Venous imaging-based biomarkers in acute ischaemic stroke

Area of Science:

• Neurology
• Radiology
• Vascular Imaging

Background:

• Arterial neuroimaging is crucial for acute ischemic stroke therapy selection.
• The role of venous imaging in ischemic stroke remains underexplored.
• Venous imaging offers potential insights into cerebral perfusion and oxygen extraction.

Purpose of the Study:

• To review major venous imaging-based biomarkers for acute ischemic stroke.
• To explore the physiological basis and clinical correlations of these venous biomarkers.
• To assess the potential complementary role of venous imaging in stroke decision-making.

Main Methods:

• Review of existing literature on venous imaging in ischemic stroke.
• Identification of key venous imaging biomarkers: hypodense veins on CT angiography, venous drainage asymmetry on dynamic angiography (CT/MRI), and hypodense veins on T2*-weighted MRI.
• Discussion of physiological underpinnings (perfusion, oxygen extraction) and clinical correlations.

Main Results:

• Identified three major venous imaging biomarkers in acute ischemic stroke.
• These biomarkers reflect alterations in brain perfusion and oxygen extraction (misery perfusion).
• Correlations exist between venous biomarkers, collateral circulation, ischemic penumbra, and clinical outcomes.

Conclusions:

• Venous imaging biomarkers offer a potential complementary role in acute stroke management.
• Further validation is required, but growing evidence supports their utility.
• These biomarkers may enhance clinical decision-making for stroke therapy selection.