Skip to main content

Advertisement

SpringerLink
Log in

Imaging of acute ischemic stroke

  • Review Article
  • Published:
Emergency Radiology Aims and scope Submit manuscript

Abstract

For decades, imaging has been a critical component of the diagnostic evaluation and management of patients suspected of acute ischemic stroke (AIS). With each new advance in the treatment of AIS, the role of imaging has expanded in scope, sophistication, and importance in selecting patients who stand to benefit from potential therapies. Although the field of stroke imaging has been evolving for many years, there have been several major recent changes. Most notably, in late 2017, the window for treatment expanded to 24 h from onset of stroke symptoms in selected patients. Furthermore, for those patients in expanded time windows, guidelines issued in early 2018 now recommend the use of “advanced” imaging techniques in the acute setting, including CT perfusion and MRI, to guide therapeutic decision-making. With these and other changes, the emergency radiologist must be prepared to handle a growing volume and complexity of AIS imaging. This article reviews the various imaging modalities and techniques employed in the imaging of AIS patients, with an emphasis on recommendations from recent randomized controlled trials and national consensus guidelines.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Talwalkar A, Uddin S (2015) Trends in emergency department visits for ischemic stroke and transient ischemic attack: United States, 2001–2011. NCHS data brief, no 194. Hyattsville: National Center for Health Statistics

  2. Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, McTaggart R, Torbey MT, Kim-Tenser M, Leslie-Mazwi T, Sarraj A, Kasner SE, Ansari SA, Yeatts SD, Hamilton S, Mlynash M, Heit JJ, Zaharchuk G, Kim S, Carrozzella J, Palesch YY, Demchuk AM, Bammer R, Lavori PW, Broderick JP, Lansberg MG, DEFUSE 3 Investigators (2018) Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 378:708–718. https://doi.org/10.1056/NEJMoa1713973

    Article  PubMed  PubMed Central  Google Scholar 

  3. Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, Yavagal DR, Ribo M, Cognard C, Hanel RA, Sila CA, Hassan AE, Millan M, Levy EI, Mitchell P, Chen M, English JD, Shah QA, Silver FL, Pereira VM, Mehta BP, Baxter BW, Abraham MG, Cardona P, Veznedaroglu E, Hellinger FR, Feng L, Kirmani JF, Lopes DK, Jankowitz BT, Frankel MR, Costalat V, Vora NA, Yoo AJ, Malik AM, Furlan AJ, Rubiera M, Aghaebrahim A, Olivot JM, Tekle WG, Shields R, Graves T, Lewis RJ, Smith WS, Liebeskind DS, Saver JL, Jovin TG, DAWN Trial Investigators (2018) Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 378:11–21. https://doi.org/10.1056/NEJMoa1706442

    Article  PubMed  Google Scholar 

  4. Powers et al (2018) 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 49:e1–e55. https://doi.org/10.1161/STR.0000000000000158

    Article  Google Scholar 

  5. Aghaebrahim A, Streib C, Rangaraju S, Kenmuir CL, Giurgiutiu DV, Horev A, Saeed Y, Callaway CW, Guyette FX, Martin-Gill C, Pacella C, Ducruet AF, Jankowitz BT, Jovin TG, Jadhav AP (2017) Streamlining door to recanalization processes in endovascular stroke therapy. J Neurointerv Surg 9:340–345. https://doi.org/10.1136/neurintsurg-2016-012324

    Article  PubMed  Google Scholar 

  6. Messe SR, Khatri P, Reeves MJ, Smith EE, Saver JL, Bhatt DL, Grau-Sepulveda MV, Cox M, Peterson ED, Fonarow GC, Schwamm LH (2016) Why are acute ischemic stroke patients not receiving IV tPA? Results from a national registry. Neurology 87:1565–1574. https://doi.org/10.1212/WNL.0000000000003198

