Multimodality Imaging in Acute Ischemic Stroke | Bentham Science
Login Register Cart 0
Generic placeholder image

Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Review Article

Multimodality Imaging in Acute Ischemic Stroke

Author(s): Shahla Zameer, Ayesha Shamim Siddiqui and Ramish Riaz*

Volume 17, Issue 5, 2021

Published on: 30 November, 2020

Page: [567 - 577] Pages: 11

DOI: 10.2174/1573405616666201130094948

Price: $65

Open Access Journals Promotions 2
Abstract

Stroke is the most common cause of mortality and morbidity worldwide. The prognosis of stroke depends upon the area affected and its early treatment. Time is of the essence in the care of stroke patients as it is estimated that approximately 1.9 million neurons, 14 billion synapses, and 12 km myelinated nerve fibers are lost per minute. Therefore, early diagnosis and prompt treatment are necessary. The primary goal of imaging in acute stroke is to diagnose the underlying cause, estimate the area affected, predict response towards thrombolytic therapy and to exclude the conditions mimicking stroke. With advancements in radiology, multiple imaging modalities are available for diagnosis and predicting prognosis. None of them is considered alone to be perfect. In this era of multimodality imaging, the decision of choosing appropriate techniques depends upon purpose and availability. Non-Contrast Computed Tomography is time effective, and helps in excluding other causes, Trans Cranial Doppler is time-effective and cost-effective with wide availability, however, is operator dependent and less sensitive. It holds a great future in sonothrombolysis. Magnetic Resonance Imaging is so far considered to be the most superior one in terms of early diagnosis, planning for interventional treatment and predicting the response of treatment. However, it is limited due to high cost and lack of availability. The current review gives a detailed account of all imaging modalities available for imaging stroke and their associated pros and cons.

Keywords: Stroke, imaging, perfusion imaging, transcranial doppler, magnetic resonance imaging, computed tomography.

