Advanced Imaging for Acute Stroke Treatment Selection: CT, CTA, CT Perfusion, and MR Imaging

Robert W Regenhardt; Christopher A Potter; Samuel S Huang; Michael H Lev

doi:10.1016/j.rcl.2023.01.003

Advanced Imaging for Acute Stroke Treatment Selection: CT, CTA, CT Perfusion, and MR Imaging

Radiol Clin North Am. 2023 May;61(3):445-456. doi: 10.1016/j.rcl.2023.01.003.

Authors

Robert W Regenhardt¹, Christopher A Potter², Samuel S Huang³, Michael H Lev⁴

Affiliations

¹ Massachusetts General Hospital, 55 Fruit Street, WAC 7-745, Boston, MA 02114, USA. Electronic address: https://twitter.com/rwregen.
² Brigham and Women's Hospital, 45 Francis Street, Boston, MA 02115, USA. Electronic address: cpotter3@bwh.harvard.edu.
³ Albany Medical College, 438 Waltham Street, Lexington, MA 02421, USA.
⁴ Massachusetts General Hospital, 55 Fruit Street, WAC 7-745, Boston, MA 02114, USA.

PMID: 36931761
DOI: 10.1016/j.rcl.2023.01.003

Abstract

There is constant evolution in the diagnosis and treatment of acute ischemic stroke due to advances in treatments, imaging, and outreach. Two major revolutions were the advent of intravenous thrombolysis in the 1990s and endovascular thrombectomy in 2010s. Neuroimaging approaches have also evolved with key goals-detect hemorrhage, augment thrombolysis treatment selection, detect arterial occlusion, estimate infarct core, estimate viable penumbra, and augment thrombectomy treatment selection. The ideal approach to diagnosis and treatment may differ depending on the system of care and available resources. Future directions include expanding indications for these treatments, including a shift from time-based to tissue-based selection.

Keywords: Acute ischemic stroke; Computed tomography; Endovascular thrombectomy; Intravenous thrombolysis; Large vessel occlusion; MR imaging; Neuroimaging; Systems of care.

Publication types

Review

MeSH terms

Brain Ischemia* / diagnostic imaging
Brain Ischemia* / therapy
Humans
Ischemic Stroke*
Magnetic Resonance Imaging / methods
Perfusion
Perfusion Imaging
Stroke* / diagnostic imaging
Stroke* / therapy
Tomography, X-Ray Computed / methods
Treatment Outcome