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Zaidi SF, Shawver J, Espinosa Morales A, Salahuddin H, Tietjen G, Lindstrom D, Parquette B, Adams A, Korsnack A, Jumaa MA (2017) Stroke care: initial data from a county-based bypass protocol for patients with acute stroke. J Neurointerv Surg 9:631–635. https://doi.org/10.1136/neurintsurg-2016-012476

    Article  PubMed  Google Scholar 

  8. Rowley HA (2001) The four Ps of acute stroke imaging: parenchyma, pipes, perfusion, and penumbra. AJNR Am J Neuroradiol 22:599–601

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Wintermark M, Sanelli PC, Albers GW, Bello J, Derdeyn C, Hetts SW, Johnson MH, Kidwell C, Lev MH, Liebeskind DS, Rowley H, Schaefer PW, Sunshine JL, Zaharchuk G, Meltzer CC (2013) Imaging recommendations for acute stroke and transient ischemic attack patients: a joint statement by the American Society of Neuroradiology, the American College of Radiology and the Society of NeuroInterventional Surgery. Am J Neuroradiol 34:E117–E127. https://doi.org/10.3174/ajnr.A3690

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Morgan CD, Stephens M, Zuckerman SL, Waitara MS, Morone PJ, Dewan MC, Mocco J (2015) Physiologic imaging in acute stroke: patient selection. Interv Neuroradiol 21:499–510. https://doi.org/10.1177/1591019915587227

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sá de Camargo EC, Koroshetz WJ (2005) Neuroimaging of ischemia and infarction. NeuroRx 2:265–276. https://doi.org/10.1602/neurorx.2.2.265

    Article  PubMed  PubMed Central  Google Scholar 

  12. Vo KD, Yoo AJ, Gupta A, Qiao Y, Vagal AS, Hirsch JA, Yousem DM, Lum C (2015) Multi-modal diagnostic imaging for acute stroke. Am J Neuroradiol 36:2206–2213. https://doi.org/10.3174/ajnr.A4530

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Wintermark M, Rowley HA, Lev MH (2009) Acute stroke triage to intravenous thrombolysis and other therapies with advanced CT or MR imaging: pro CT. Radiology 251:619–626. https://doi.org/10.1148/radiol.2513081073

    Article  PubMed  Google Scholar 

  14. Köhrmann M, Schellinger PD (2009) Acute stroke triage to intravenous thrombolysis and other therapies with advanced CT or MR imaging: pro MR imaging. Radiology 251:627–633. https://doi.org/10.1148/radiol.2513081074

    Article  PubMed  Google Scholar 

  15. Kidwell CS, Chalela JA, Saver JL, Starkman S, Hill MD, Demchuk AM, Butman JA, Patronas N, Alger JR, Latour LL, Luby ML, Baird AE, Leary MC, Tremwel M, Ovbiagele B, Fredieu A, Suzuki S, Villablanca JP, Davis S, Dunn B, Todd JW, Ezzeddine MA, Haymore J, Lynch JK, Davis L, Warach S (2004) Comparison of MRI and CT for detection of acute intracerebral hemorrhage. JAMA 292:1823–1830. https://doi.org/10.1001/jama.292.15.1823

    Article  CAS  PubMed  Google Scholar 

  16. Fiebach JB (2004) Stroke magnetic resonance imaging is accurate in hyperacute intracerebral hemorrhage: a multicenter study on the validity of stroke imaging. Stroke 35:502–506. https://doi.org/10.1161/01.STR.0000114203.75678.88

    Article  PubMed  Google Scholar 

  17. Liu X, Almast J, Ekholm S (2013) Lesions masquerading as acute stroke. J Magn Reson Imaging 37:15–34. https://doi.org/10.1002/jmri.23647

    Article  PubMed  Google Scholar 

  18. Vilela P, Rowley H (2017) Brain ischemia: CT and MRI techniques in acute ischemic stroke. Eur J Radiol 96:162–172. https://doi.org/10.1016/j.ejrad.2017.08.014