Graphical Abstract

[1]
Mumtaz H, Riaz R, Rajput HM, Akhtar A. Correlation between degree of compliance to antihypertensive with severity of stroke. ASKMH 2018; 23(3): 148-55.
[2]
Walter J, Oyere O. WHO bulletin Stroke: a global response is needed 2016. 2016.
[3]
Hussain G, Rasul A, Anwar H, et al. Epidemiological data of neurological disorders in Pakistan and neighboring countries: A review. PJNS 2017; 12(4): Article 12.
[4]
Ragoschke-Schumm A, Walter S, Haass A, et al. Translation of the ‘time is brain’ concept into clinical practice: focus on prehospital stroke management. Int J Stroke 2014; 9(3): 333-40.
[http://dx.doi.org/10.1111/ijs.12252] [PMID: 24593156]
[5]
Abbott AL, Silvestrini M, Topakian R, et al. Optimizing the definitions of stroke, transient ischemic attack, and infarction for research and application in clinical practice. Front Neurol 2017; 8: 537.
[http://dx.doi.org/10.3389/fneur.2017.00537] [PMID: 29104559]
[6]
Musuka TD, Wilton SB, Traboulsi M, Hill MD. Diagnosis and management of acute ischemic stroke: speed is critical. CMAJ 2015; 187(12): 887-93.
[http://dx.doi.org/10.1503/cmaj.140355] [PMID: 26243819]
[7]
Caceres JA, Goldstein JN. Intracranial hemorrhage. Emerg Med Clin North Am 2012; 30(3): 771-94.
[http://dx.doi.org/10.1016/j.emc.2012.06.003] [PMID: 22974648]
[8]
Saver JL. Time is brain--quantified. Stroke 2006; 37(1): 263-6.
[http://dx.doi.org/10.1161/01.STR.0000196957.55928.ab] [PMID: 16339467]
[9]
Long B, Koyfman A. Clinical mimics: an emergency medicine-focused review of stroke mimics. J Emerg Med 2017; 52(2): 176-83.
[http://dx.doi.org/10.1016/j.jemermed.2016.09.021] [PMID: 27780653]
[10]
Monbailliu T, Goossens J, Hachimi-Idrissi S. Blood protein biomarkers as diagnostic tool for ischemic stroke: a systematic review. Biomarkers Med 2017; 11(6): 503-12.
[http://dx.doi.org/10.2217/bmm-2016-0232] [PMID: 28598212]
[11]
Federau C, Wintermark MCT. CT-angiography, and perfusion-CT evaluation of stroke. Primer Cerebrovasc Dis 2017; 686-94.
[12]
Kim YS. Initial diagnosis and management of acute ischemic stroke. Stroke revisited: diagnosis and treatment of ischemic stroke. 2017; 37-48.
[http://dx.doi.org/10.1007/978-981-10-1424-6_5]
[13]
Kumar GG, Nagesh C. Acute ischemic stroke: a review of imaging, patient selection, and management in the endovascular era. Part I: initial management and imaging. J Clin Interv Radiol 2018; 2(3): 155-68.
[http://dx.doi.org/10.1055/s-0038-1675881]
[14]
Menon BK, Sajobi TT, Zhang Y, et al. Analysis of workflow and time to treatment on thrombectomy outcome in the endovascular treatment for small core and proximal occlusion ischemic stroke (ESCAPE) randomized, controlled trial. Circulation 2016; 133(23): 2279-86.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.115.019983] [PMID: 27076599]
[15]
Eskey CJ, Meyers PM, Nguyen TN, et al. American Heart Association Council on Cardiovascular Radiology and Intervention and Stroke Council. American Heart Association Council on Cardiovascular Radiology and Intervention and Stroke Council. Indications for the performance of intracranial endovascular neurointerventional procedures: a scientific statement from the American Heart Association. Circulation 2018; 137(21): e661-89.
[http://dx.doi.org/10.1161/CIR.0000000000000567] [PMID: 29674324]
[16]
Bhatia A, Pruthi S. Imaging of pediatric stroke. Indian J Pediatr 2016; 83(9): 983-94.
[http://dx.doi.org/10.1007/s12098-015-1982-1] [PMID: 26920396]
[17]
Vilela P, Rowley HA. Brain ischemia: CT and MRI techniques in acute ischemic stroke. Eur J Radiol 2017; 96: 162-72.
[http://dx.doi.org/10.1016/j.ejrad.2017.08.014] [PMID: 29054448]
[18]
Sohn CH. Radiological assessment of ischemic stroke. Acute Ischemic Stroke 2017; 35-58.
[19]
