory are independently associated with fatal brain swelling (14, 16).…”

Section: Malignant Middle Cerebral Artery Infarctionmentioning

confidence: 99%

Role of Decompressive Craniectomy in Ischemic Stroke

2019

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Ischemic stroke is one of the leading causes for death and disability worldwide. In patients with large space-occupying infarction, the subsequent edema complicated by transtentorial herniation poses a lethal threat. Especially in patients with malignant middle cerebral artery infarction, brain swelling secondary to the vessel occlusion is associated with high mortality. By decompressive craniectomy, a significant proportion of the skull is surgically removed, allowing the ischemic tissue to shift through the surgical defect rather than to the unaffected regions of the brain, thus avoiding secondary damage due to increased intracranial pressure. Several studies have shown that decompressive craniectomy reduces the mortality rate in patients with malignant cerebral artery infarction. However, this is done for the cost of a higher proportion of patients who survive with severe disability. In this review, we will describe the clinical and radiological features of malignant middle cerebral artery infarction and the role of decompressive craniectomy and additional therapies in this condition. We will also discuss large cerebellar stroke and the possibilities of suboccipital craniectomy.

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Section: Malignant Middle Cerebral Artery Infarctionmentioning

confidence: 99%

Role of Decompressive Craniectomy in Ischemic Stroke

2019

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“…DWI in combination with PWI has shown great promise for the identification of brain tissue in patients with acute ischemic stroke ( Fig. 6 ) that is dysfunctional because of low blood flow but potentially salvageable on the restoration of blood flow [9] . The mismatch between DWI and PWI volumes represents the tissue at risk of an infraction and thus, the target tissue for reperfusion treatment.…”

Section: Discussionmentioning

confidence: 99%

Identification of penumbra in acute ischemic stroke using multimodal MR imaging analysis: A case report study

Sodaei

Shahmaei

2020

Radiology Case Reports

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Ischemic etiology of stroke is the most common health issue. Differentiating the ischemic core from the associated penumbra is tremendously important in tailoring an effective therapeutic strategy and potential intervention. Additionally, the degree of cell damage adjacent to the ischemic core may be either reversible or irreversible, which may also affect clinical outcomes. We describe a case of a 58-year-old female, who was diagnosed with global aphasia and fluctuating right-sided hypoesthesia. Multimodal MR imaging analysis was obtained, with cerebral blood flow and mean transit time , demonstrating an infarcted core with an even larger penumbra, suggesting potentially salvageable tissue. We concluded that quantified perfusion imaging data should be used in combination with other MR protocols to determine at-risk tissues. This case substantiates the role of multimodal imaging of the penumbra as a routine part of acute stroke workup and management.

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“…These measures have been validated with histology, 8 and the model has been applied to various pathologies 9,10 . Incidence of stroke results in diffusivity inhomogeneities due to ischemic hyperintensity, 11,12 which makes DWI an important method in stroke evaluation. NODDI expands on DWI measurements in ischemia, as NODDI indices may compliment FA measurements, highlighting anisotropic changes in neural structures potentially being caused by changes in neurite density or orientation dispersion, 13 and may even be a predictor of outcomes after stroke incidence 14,15 .…”

Section: Introductionmentioning

confidence: 99%

NODDI highlights recovery mechanisms in white and gray matter in ischemic stroke following human stem cell treatment

Bagdasarian

Yuan

Athey

et al. 2021

Magnetic Resonance in Med

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Purpose Diffusion MRI offers insight into ischemic stroke progression in both human and rodent models. However, diffusion MRI to evaluate therapeutic application of mesenchymal stem cells is limited. Robust analytical techniques are required to identify potential physiological changes as a function of cell therapy in stroke. Here, we seek to establish Neurite Orientation Dispersion and Density Imaging (NODDI) as a feasible method in evaluating stroke evolution in response to cell‐based therapeutics. Methods Diffusion MRI data at 21.1T were acquired from 16 male rats. Rats were grouped randomly: naïve (baseline, N = 5), stroke with injections of phosphate buffered saline (N = 6), stroke with injection of 2D human mesenchymal stem cells (hMSC, N = 5). Data were acquired on days 1, 3, 7, and 21 post‐surgery. DTI and NODDI maps were generated, with regions of interest placed in the ischemic hemisphere external capsule and striatum. Diffusion parameters were compared between groups each day, and within groups across hemispheres and longitudinally. Behavioral characterizations were on days 0 (pre‐surgery), 3, 7, 14, and 21. Results The 2D hMSC preserved diffusional restriction in the external capsule compared to saline (day 1: MD, P = .4060; AD, P = .0220). NODDI indicates that hMSC may have preserved intracellular volume fractions (ICVF: day 1, P = .0086; day 3, P = .0021; day 21, P = .0383). Diffusion metrics of hMSC treated animals were comparable to naïve for the external capsule. Conclusions NODDI compliments DTI metrics, enhances interpretation of tissue outcome in ischemic stroke following hMSC application, and may be useful in evaluating or predicting therapeutic response.

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Imaging in acute stroke

Cited by 7 publications

References 104 publications

Role of Decompressive Craniectomy in Ischemic Stroke

Role of Decompressive Craniectomy in Ischemic Stroke

Identification of penumbra in acute ischemic stroke using multimodal MR imaging analysis: A case report study

NODDI highlights recovery mechanisms in white and gray matter in ischemic stroke following human stem cell treatment

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