    Article  PubMed  Google Scholar 

  19. Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, Johnston KC, Johnston SC, Khalessi AA, Kidwell CS, Meschia JF, Ovbiagele B, Yavagal DR, American Heart Association Stroke Council (2015) American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment. Stroke 46:3020–3303. https://doi.org/10.1161/STR.0000000000000074

    Article  CAS  PubMed  Google Scholar 

  20. Muir KW, Buchan A, von Kummer R, Rother J, Baron JC (2006) Imaging of acute stroke. Lancet 5:755–768. https://doi.org/10.1016/S1474-4422(06)70545-2

    Article  Google Scholar 

  21. Lev MH, Farkas J, Gemmete JJ, Hossain ST, Hunter GJ, Koroshetz WJ, Gonzalez RG (1999) Acute stroke: improved nonenhanced CT detection—benefits of soft-copy interpretation by using variable window width and center level settings. Radiology 213:150–155. https://doi.org/10.1148/radiology.213.1.r99oc10150

    Article  CAS  PubMed  Google Scholar 

  22. Srinivasan A, Goyal M, Al Azri F, Lum C (2006) State-of-the-art imaging of acute stroke. Radiographics 26:S75–S95. https://doi.org/10.1148/rg.26si065501

    Article  PubMed  Google Scholar 

  23. De Lucas EM, Sánchez E, Gutiérrez A, Mandly AG, Ruiz E, Flórez AF, Izquierdo J, Arnáiz J, Piedra T, Valle N, Bañales I, Quintana F (2008) CT protocol for acute stroke: tips and tricks for general radiologists. Radiographics 28:1673–1687. https://doi.org/10.1148/rg.286085502

    Article  PubMed  Google Scholar 

  24. Mair G, Boyd EV, Chappell FM, von Kummer R, Lindley RI, Sandercock P, Wardlaw JM, IST-3 Collaborative Group (2015) Sensitivity and specificity of the hyperdense artery sign for arterial obstruction in acute ischemic stroke. Stroke 46:102–107. https://doi.org/10.1161/STROKEAHA.114.007036

    Article  PubMed  Google Scholar 

  25. Rha JH, Saver JL (2007) The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke 38:967–973. https://doi.org/10.1161/01.STR.0000258112.14918.24

    Article  PubMed  Google Scholar 

  26. Bhatia R, Hill MD, Shobha N, Menon B, Bal S, Kochar P, Watson T, Goyal M, Demchuk AM (2010) Low rates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke: real-world experience and a call for action. Stroke 41:2254–2258. https://doi.org/10.1161/STROKEAHA.110.592535

    Article  CAS  PubMed  Google Scholar 

  27. Saqqur M, Uchino K, Demchuk AM, Molina CA, Garami Z, Calleja S, CLOTBUST Investigators et al (2007) Site of arterial occlusion identified by transcranial Doppler predicts the response to intravenous thrombolysis for stroke. Stroke 38:948–954. https://doi.org/10.1161/01.STR.0000257304.21967.ba

    Article  PubMed  Google Scholar 

  28. Broderick JP, Palesch YY, Demchuk AM, Yeatts SD, Khatri P, Hill MD, Interventional Management of Stroke (IMS) III Investigators et al (2013) Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med 368:893–903. https://doi.org/10.1056/NEJMoa1214300

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Barber PA, Demchuk AM, Zhang J, Buchan AM (2000) Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. Lancet 355:1670–1674. https://doi.org/10.1016/S0140-6736(00)02237-6

    Article  CAS  PubMed  Google Scholar 

  30. Yoo AJ (2014) Impact of pretreatment noncontrast CT Alberta stroke program early CT score on clinical outcome after intra-arterial stroke therapy. Stroke 45:746–751. https://doi.org/10.1161/STROKEAHA.113.004260

    Article  CAS  PubMed  Google Scholar 

  31. Smith EE, Kent DM, Bulsara KR, Leung LY, Lichtman JH, Reeves MJ, Towfighi A, Whiteley WN, Zahuranec DB, American Heart Association Stroke Council (2018) Accuracy of prediction instruments for diagnosing large vessel occlusion in individuals with suspected stroke: a systematic review for the 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 49:E1–E76. https://doi.org/10.1161/STR.0000000000000160

