Timing stroke: A review on stroke pathophysiology and its influence over time on diffusion measures

Area of Science:

• Neuroimaging
• Stroke Pathophysiology
• Neuroinflammation

Background:

• Diffusion imaging (DWI) is optimal for detecting hyperacute cerebral ischemia.
• Diffusion Tensor Imaging (DTI) measures are proposed as stroke progression biomarkers.
• Understanding diffusion changes related to cytotoxic and vasogenic edema in stroke is crucial.

Purpose of the Study:

• To review pathophysiological events in stroke from onset to late subacute stages.
• To explore the relationship between stroke pathology, brain edema, and diffusion changes.
• To unify the understanding of diffusion changes as stroke progression biomarkers.

Main Methods:

• Narrative review of studies using DWI and/or DTI analysis.
• Inclusion of studies across hyperacute, acute, and subacute stroke phases (human and animal models).
• Analysis of diffusion changes related to cytotoxic and vasogenic edema.

Main Results:

• Diffusion measures correlate with pathophysiological events in stroke.
• Diffusion changes reflect different forms of brain edema.
• A unified understanding of diffusion changes across stroke phases is needed.

Conclusions:

• Diffusion measures can serve as a proxy for stroke neuroinflammation status, particularly in early stages.
• Diffusion measures and their interpretation must be phase-specific for accurate assessment of stroke progression and neuroinflammation.
• Linking diffusion changes to distinct stroke phases is essential for research and clinical settings.