Smith AG, Rowland Hill C. Imaging assessment of acute ischaemic stroke: a review of radiological methods. Br J Radiol 2018; 91(1083): 20170573.
[http://dx.doi.org/10.1259/bjr.20170573] [PMID: 29144166]
[20]
Mirza S, Gokhale S. Neuroimaging in stroke in neuroimaging SMG Pulishers. 2016.
[21]
Muir KW, Santosh C. Imaging of acute stroke and transient ischaemic attack. J Neurol Neurosurg Psychiatry 2005; 76(Suppl. 3): iii19-28.
[http://dx.doi.org/10.1136/jnnp.2005.075168] [PMID: 16107386]
[22]
Na DG, Kim EY, Ryoo JW, et al. CT sign of brain swelling without concomitant parenchymal hypoattenuation: comparison with diffusion- and perfusion-weighted MR imaging. Radiology 2005; 235(3): 992-48.
[http://dx.doi.org/10.1148/radiol.2353040571] [PMID: 15860675]
[23]
Yu W, Jiang WJ. A simple imaging guide for endovascular thrombectomy in acute ischemic stroke: from time window to perfusion mismatch and beyond. Front Neurol 2019; 10: 502.
[http://dx.doi.org/10.3389/fneur.2019.00502] [PMID: 31178813]
[24]
Garg R, Biller J. Neuroimaging predictors of clinical outcome in acute basilar artery occlusion. Front Neurol 2017; 8: 293.
[http://dx.doi.org/10.3389/fneur.2017.00293] [PMID: 28674517]
[25]
Khatibi K, Nour M, Tateshima S, et al. Posterior circulation thrombectomy-pc-ASPECT score applied to preintervention magnetic resonance imaging can accurately predict functional outcome. World Neurosurg 2019; 129: e566-71.
[http://dx.doi.org/10.1016/j.wneu.2019.05.217] [PMID: 31158539]
[26]
Mokin M, Primiani CT, Siddiqui AH, Turk AS. ASPECTS (Alberta Stroke Program Early CT Score) measurement using hounsfield unit values when selecting patients for stroke thrombectomy. Stroke 2017; 48(6): 1574-9.
[http://dx.doi.org/10.1161/STROKEAHA.117.016745] [PMID: 28487329]
[27]
Hill MD, Demchuk AM, Goyal M, et al. Investigators, I.M.S. Alberta Stroke Program early computed tomography score to select patients for endovascular treatment: Interventional Management of Stroke (IMS). III Trial Stroke 2014; 45(2): 444-9.
[http://dx.doi.org/10.1161/STROKEAHA.113.003580] [PMID: 24335227]
[28]
Nael K, Khan R, Choudhary G, et al. Six-minute magnetic resonance imaging protocol for evaluation of acute ischemic stroke: pushing the boundaries. Stroke 2014; 45(7): 1985-91.
[http://dx.doi.org/10.1161/STROKEAHA.114.005305] [PMID: 24916906]
[29]
Rotman J, Zimmerman R. Patterns of ischemic stroke: from lacunar to territorial to multiple embolic to watershed hypotensive.Neurovascular imaging: from basics to advanced concepts. New York, NY: Springer New York 2016; pp. 329-62.
[30]
Chung MS, Lee JY, Jung SC, et al. Reliability of fast magnetic resonance imaging for acute ischemic stroke patients using a 1.5-T scanner. Eur Radiol 2019; 29(5): 2641-50.
[http://dx.doi.org/10.1007/s00330-018-5812-5] [PMID: 30421013]
[31]
Horwood L, Attili A, Luba F, et al. Magnetic resonance imaging in patients with cardiac implanted electronic devices: focus on contraindications to magnetic resonance imaging protocols. Europace 2017; 19(5): 812-7.
[http://dx.doi.org/10.1093/europace/euw122] [PMID: 27256419]
[32]
Mann RM, Balleyguier C, Baltzer PA, et al. European Society of Breast Imaging (EUSOBI), with language review by Europa Donna–The European Breast Cancer Coalition Breast MRI: EUSOBI recommendations for women’s information. Eur Radiol 2015; 25(12): 3669-78.
[http://dx.doi.org/10.1007/s00330-015-3807-z] [PMID: 26002130]
[33]
Okorie CK, Ogbole GI, Owolabi MO, Ogun O, Adeyinka A, Ogunniyi A. Role of diffusion-weighted imaging in acute stroke management using low-field magnetic resonance imaging in resource-limited settings. West Afr J Radiol 2015; 22(2): 61-6.
[http://dx.doi.org/10.4103/1115-3474.162168] [PMID: 26709342]
[34]