    Article  Google Scholar 

  32. Vilela P, Goulão A (2005) Ischemic stroke: carotid and vertebral artery disease. Eur Radiol 15:427–433. https://doi.org/10.1007/s00330-004-2632-6

    Article  CAS  PubMed  Google Scholar 

  33. Bash S, Villablanca JP, Jahan R, Duckwiler G, Tillis M, Kidwell C, Saver J, Sayre J (2005) Intracranial vascular stenosis and occlusive disease: evaluation with CT angiography, MR angiography, and digital subtraction angiography. Am J Neuroradiol 26:1012–1021

    PubMed  PubMed Central  Google Scholar 

  34. Lev MH, Farkas J, Rodriguez VR, Schwamm LH, Hunter GJ, Putman CM, Rordorf GA, Buonanno FS, Budzik R, Koroshetz WJ, Gonzalez RG (2001) CT angiography in the rapid triage of patients with hyperacute stroke to intraarterial thrombolysis: accuracy in the detection of large vessel thrombus. J Comput Assist Tomogr 25:520–528

    Article  CAS  PubMed  Google Scholar 

  35. Rai AT, Seldon AE, Boo S, Link PS, Domico JR, Tarabishy AR, Lucke-Wold N, Carpenter JS (2017) A population-based incidence of acute large vessel occlusions and thrombectomy eligible patients indicates significant potential for growth of endovascular stroke therapy in the USA. J NeuroInterv Surg 9:722–726. https://doi.org/10.1136/neurintsurg-2016-012515

    Article  PubMed  Google Scholar 

  36. Smith WS, Lev MH, English JD, Camargo EC, Chou M, Johnston SC, Gonzalez G, Schaefer PW, Dillon WP, Koroshetz WJ, Furie KL (2009) Significance of large vessel intracranial occlusion causing acute ischemic stroke and TIA. Stroke 40:3834–3840. https://doi.org/10.1161/STROKEAHA.109.561787

    Article  PubMed  PubMed Central  Google Scholar 

  37. Ehrlich ME, Turner HL, Currie LJ, Wintermark M, Worrall BB, Southerland AM (2016) Safety of computed tomographic angiography in the evaluation of patients with acute stroke: a single-center experience. Stroke 47:2045–2050. https://doi.org/10.1161/STROKEAHA.116.013973

    Article  PubMed  Google Scholar 

  38. Aulicky P, Mikulík R, Goldemund D, Reif M, Dufek M, Kubelka T (2010) Safety of performing CT angiography in stroke patients treated with intravenous thrombolysis. J Neurol Neurosurg Psychiatry 81:783–787. https://doi.org/10.1136/jnnp.2009.184002

    Article  CAS  PubMed  Google Scholar 

  39. Lima FO, Lev MH, Levy RA, Silva GS, Ebril M, de Camargo EC, Pomerantz S, Singhal AB, Greer DM, Ay H, González RG, Koroshetz WJ, Smith WS, Furie KL (2010) Functional contrast-enhanced CT for evaluation of acute ischemic stroke does not increase the risk of contrast-induced nephropathy. AJNR Am J Neuroradiol 31:817–821. https://doi.org/10.3174/ajnr.A1927

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Hopyan JJ, Gladstone DJ, Mallia G, Schiff J, Fox AJ, Symons SP, Buck BH, Black SE, Aviv RI (2008) Renal safety of CT angiography and perfusion imaging in the emergency evaluation of acute stroke. AJNR Am J Neuroradiol 29:1826–1830. https://doi.org/10.3174/ajnr.A1257

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Krol AL, Dzialowski I, Roy J, Puetz V, Subramaniam S, Coutts SB, Demchuk AM (2007) Incidence of radiocontrast nephropathy in patients undergoing acute stroke computed tomography angiography. Stroke 38:2364–2366. https://doi.org/10.1161/STROKEAHA.107.482778

