Imaging Acute Stroke: From One-Size-Fit-All to Biomarkers

Jianfei Lu; Qiyong Mei; Xianhua Hou; Anatol Manaenko; Lili Zhou; David S Liebeskind; John H Zhang; Yao Li; Qin Hu

doi:10.3389/fneur.2021.697779

Imaging Acute Stroke: From One-Size-Fit-All to Biomarkers

Front Neurol. 2021 Sep 23:12:697779. doi: 10.3389/fneur.2021.697779. eCollection 2021.

Authors

Jianfei Lu¹, Qiyong Mei², Xianhua Hou³, Anatol Manaenko⁴, Lili Zhou⁵, David S Liebeskind⁶, John H Zhang⁷, Yao Li⁸, Qin Hu¹

Affiliations

¹ Central Laboratory, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Department of Neurosurgery, Changzheng Hospital, Navy Medical University, Shanghai, China.
³ Department of Neurology, Southwest Hospital, Army Medical University, Chongqing, China.
⁴ National Health Commission Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
⁵ Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing, China.
⁶ Neurovascular Imaging Research Core and University of California Los Angeles Stroke Center, University of California, Los Angeles, Los Angeles, CA, United States.
⁷ Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, CA, United States.
⁸ School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.

Abstract

In acute stroke management, time window has been rigidly used as a guide for decades and the reperfusion treatment is only available in the first few limited hours. Recently, imaging-based selection of patients has successfully expanded the treatment window out to 16 and even 24 h in the DEFUSE 3 and DAWN trials, respectively. Recent guidelines recommend the use of imaging techniques to guide therapeutic decision-making and expanded eligibility in acute ischemic stroke. A tissue window is proposed to replace the time window and serve as the surrogate marker for potentially salvageable tissue. This article reviews the evolution of time window, addresses the advantage of a tissue window in precision medicine for ischemic stroke, and discusses both the established and emerging techniques of neuroimaging and their roles in defining a tissue window. We also emphasize the metabolic imaging and molecular imaging of brain pathophysiology, and highlight its potential in patient selection and treatment response prediction in ischemic stroke.

Keywords: ischemic stroke; metabolic imaging; molecular imaging; reperfusion therapy; tissue window.

Publication types

Review