Suo S, Cao M, Zhu W, et al. Stroke assessment with intravoxel incoherent motion diffusion-weighted MRI. NMR Biomed 2016; 29(3): 320-8.
[http://dx.doi.org/10.1002/nbm.3467] [PMID: 26748572]
[35]
Bevers MB, Battey TWK, Ostwaldt AC, et al. Apparent diffusion coefficient signal intensity ratio predicts the effect of revascularization on ischemic cerebral edema. Cerebrovasc Dis 2018; 45(3-4): 93-100.
[http://dx.doi.org/10.1159/000487406] [PMID: 29533946]
[36]
Lövblad KO, Altrichter S, Mendes Pereira V, et al. Imaging of acute stroke: CT and/or MRI. J Neuroradiol 2015; 42(1): 55-64.
[http://dx.doi.org/10.1016/j.neurad.2014.10.005] [PMID: 25466468]
[37]
Dmytriw AA, Sawlani V, Shankar J. Diffusion-weighted imaging of the brain: beyond stroke. Can Assoc Radiol J 2017; 68(2): 131-46.
[http://dx.doi.org/10.1016/j.carj.2016.10.001] [PMID: 28131336]
[38]
Choi Y, Hwang EJ, Nam Y, et al. Analysis of apparent diffusion coefficients of the brain in healthy controls: a comparison study between single-shot echo-planar imaging and read-out-segmented echo-planar imaging. Korean J Radiol 2019; 20(7): 1138-45.
[http://dx.doi.org/10.3348/kjr.2018.0899] [PMID: 31270977]
[39]
Tae WS, Ham BJ, Pyun SB, Kang SH, Kim BJ. Current clinical applications of diffusion-tensor imaging in neurological disorders. J Clin Neurol 2018; 14(2): 129-40.
[http://dx.doi.org/10.3988/jcn.2018.14.2.129] [PMID: 29504292]
[40]
Heit JJ, Iv M, Wintermark M. Imaging of intracranial hemorrhage. J Stroke 2017; 19(1): 11-27.
[http://dx.doi.org/10.5853/jos.2016.00563] [PMID: 28030895]
[41]
Young JY, Schaefer PW. Acute ischemic stroke imaging: a practical approach for diagnosis and triage. Int J Cardiovasc Imaging 2016; 32(1): 19-33.
[http://dx.doi.org/10.1007/s10554-015-0757-0] [PMID: 26362874]
[42]
Azad R, Mittal P, Malhotra A, Gangrade S. Detection and differentiation of focal intracranial calcifications and chronic microbleeds using MRI. J Clin Diagn Res 2017; 11(5): TC19-23.
[http://dx.doi.org/10.7860/JCDR/2017/24076.9846] [PMID: 28658873]
[43]
Hsu CC, Kwan GNC, Hapugoda S, Craigie M, Watkins TW, Haacke EM. Susceptibility weighted imaging in acute cerebral ischemia: review of emerging technical concepts and clinical applications. Neuroradiol J 2017; 30(2): 109-19.
[http://dx.doi.org/10.1177/1971400917690166] [PMID: 28424015]
[44]
Hartung MP, Grist TM, François CJ. Magnetic resonance angiography: current status and future directions. J Cardiovasc Magn Reson 2011; 13: 19-32.
[http://dx.doi.org/10.1186/1532-429X-13-19] [PMID: 21388544]
[45]
Kilburg C, Scott McNally J, de Havenon A, Taussky P, Kalani MY, Park MS. Advanced imaging in acute ischemic stroke. Neurosurg Focus 2017; 42(4): E10.
[http://dx.doi.org/10.3171/2017.1.FOCUS16503] [PMID: 28366054]
[46]
Ehrlich ME, Turner HL, Currie LJ, Wintermark M, Worrall BB, Southerland AM. Safety of computed tomographic angiography in the evaluation of patients with acute stroke: a single-center experience. Stroke 2016; 47(8): 2045-50.
[http://dx.doi.org/10.1161/STROKEAHA.116.013973] [PMID: 27364528]
[47]
Alexandrov AV, Sloan MA, Tegeler CH, et al. American Society of Neuroimaging Practice Guidelines Committee. Practice standards for transcranial Doppler (TCD) ultrasound. Part II. Clinical indications and expected outcomes. J Neuroimaging 2012; 22(3): 215-24.
[http://dx.doi.org/10.1111/j.1552-6569.2010.00523.x] [PMID: 20977531]
[48]
Simon B, Mani SE, Keshava SN, Alexander M, Aaron S. Role of noninvasive imaging of cerebral arterial system in ischemic stroke: comparison of transcranial color-coded doppler sonography with magnetic resonance angiography. J Clin Imaging Sci 2018; 8: 19.
[http://dx.doi.org/10.4103/jcis.JCIS_13_18] [PMID: 29770267]
[49]