    Article  PubMed  Google Scholar 

  42. Josephson SA, Dillon WP, Smith WS (2005) Incidence of contrast nephropathy from cerebral CT angiography and CT perfusion imaging. Neurology 64:1805–1806. https://doi.org/10.1212/01.WNL.0000161845.69114.62

    Article  PubMed  Google Scholar 

  43. Camargo EC, Furie KL, Singhal AB et al (2007) Acute brain infarct: detection and delineation with CT angiographic source images versus nonenhanced CT scans. Radiology 244:541–548. https://doi.org/10.1148/radiol.2442061028

    Article  PubMed  Google Scholar 

  44. Menon BK, d'Esterre CD, Qazi EM, Almekhlafi M, Hahn L, Demchuk AM, Goyal M (2015) Multiphase CT angiography: a new tool for the imaging triage of patients with acute ischemic stroke. Radiology 275:510–520. https://doi.org/10.1148/radiol.15142256

    Article  PubMed  Google Scholar 

  45. Goyal M, ESCAPE Trial Investigators et al (2017) Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 372:1019–1030. https://doi.org/10.1056/NEJMoa1414905

    Article  CAS  Google Scholar 

  46. Yoo AJ, Verduzco LA, Schaefer PW, Hirsch JA, Rabinov JD, González RG (2009) MRI-based selection for intra-arterial stroke therapy: value of pretreatment diffusion-weighted imaging lesion volume in selecting patients with acute stroke who will benefit from early recanalization. Stroke 40:2046–2054. https://doi.org/10.1161/STROKEAHA.108.541656

    Article  PubMed  PubMed Central  Google Scholar 

  47. Wisco D, Uchino K, Saqqur M, Gebel JM, Aoki J, Alam S, George P, Newey CR, Man S, Tateishi Y, McNeil J, Winfield M, Cheng-Ching E, Hui FK, Toth G, Bain M, Rasmussen PA, Masaryk T, Ruggieri P, Hussain MS (2014) Addition of hyperacute MRI aids in patient selection, decreasing the use of endovascular stroke therapy. Stroke 45:467–447. https://doi.org/10.1161/STROKEAHA.113.003880

    Article  PubMed  Google Scholar 

  48. Allen LM, Hasso AN, Handwerker J, Farid H (2012) Sequence-specific MR imaging findings that are useful in dating ischemic stroke. RadioGraphics 32:1285–1297. https://doi.org/10.1148/rg.325115760

    Article  PubMed  Google Scholar 

  49. Leslie-Mazwi TM, Hirsch JA, Falcone GJ, Schaefer PW, Lev MH, Rabinov JD, Rost NS, Schwamm L, González RG (2016) Endovascular stroke treatment outcomes after patient selection based on magnetic resonance imaging and clinical criteria. JAMA Neurol 73:43–49. https://doi.org/10.1001/jamaneurol.2015.3000

    Article  PubMed  Google Scholar 

  50. Jovin TG, REVASCAT Trial Investigators et al (2015) Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 372:2296–2306. https://doi.org/10.1056/NEJMoa1503780

    Article  CAS  PubMed  Google Scholar 

  51. Saver JL, SWIFT PRIME Investigators et al (2015) Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 372:2285–2295. https://doi.org/10.1056/NEJMoa1415061

    Article  CAS  PubMed  Google Scholar 

  52. Campbell BC, Mitchell PJ, EXTEND-IA Investigators et al (2015) Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 372:1009–1018. https://doi.org/10.1056/NEJMoa1414792

    Article  CAS  PubMed  Google Scholar 

  53. Bracard S, Ducrocq X, Mas JL, Soudant M, Oppenheim C, Moulin T, Guillemin F, THRACE Investigators (2016) Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. Lancet Neurol 15:1138–1147. https://doi.org/10.1016/S1474-4422(16)30177-6

