Abstract
Multimodal computed tomography (CT) and magnetic resonance (MR) neuroimaging techniques represent powerful tools that allow management decisions to be informed by precise characterization of individual pathophysiologic processes. They carry the prospect and hope of expanding the time window for acute stroke treatment and reaching a much higher number of acute stroke patients. Multimodal imaging allows to identify areas of hemorrhage or infarction and also areas of tissue viability or penumbra. The goal of this chapter is to discuss stroke imaging technologies. Particularly, how to interpret imaging findings, the advantages and disadvantages, as well as literature about the efficacy of each imaging technology will be addressed. Also, the latest trials on stroke intervention will be reviewed.
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References
Lloyd-Jones D et al. Heart disease and stroke statistics – 2010 Update: A Report From the American Heart Association. Circulation. 2009;121(7):948–54.
Writing Group Members et al. Heart disease and stroke statistics – 2010 Update: A report from the American Heart Association. Circulation. 2010;121(7):e46–215.
The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333(24):1581–7.
Hacke W et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet. 1998;352(9136):1245–51.
Rohl L et al. Viability thresholds of ischemic penumbra of hyperacute stroke defined by perfusion-weighted MRI and apparent diffusion coefficient. Stroke. 2001;32(5):1140–6.
Schellinger PD et al. Thrombolytic therapy for ischemic stroke – a review. Part II – Intra-arterial thrombolysis, vertebrobasilar stroke, phase IV trials, and stroke imaging. Crit Care Med. 2001;29(9):1819–25.
Warach S. New imaging strategies for patient selection for thrombolytic and neuroprotective therapies. Neurology. 2001;57(5 Suppl 2):S48–52.
Warach S. Thrombolysis in stroke beyond three hours: Targeting patients with diffusion and perfusion MRI. Ann Neurol. 2002;51(1):11–3.
Mayer TE et al. Serial CT and MRI of ischaemic cerebral infarcts: frequency and clinical impact of haemorrhagic transformation. Neuroradiology. 2000;42(4):233–9.
Zaheer A, Ozsunar Y, Schaefer PW. Magnetic resonance imaging of cerebral hemorrhagic stroke. Top Magn Reson Imaging. 2000;11(5):288–99.
Warach S. Tissue viability thresholds in acute stroke: the 4-factor model. Stroke. 2001;32(11):2460–1.
Crain MR et al. Cerebral ischemia: evaluation with contrast-enhanced MR imaging. AJNR Am J Neuroradiol. 1991;12(4):631–9.
Lovblad KO et al. Ischemic lesion volumes in acute stroke by diffusion-weighted magnetic resonance imaging correlate with clinical outcome. Ann Neurol. 1997;42(2):164–70.
Kamran S et al. Significance of hyperintense vessels on FLAIR MRI in acute stroke. Neurology. 2000;55(2):265–9.
Moseley ME et al. Early detection of regional cerebral ischemia in cats: comparison of diffusion- and T2-weighted MRI and spectroscopy. Magn Reson Med. 1990;14(2):330–46.
Moseley ME et al. Diffusion-weighted MR imaging of acute stroke: correlation with T2-weighted and magnetic susceptibility-enhanced MR imaging in cats. AJNR Am J Neuroradiol. 1990;11(3):423–9.
Chalela JA et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet. 2007;369(9558):293–8.
Saur D et al. Sensitivity and interrater agreement of CT and diffusion-weighted MR imaging in hyperacute stroke. AJNR Am J Neuroradiol. 2003;24(5):878–85.
Fiebach J et al. Comparison of CT with diffusion-weighted MRI in patients with hyperacute stroke. Neuroradiology. 2001;43(8):628–32.
Lansberg MG et al. Advantages of adding diffusion-weighted magnetic resonance imaging to conventional magnetic resonance imaging for evaluating acute stroke. Arch Neurol. 2000;57(9):1311–6.
Ay H et al. Normal diffusion-weighted MRI during stroke-like deficits. Neurology. 1999;52(9):1784–92.
Kidwell CS et al. Thrombolytic reversal of acute human cerebral ischemic injury shown by diffusion/perfusion magnetic resonance imaging. Ann Neurol. 2000;47(4):462–9.
Lefkowitz D et al. Hyperacute ischemic stroke missed by diffusion-weighted imaging. AJNR Am J Neuroradiol. 1999;20(10):1871–5.
Oppenheim C et al. False-negative diffusion-weighted MR findings in acute ischemic stroke. AJNR Am J Neuroradiol. 2000;21(8):1434–40.
Wang PY et al. Diffusion-negative stroke: a report of two cases. AJNR Am J Neuroradiol. 1999;20(10):1876–80.
