Choice of neuroimaging in perioperative acute stroke management

At the time of this publication, the fast examination time, wide availability, lack of contraindications, and high accuracy for detecting hemorrhage make NCCT the diagnostic study of choice for initial evaluation of patients who have preoperative stroke. NCCT also has a role in excluding patients who will not benefit from IV thrombolysis, including those who have ICH and patients who have ASPECTS less than 7 or ischemic signs exceeding one third of the MCA territory. Because optimal selection of inpatients who have acute stroke mandates not just brain tissue data but also information about the aortic arch, cervical and intracranial vasculature, and cerebral hemodynamics, additional imaging with multimodal CT technology can, in one scanning session, depicts early ischemic changes, demonstrates hypoperfusion/ischemic penumbra, and locates the vascular lesion. When combined with the clinical scenario, the information provided by CT often is sufficient to help clinicians decide on the appropriate treatment, especially determining eligibility for thrombolysis. The rapidly evolving field of neuroradiology will provide a newer armamentarium in the near future. Although MRI can provide more precise information, it is more time consuming and currently should be considered the method of choice for follow-up imaging, rather than initial imaging, in patients who have perioperative stroke.