    Article  CAS  PubMed  Google Scholar 

  54. Berkhemer OA, MR CLEAN Investigators et al (2015) A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372:11–20. https://doi.org/10.1056/NEJMoa1411587

    Article  CAS  PubMed  Google Scholar 

  55. Charidimou A, Shoamanesh A, International META-MICROBLEEDS Initiative (2016) Clinical relevance of microbleeds in acute stroke thrombolysis: comprehensive meta-analysis. Neurology 87:1534–1154. https://doi.org/10.1212/WNL.0000000000003207

    Article  CAS  PubMed  Google Scholar 

  56. Tsivgoulis G, Zand R, Katsanos AH, Turc G, Nolte CH, Jung S, Cordonnier C, Fiebach JB, Scheitz JF, Klinger-Gratz PP, Oppenheim C, Goyal N, Safouris A, Mattle HP, Alexandrov AW, Schellinger PD, Alexandrov AV (2016) Risk of symptomatic intracerebral hemorrhage after intravenous thrombolysis in patients with acute ischemic stroke and high cerebral microbleed burden: a meta-analysis. JAMA Neurol 73:675–683. https://doi.org/10.1001/jamaneurol.2016.0292

    Article  PubMed  Google Scholar 

  57. Nael K, Khan R, Choudhary G, Meshkar A, Villablanca P, Tay J, Drake K, Couli BM, Kidwell CS (2014) Six-minute magnetic resonance imaging protocol for evaluation of acute ischemic stroke pushing the boundaries. Stroke 45:1985–1991. https://doi.org/10.1161/STROKEAHA.114.005305

    Article  PubMed  Google Scholar 

  58. González RG, Copen W, Schaefer P, Lev MH, Pomerantz S, Rapalino O, Chen JW, Hunter GJ, Romero JM, Buchbinder BR, Larvie M, Hirsch J, Gupta R (2013) The Massachusetts General Hospital acute stroke imaging algorithm: an experience and evidence based approach. J NeuroIntervent Surg 5:1–6. https://doi.org/10.1136/neurintsurg-2013-010715

    Article  Google Scholar 

  59. González RG, Hirsch JA, Lev MH, Schaefer PW, Schwamm LH (2011) Acute ischemic stroke: imaging and intervention. Springer-Verlag, Berlin Heidelberg, pp 115–137. https://doi.org/10.1007/978-3-642-12751-9

    Book  Google Scholar 

  60. Goyal M, Menon BK, Derdeyn CP (2013) Perfusion imaging in acute ischemic stroke: let us improve the science before changing clinical practice. Radiology 266:16–21. https://doi.org/10.1148/radiol.12112134

    Article  PubMed  Google Scholar 

  61. Lansberg MG, Straka M, Kemp S, Mlynash M, Wechsler LR, Jovin TG, Wilder MJ, Lutsep HL, Czartoski TJ, Bernstein RA, Chang CW, Warach S, Fazekas F, Inoue M, Tipirneni A, Hamilton SA, Zaharchuk G, Marks MP, Bammer R, Albers GW, DEFUSE 2 study investigators (2012) MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): a prospective cohort study. Lancet Neurol 11:860–867. https://doi.org/10.1016/S1474-4422(12)70203-X

    Article  PubMed  PubMed Central  Google Scholar 

  62. Lansberg MG, Thijs VN, Bammer R, Kemp S, Wijman CA, Marks MP, Albers GW, DEFUSE Investigators (2007) Risk factors of symptomatic intracerebral hemorrhage after tPA therapy for acute stroke. Stroke 38:2275–2278. https://doi.org/10.1161/STROKEAHA.106.480475

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Singer OC, Humpich MC, Fiehler J, Albers GW, Lansberg MG, Kastrup A, Rovira A, Liebeskind DS, Gass A, Rosso C, Derex L, Kim JS, Neumann-Haefelin T, MR Stroke Study Group Investigators (2008) Risk for symptomatic intracerebral hemorrhage after thrombolysis assessed by diffusion-weighted magnetic resonance imaging. Ann Neurol 63:52–60. https://doi.org/10.1002/ana.21222

