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Published on: September 25, 2019
MR imaging in hyperacute ischemic stroke
Carla Vert1, Carmen Parra-Fariñas1, Àlex Rovira1
1Section of Neuroradiology and MR Unit (Department of Radiology), Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
Abstract:
Brain and vascular imaging are required components of the emergency assessment of patients with suspected stroke. Either CT or MRI may be used as the initial imaging test. MRI is more sensitive to the presence of acute and chronic ischemic lesions, and chronic microbleeds, but CT remains the most practical and used initial brain imaging test. Although, a non-enhanced CT or T2* MRI sequence showing no haemorrhage is sufficient for deciding intravenous treatment eligibility within the first 4.5h after stroke onset, a non-invasive intracranial vascular study is strongly recommended during the initial imaging evaluation of the acute stroke patient, particularly if mechanical thrombectomy is contemplated. Advanced imaging with multimodal MRI may facilitate accurate ischemic stroke diagnosis and characterization, and should be considered as an alternative to CT, especially for the selection of patients for acute reperfusion therapy in extended time windows, and in patients in which time of stroke onset is unknown. However, MRI should only be considered in the acute stroke workflow if centres are able to achieve speed and triaging efficiency similar to that which is currently available with CT-based imaging.
Insights
Brain and vascular imaging, including CT and MRI, are crucial for stroke assessment. While CT is practical, MRI offers greater sensitivity for detecting ischemic lesions and microbleeds, aiding treatment decisions.
Area of Science:
- Neurology
- Radiology
- Emergency Medicine
Background:
- Stroke assessment necessitates brain and vascular imaging.
- Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are primary imaging modalities.
- CT is currently the most practical initial imaging test for stroke.
Purpose of the Study:
- To evaluate the roles of CT and MRI in acute stroke imaging.
- To determine optimal imaging strategies for reperfusion therapy selection.
- To compare the diagnostic capabilities of CT and MRI in stroke patients.
Main Methods:
- Review of current literature on brain and vascular imaging in acute stroke.
- Comparison of CT and MRI sensitivity and specificity for ischemic lesions and hemorrhage.
- Analysis of advanced imaging techniques, including multimodal MRI.
Main Results:
- MRI is more sensitive than CT for acute/chronic ischemic lesions and microbleeds.
- Non-enhanced CT or T2* MRI is sufficient for identifying hemorrhage to guide intravenous treatment.
- Non-invasive intracranial vascular imaging is recommended, especially for mechanical thrombectomy candidates.
- Multimodal MRI can improve ischemic stroke diagnosis and characterization, aiding reperfusion therapy selection in extended or unknown time windows.
Conclusions:
- CT remains the most practical initial imaging test for acute stroke.
- MRI offers superior sensitivity for lesion detection and is valuable for extended reperfusion therapy windows.
- The implementation of MRI in acute stroke workflows requires efficiency comparable to CT.
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