Acute neuroradiology: methods, indications and timing

The rapid development of radiological examination methods, technical innovations and creative and critical radiological research have dramatically changed the diagnostic approach with new indications and changed timing in the examination of patients with acute neurological lesions. The role of CT as the primary radiological examination method in these patients is well established, and is routinely used before the start of suitable treatment to detect or exclude intracranial haemorrhage, either traumatic or nontraumatic, or to detect other causes of acute onset of neurological disease, such as intracerebral tumours or subdural haematoma. The role of MRI still needs further confirmation. The sensitivity of MRI is superior to that of CT, especially in examination of the spinal cord. The main drawbacks of MRI are the problems in monitoring acutely ill patients, the unfamiliarity with the method, and capacity problems. Today, MRI is mainly used as a complement to CT, with the exception of spine injuries where MRI is the method of first choice. Also, the role of digital subtraction angiography is changing from diagnostic examinations towards endovascular therapeutic procedures. An experienced neuroradiologist has the key position in choosing and performing the most suitable examination method for each specific indication.