    Article  PubMed  Google Scholar 

  64. Yoo AJ, Barak ER, Copen WA, Kamalian S, Gharai LR, Pervez MA, Schwamm LH, González RG, Schaefer PW (2010) Combining acute diffusion-weighted imaging and mean transmit time lesion volumes with national institutes of health stroke scale score improves the prediction of acute stroke outcome. Stroke 411:728–1735. https://doi.org/10.1161/STROKEAHA.110.582874

    Article  Google Scholar 

  65. Olivot JM, Mosimann PJ, Labreuche J, Inoue M, Meseguer E, Desilles JP, Rouchaud A, Klein IF, Straka M, Bammer R, Mlynash M, Amarenco P, Albers GW, Mazighi M (2013) Impact of diffusion-weighted imaging lesion volume on the success of endovascular reperfusion therapy. Stroke 44:2205–2211. https://doi.org/10.1161/STROKEAHA.113.000911

    Article  PubMed  PubMed Central  Google Scholar 

  66. Sanák D, Nosál' V, Horák D, Bártková A, Zelenák K, Herzig R, Bucil J, Skoloudík D, Burval S, Cisariková V, Vlachová I, Köcher M, Zapletalová J, Kurca E, Kanovský P (2006) Impact of diffusion-weighted MRI-measured initial cerebral infarction volume on clinical outcome in acute stroke patients with middle cerebral artery occlusion treated by thrombolysis. Neuroradiology 48:632–639. https://doi.org/10.1007/s00234-006-0105-0

    Article  PubMed  Google Scholar 

  67. Campbell BC, Christensen S, Levi CR, Desmond PM, Donnan GA, Davis SM, Parsons MW (2012) Comparison of computed tomography perfusion and magnetic resonance imaging perfusion-diffusion mismatch in ischemic stroke. Stroke 43:2648–2653. https://doi.org/10.1161/STROKEAHA.112.660548

    Article  PubMed  Google Scholar 

  68. Thomalla G, Cheng B, Ebinger M, Hao Q, Tourdias T, Wu O, Kim JS, Breuer L, Singer OC, Warach S, Christensen S, Treszl A, Forkert ND, Galinovic I, Rosenkranz M, Engelhorn T, Köhrmann M, Endres M, Kang DW, Dousset V, Sorensen AG, Liebeskind DS, Fiebach JB, Fiehler J, Gerloff C, STIR and VISTA Imaging Investigators (2011) DWI-FLAIR mismatch for the identification of patients with acute ischaemic stroke within 4·5 h of symptom onset (PRE-FLAIR): a multicentre observational study. Lancet Neurol 10:978–986. https://doi.org/10.1016/S1474-4422(11)70192-2

    Article  PubMed  Google Scholar 

  69. Mlynash M, Lansberg MG, De Silva DA et al (2011) Refining the definition of the malignant profile: insights from the DEFUSE-EPITHET pooled data set. Stroke 42:1270–1275. https://doi.org/10.1161/STROKEAHA.110.601609

    Article  PubMed  PubMed Central  Google Scholar 

  70. Rowley HA (2005) Extending the time window for thrombolysis: evidence from acute stroke trials. Neuroimaging Clin N Am 15:575–587. https://doi.org/10.1016/j.nic.2005.08.002

    Article  PubMed  Google Scholar 

  71. Berkhemer OA, Kamalian S, González RG, Majoie CBLM, Yoo AJ (2013) Imaging biomarkers for intra-arterial stroke therapy. Cardiovasc Eng Technol 4:339–351. https://doi.org/10.1007/s13239-013-0148-4

    Article  PubMed  PubMed Central  Google Scholar 

  72. Lansberg MG, Lee J, Christensen S, Straka M, De Silva DA, Mlynash M, Campbell BC, Bammer R, Olivot JM, Desmond P, Davis SM, Donnan GA, Albers GW (2011) RAPID automated patient selection for reperfusion therapy: a pooled analysis of the echoplanar imaging thrombolytic evaluation trial (EPITHET) and the diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study. Stroke 42:1608–1614. https://doi.org/10.1161/STROKEAHA.110.609008

