The novel imaging methods in diagnosis and assessment of cerebrovascular diseases: an overview

Abstract

Cerebrovascular diseases, including ischemic strokes, hemorrhagic strokes, and vascular malformations, are major causes of morbidity and mortality worldwide. The advancements in neuroimaging techniques have revolutionized the field of cerebrovascular disease diagnosis and assessment. This comprehensive review aims to provide a detailed analysis of the novel imaging methods used in the diagnosis and assessment of cerebrovascular diseases. We discuss the applications of various imaging modalities, such as computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and angiography, highlighting their strengths and limitations. Furthermore, we delve into the emerging imaging techniques, including perfusion imaging, diffusion tensor imaging (DTI), and molecular imaging, exploring their potential contributions to the field. Understanding these novel imaging methods is necessary for accurate diagnosis, effective treatment planning, and monitoring the progression of cerebrovascular diseases.

Keywords: assessment; cerebrovascular diseases; diagnosis; imaging techniques; neuroimaging.

Figure 1

Sketch map of three main types DECT. (A) Dualsource-DECT: Composed of two independent x-ray tubes and two independent detectors. (B) Singlesource-DECT: Containing a dedicated generator that can quickly switch between low-energy and high-energy projections that are collected separately by a fast sampling-detector. (C) Duallayer-detector DECT: Composed of a two-layers-detector with different energy sensitivity.

Figure 2

A 52-year-old male patient was admitted to the hospital with “weakness of left limb for 5 h” and was treated with intravenous thrombolysis by alteplase combined with arterial thrombectomy. (A) CTA-MIP: occlusion of the basilar artery; (B) PCT: the picture contained four important parameters of PCT like CBF, CBV, MTT and TTD, which showed the value of CBF, CBV became lower and the value of MTT, TTD became longer in the right occipital lobe compared to the left, that meant hypoperfusion in the basilar artery supply area; (C,D) DSA: occlusion of the basilar artery was demonstrated by left vertebral artery angiography, and the basilar artery was recanalized with moderate proximal stenosis after thrombectomy, the left posterior cerebral artery was patent, and the distal right posterior cerebral artery did not have significant visualization; (E) MRI-T2WI, (F) MRI-DTI-FA, (G) MRI-DTI-colorful FA, (H) MRI-DTI-fiber tractography: 4 days after thrombectomy, T2WI showed the right temporo-occipital lobe had a patchy infarct focus, and DTI demonstrated the right tractus pyramidalis were thinner than those on the left side.

Figure 3

A 59-year-old male patient was admitted to the hospital with “weakness of right limb for 13 h” and was treated with arterial thrombectomy. (A) CTA-MIP: occlusion of the left middle cerebral artery; (B) PCT: the value of CBF, CBV became lower and the value of MTT, TTD became longer in the left middle cerebral artery supply area compared to the right, which meant hypoperfusion in the left middle cerebral artery supply area; (C,D) DSA: angiography suggested occlusion of the left middle cerebral artery, and after thrombectomy, re-angiography showed that the main trunk of the left middle cerebral artery was patent, with some thrombus escaping to the distal branches; (E) MRI-DWI, (F) MRI-ADC, (G) MRI-DTI-colorful FA: 3 days after thrombectomy, DWI and ADC demonstrated multiple infarct foci in the blood-supplying area of the left middle cerebral artery, and a few hemorrhagic transformed foci in the basal ganglia area, DTI showed the left nerve fiber bundles were thinner than those on the right side; (H) MRA-TOF: 4 days after thrombectomy, the left middle cerebral artery was still patent.