Rasanen HT et al. Mild carotid artery atherosclerosis: assessment by 3-dimensional time-of-flight magnetic resonance angiography, with reference to intravascular ultrasound imaging and contrast angiography. Stroke. 1999;30(4):827–33.
Scarabino T et al. Contrast-enhanced MR angiography (CE MRA) in the study of the carotid stenosis: comparison with digital subtraction angiography (DSA). J Neuroradiol. 1999;26(2):87–91.
Nederkoorn PJ, van der Graaf Y, Hunink MGM. Duplex ultrasound and magnetic resonance angiography compared with digital subtraction angiography in carotid artery stenosis: A systematic review. Stroke. 2003;34(5):1324–31.
Sitzer M et al. Between-method correlation in quantifying internal carotid stenosis. Stroke. 1993;24(10):1513–8.
Fellner C et al. Magnetic resonance angiography of the carotid arteries using three different techniques: Accuracy compared with intraarterial x-ray angiography and endarterectomy specimens. J Magn Reson Imaging. 2005;21(4):424–31.
Patel SG et al. Outcome, observer reliability, and patient preferences if CTA, MRA, or Doppler ultrasound were used, individually or together, instead of digital subtraction angiography before carotid endarterectomy. J Neurol Neurosurg Psychiatry. 2002;73(1):21–8.
Binaghi S et al. Three-dimensional computed tomography angiography and magnetic resonance angiography of carotid bifurcation stenosis. Eur Neurol. 2001;46(1):25–34.
Yang CW et al. Contrast-enhanced MR angiography of the carotid and vertebrobasilar circulations. AJNR Am J Neuroradiol. 2005;26(8):2095–101.
Borisch I et al. Preoperative evaluation of carotid artery stenosis: Comparison of contrast-enhanced MR angiography and duplex sonography with digital subtraction angiography. AJNR Am J Neuroradiol. 2003;24(6):1117–22.
Townsend TC et al. Contrast material-enhanced MRA overestimates severity of carotid stenosis, compared with 3D time-of-flight MRA. J Vasc Surg. 2003;38(1):36–40.
Kidwell CS, Alger JR, Saver JL. Beyond mismatch: evolving paradigms in imaging the ischemic penumbra with multimodal magnetic resonance imaging. Stroke. 2003;34(11):2729–35.
Kidwell CS et al. The Role of CT and MRI in the emergency evaluation of persons with suspected stroke. Current Science Inc.: Philadelphia, PA; 2001. p. 21–28.
McCunn M et al. Physician utilization of a portable computed tomography scanner in the intensive care unit. Crit Care Med. 2000;28(12):3808–13.
Vliegenthart R et al. Stroke is associated with coronary calcification as detected by electron-beam CT: the Rotterdam Coronary Calcification Study. Stroke. 2002;33(2):462–5.
Lell MM et al. New techniques in CT angiography. Radiographics. 2006;26 Suppl 1:S45–62.
Josephson SA et al. Evaluation of carotid stenosis using CT angiography in the initial evaluation of stroke and TIA. Neurology. 2004;63(3):457–60.
Wintermark M et al. Perfusion-CT assessment of infarct core and penumbra: receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke. Stroke. 2006;37(4):979–85.
Wintermark M et al. Accuracy of dynamic perfusion CT with deconvolution in detecting acute hemispheric stroke. AJNR Am J Neuroradiol. 2005;26(1):104–12.
Wintermark M et al. Comparison of admission perfusion computed tomography and qualitative diffusion- and perfusion-weighted magnetic resonance imaging in acute stroke patients. Stroke. 2002;33(8):2025–31.
Wintermark M et al. Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients. Ann Neurol. 2002;51(4):417–32.
Schramm P et al. Comparison of perfusion computed tomography and computed tomography angiography source images with perfusion-weighted imaging and diffusion-weighted imaging in patients with acute stroke of less than 6 hours’ duration. Stroke. 2004;35(7):1652–8.
Rosamond WD et al. Stroke incidence and survival among middle-aged adults: 9-Year follow-up of the Atherosclerosis Risk in Communities (ARIC) Cohort. Stroke. 1999;30(4):736–43.
Kidwell CS et al. Comparison of MRI and CT for detection of acute intracerebral hemorrhage. JAMA. 2004;292(15):1823–30.
Fiebach JB et al. Stroke magnetic resonance imaging is accurate in hyperacute intracerebral hemorrhage: A multicenter study on the validity of stroke imaging. Stroke. 2004;35(2):502–6.
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Dasgupta, N., Wintermark, M. (2011). Stroke: Clinical Application of Perfusion and Diffusion. In: Faro, S., Mohamed, F., Law, M., Ulmer, J. (eds) Functional Neuroradiology. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-0345-7_6
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DOI: https://doi.org/10.1007/978-1-4419-0345-7_6
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