    Article  PubMed  PubMed Central  Google Scholar 

  73. Olivot JM, Albers GW (2011) Diffusion–perfusion MRI for triaging transient ischemic attack and acute cerebrovascular syndromes. Curr Opin Neurol 24:44–49. https://doi.org/10.1097/WCO.0b013e328341f8a5

    Article  PubMed  Google Scholar 

  74. Rowley HA, Vilela P (2016) Brain ischemia: CT and MRI techniques in acute stroke. In: Hodler J., Kubik-Huch R., von Schulthess G. (eds) Diseases of the brain, head and neck, spine 2016–2019, pp 37–47. https://doi.org/10.1007/978-3-319-30081-8_5

    Chapter  Google Scholar 

  75. Souza LCS, Yoo AJ, Chaudhry ZA, Payabvash S, Kemmling A, Schaefer PW, Hirsch JA, Furie KL, González RG, Nogueira RG, Lev MH (2012) Malignant CTA collateral profile is highly specific for large admission DWI infarct core and poor outcome in acute stroke. Am J Neuroradiol 33:1331–1336. https://doi.org/10.3174/ajnr.A2985

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Angermaier AA, Langner SB, Kirsch MB, Kessler CA, Hosten NB, Khaw AV (2011) CT-angiographic collateralization predicts final infarct volume after intra-arterial thrombolysis for acute anterior circulation ischemic stroke. Cerebrovasc Dis 31:177–184. https://doi.org/10.1159/000321868

    Article  CAS  PubMed  Google Scholar 

  77. Goyal M, Yu AY, Menon BK, Dippel DW, Hacke W, Davis SM, Fisher M, Yavagal DR, Turjman F, Ross J, Yoshimura S, Miao Z, Bhatia R, Almekhlafi M, Murayama Y, Sohn SI, Saver JL, Demchuk AM, Hill MD (2016) Endovascular therapy in acute ischemic stroke: challenges and transition from trials to bedside. Stroke 47:548–553. https://doi.org/10.1161/STROKEAHA.115.011426

    Article  PubMed  Google Scholar 

  78. Liebeskind DS (2003) Collateral circulation. Stroke 34:2279–2284. https://doi.org/10.1161/01.STR.0000086465.41263.06

    Article  PubMed  Google Scholar 

  79. Liebeskind DS (2012) Collateral perfusion: time for novel paradigms in cerebral ischemia. Int J Stroke 7:309–310. https://doi.org/10.1111/j.1747-4949.2012.00818.x

    Article  PubMed  PubMed Central  Google Scholar 

  80. Markus HS (2004) Cerebral perfusion and stroke. J Neurol Neurosurg Psychiatry 75:353–361. https://doi.org/10.1136/jnnp.2003.025825

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  81. Hacke W (2018) A new DAWN for imaging-based selection in the treatment of acute stroke. N Engl J Med 378:81–83. https://doi.org/10.1056/NEJMe1713367

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Division of Neuroradiology, Allegheny Health Network, 320 E. North Ave, Pittsburgh, PA, 15212, USA

    Scott Rudkin & Michael F. Goldberg

  2. Department of Neurology, Comprehensive Stroke Center, Allegheny Health Network, 320 E. North Ave, Pittsburgh, PA, 15212, USA

    Russell Cerejo & Ashis Tayal

Authors
  1. Scott Rudkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Russell Cerejo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ashis Tayal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael F. Goldberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael F. Goldberg.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rudkin, S., Cerejo, R., Tayal, A. et al. Imaging of acute ischemic stroke. Emerg Radiol 25, 659–672 (2018). https://doi.org/10.1007/s10140-018-1623-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10140-018-1623-x

Keywords

Search

Navigation