What is new in stroke imaging and intervention?

Abstract

s13-s6 STROKE NCCT brain exam is performed 'immediately' or at least within an hour of presentation. 3 The diagnostic utility of NCCT brain imaging is well established, but it can also provide an indication of prognosis. The Alberta Stroke Programme Early CT Score (ASPECTS) is a means of deriving prognostic information for patients with an anterior circulation stroke. 4 The cerebrum is divided into 10 topographic regions. For each region affected by an anterior circulation infarction, a point is deducted. The stroke-affected regions are best assessed with a narrow window width and window level, eg between 35 and 45 Hounsfield units. Good interobserver reproducibility is seen with this scoring method. 5 A score of fewer than 8 is an indicator of an increased risk of symptomatic intracranial haemorrhage and of a worse outcome following intravenous thrombolysis. Advances in the imaging of acute ischaemic strokeFollowing the diagnosis of an acute ischaemic stroke, it is established practice to administer intravenous thrombolysis (IVT) within 4.5 hours of the onset of symptoms. 6 However,IVT is not without its risks. In fact, a 6% increase in symptomatic intracerebral haemorrhage was noted by a Cochrane systematic review. 6Is advanced brain imaging able to better select patients for treatment by identifying those who are at an increased risk of complications, such as symptomatic intracerebral haemorrhage? Could imaging also identify patients who may benefit from treatment despite not presenting within 4.5 hours of symptom onset? Advanced brain imaging in stroke consists of all magnetic resonance imaging (MRI) and any form of CT imaging other than an NCCT brain scan. CT angiographyCT angiography (CTA), from aortic arch to skull vertex, has a variety of clinical benefits as well as being quick and cheap to perform. Firstly, it adds diagnostic certainty to the NCCT brain scan. CTA can identify the location of the arterial occlusion, which is essential if proceeding on to endovascular therapy. Furthermore, the degree of any vessel stenosis can be identified, which is relevant for both the acute and long-term management of patients. 8 A recent study based on multiple randomised controlled trials of individual patient record data found that use of IVT was associated with an improvement in functional outcome if CTA demonstrated arterial obstruction (Fig 1 )

Diagnostic Value of Perfusion-Weighted Magnetic Resonance Imaging as an Adjunct to Routine Magnetic Resonance Protocols for Adults Presenting with Acute Ischemic Stroke

“…However, perfusion imaging using CT or an MRI equivalent is essential for those who may be candidates for thrombectomy and presenting beyond 6 hours of symptom onset. 15,16 Presently, MRI is reserved as a second-line imaging modality to CT for the diagnosis of AIS, although MRI offers the benefit of avoiding ionizing radiation exposure and specific protocols, and it may provide superior imaging quality to permit accurate diagnosis. 4 This systematic literature review employed a central research question derived using the recommended PICO framework.…”

An Intermodal Correlation Study among Imaging, Histology, Procedural and Clinical Parameters in Cerebral Thrombi Retrieved from Anterior Circulation Ischemic Stroke Patients

“…The most-often used imaging modality in the diagnosis of stroke is CT [ 16 ]. While native CT provides relatively poor contrasted images of patients suspected of stroke, its contrasted version used for CT angiography can clearly depict the site of the occluded artery and the extent of penumbra.…”