Advanced imaging in acute ischemic stroke

Abstract

Advances in stroke neuroimaging have evolved from excluding acute intracranial hemorrhage on computed tomography (CT) to now using perfusion studies (PWI) and magnetic resonance imaging (MRI) to possibly expand thrombolytic treatment to patients most likely to benefit from reperfusion therapy. Advanced imaging has also helped identify those at high risk for hemorrhage and poor outcome so appropriate treatment can occur with fewer complications. Identifying those who can benefit from endovascular recanalization using advanced neuroimaging techniques is particularly useful because endovascular treatment is often initiated much later than intravenous thrombolytic treatment due to logistical constraints. Using imaging markers of tissue injury may eventually lead to a paradigm shift from time-based treatment eligibility in acute stroke reperfusion treatment as the sensitivity and specificity to identify ischemic penumbra improves and correlation with clinical outcomes becomes clearer.