Magnetic resonance imaging in the evaluation of acute stroke

The ability to use physiologic imaging with either magnetic resonance (MR) or computed tomography to help define irreversibly injured brain (the infarct core) and tissue at risk of infarct (reversible ischemic penumbra) holds great promise in the future treatment of stroke. The physiologic principles and concepts underlying the evaluation for mismatch between injured tissue and tissue at risk are similar for the 2 imaging techniques. Multimodal MR imaging (diffusion-weighted imaging/perfusion-weighted imaging/MR angiography) provides a validated penumbral selection criteria based on the results of 2 clinical trials (diffusion and perfusion imaging evaluation for understanding stroke evolution and echoplanar imaging thrombolysis evaluation). Computed tomographic perfusion parameters have also been calculated to optimize final infarct prediction. Both techniques await further study to prove their capability of selecting cases for short-term recanalization/reperfusion therapy.