Alexandrov AV, Köhrmann M, Soinne L, et al. CLOTBUST-ER Trial Investigators. Safety and efficacy of sonothrombolysis for acute ischaemic stroke: a multicentre, double-blind, phase 3, randomised controlled trial. Lancet Neurol 2019; 18(4): 338-47.
[http://dx.doi.org/10.1016/S1474-4422(19)30026-2] [PMID: 30878103]
[50]
Flottmann F, Broocks G, Faizy TD, et al. CT-perfusion stroke imaging: a threshold free probabilistic approach to predict infarct volume compared to traditional ischemic thresholds. Sci Rep 2017; 7(1): 6679.
[http://dx.doi.org/10.1038/s41598-017-06882-w] [PMID: 28751692]
[51]
Konstas AA, Wintermark M, Lev MH. CT perfusion imaging in acute stroke. Neuroimaging Clin N Am 2011; 21(2): 215-38, ix..
[http://dx.doi.org/10.1016/j.nic.2011.01.008]
[52]
Allmendinger AM, Tang ER, Lui YW, Spektor V. Imaging of stroke: Part 1, Perfusion CT--overview of imaging technique, interpretation pearls, and common pitfalls. AJR Am J Roentgenol 2012; 198(1): 52-62.
[http://dx.doi.org/10.2214/AJR.10.7255] [PMID: 22194479]
[53]
Donahue J, Wintermark M. Perfusion CT and acute stroke imaging: foundations, applications, and literature review. J Neuroradiol 2015; 42(1): 21-9.
[http://dx.doi.org/10.1016/j.neurad.2014.11.003] [PMID: 25636991]
[54]
Tong E, Hou Q, Fiebach JB, Wintermark M. The role of imaging in acute ischemic stroke. Neurosurg Focus 2014; 36(1): E3.
[http://dx.doi.org/10.3171/2013.10.FOCUS13396] [PMID: 24380480]
[55]
Heit JJ, Wintermark M. Perfusion computed Tomography for the evaluation of acute ischemic stroke. Stroke 2016; 47(4): 1153-8.
[http://dx.doi.org/10.1161/STROKEAHA.116.011873] [PMID: 26965849]
[56]
Lev MH. Perfusion imaging of acute stroke: its role in current and future clinical practice. Radiology 2013; 266(1): 22-7.
[http://dx.doi.org/10.1148/radiol.12121355] [PMID: 23264524]
[57]
McVerry F, Dani KA, MacDougall NJJ, MacLeod MJ, Wardlaw J, Muir KW. Derivation and evaluation of thresholds for core and tissue at risk of infarction using CT perfusion. J Neuroimaging 2014; 24(6): 562-8.
[http://dx.doi.org/10.1111/jon.12134] [PMID: 25039499]
[58]
Copen WA, Schaefer PW, Wu O. MR perfusion imaging in acute ischemic stroke. Neuroimaging Clin N Am 2011; 21(2): 259-83, x.
[http://dx.doi.org/10.1016/j.nic.2011.02.007]
[59]
Huang YC, Liu HL, Lee JD, et al. Comparison of arterial spin labeling and dynamic susceptibility contrast perfusion MRI in patients with acute stroke. PLoS One 2013; 8(7): e69085.
[http://dx.doi.org/10.1371/journal.pone.0069085] [PMID: 23874876]
[60]
Zaharchuk G. Arterial spin-labeled perfusion imaging in acute ischemic stroke. Stroke 2014; 45(4): 1202-7.
[http://dx.doi.org/10.1161/STROKEAHA.113.003612] [PMID: 24603069]
[61]
An H, Ford AL, Vo KD, et al. Imaging oxygen metabolism in acute stroke using MRI. Curr Radiol Rep 2014; 2(3): 39.
[http://dx.doi.org/10.1007/s40134-013-0039-3] [PMID: 24707451]
[62]
Christen T, Bolar DS, Zaharchuk G. Imaging brain oxygenation with MRI using blood oxygenation approaches: methods, validation, and clinical applications. AJNR Am J Neuroradiol 2013; 34(6): 1113-23.
[http://dx.doi.org/10.3174/ajnr.A3070] [PMID: 22859287]
[63]
Latchaw RE, Alberts MJ, Lev MH, et al. On behalf of the american heart association council on cardiovascular radiology and intervention, stroke council, and the interdisciplinary council on peripheral vascular disease. Recommendations for imaging of acute ischemic stroke: A scientific statement from the American Heart Association 2009.
[http://dx.doi.org/10.1161/STROKEAHA.108.192616]
[64]
Scrieber SJ, Valdueza JM, Doepp F. Transcranial color-coded sonography: advanced approach using ultrasound fusion imaging. Int J Clin Neurosci Ment Health 2014; 1(Suppl. 1): S16.

Rights & Permissions Print Cite
Article Metrics
57
Wayfinder Image
Open Access Journals Promotions
© 2024 Bentham Science Publishers | Privacy Policy