The new insights into human brain imaging after stroke

Abstract

Over the last two decades, developments of human brain stroke imaging have raised several questions about the place of new MRI biomarkers in the acute management of stroke and the prediction of poststroke outcome. Recent studies have demonstrated the main role of perfusion‐weighted imaging in the identification of the best cerebral perfusion profile for a better response after reperfusion therapies in acute ischemic stroke. A major issue remains the early prediction of stroke outcome. While voxel‐based lesion‐symptom mapping emphasized the influence of stroke location, the analysis of the brain parenchyma underpinning the stroke lesion showed the relevance of prestroke cerebral status, including cortical atrophy, white matter integrity, or presence of chronic cortical cerebral microinfarcts. Moreover, besides the evaluation of the visually abnormal brain tissue, the analysis of normal‐appearing brain parenchyma using diffusion tensor imaging and magnetization transfer imaging or spectroscopy offered new biomarkers to improve the prediction of the prognosis and new targets to follow in therapeutic trials. The aim of this review was to depict the main new radiological biomarkers reported in the last two decades that will provide a more thorough prediction of functional, motor, and neuropsychological outcome following the stroke. These new developments in neuroimaging might be a cornerstone in the emerging personalized medicine for stroke patients.

Relevance of Porcine Stroke Models to Bridge the Gap from Pre-Clinical Findings to Clinical Implementation

“…Non-invasive in vivo imaging techniques allow a longitudinal estimation of the brain damage location and extent and contribute to our understanding of the evolution of damage after stroke. Although the extent of damage is a critical determinant, the functions served by the brain areas damaged (e.g., language, motor, or cognition) and the nature of damage (e.g., necrosis, edema, axonal damage) determine the final disabilities [ 239 ].…”

Dengzhanxixin Injection Ameliorates Cognitive Impairment Through a Neuroprotective Mechanism Based on Mitochondrial Preservation in Patients With Acute Ischemic Stroke

“…Finally, recent results also suggested that the greatest long-term risk of dementia might occur in patients with severe stroke (Dichgans, 2019). These indicate that stroke is not just an associate, but can be an initiator of cognitive deterioration (Sagnier and Sibon, 2019). Ischemia triggers a cascade of events in the brain, including impediment of aerobic energy metabolism, extensive generation of reactive oxygen spices, and mitochondrial injury among others (George and Steinberg, 2015).…”

Association of cerebral microvascular perfusion and diffusion dynamics detected by intravoxel incoherent motion-diffusion weighted imaging with initial neurological function and clinical outcome in acute ischemic stroke

“…Computed tomography, magnetic resonance diffusion weighted imaging (DWI) and perfusion weighted imaging (PWI) have been commonly used to diagnose acute stroke and to evaluate its therapeutic effect and clinical prognosis ( Scheldeman et al, 2020 ; Suh et al, 2019 ; Zhu et al, 2019 ). Among the neuroimaging techniques mentioned above, previous studies showed that DWI is the most valuable approach for the detection of acute stroke ( Heiss & Zaro-Weber, 2019 ; Sagnier & Sibon, 2019 ; Scheldeman et al, 2020 ; Simonsen et al, 2015 ; Wolman et al, 2018 ; Wouters et al, 2016 ). The ischemic lesions exhibit themselves via evident hyperintensity on DWI, and accompanied by a decrease in apparent diffusion coefficient (ADC) values ( Liu et al, 2019 ; Wolman et al, 2018 ).…”