Top

The International Journal of Cardiovascular Imaging

Published in:

01-01-2016 | Original Paper

Acute ischemic stroke imaging: a practical approach for diagnosis and triage

Authors: Joseph Yeen Young, Pamela Whitney Schaefer

Published in: The International Journal of Cardiovascular Imaging | Issue 1/2016

Abstract

Ischemic stroke is a prevalent disease with significant associated morbidity and healthcare costs. There are currently effective intravenous and endovascular therapies that have the potential to improve functional outcome when used in the appropriate patient population. The utilization of various imaging modalities has been shown to be crucial in identifying which patients may benefit from these therapies. Therefore, a thorough understanding of the role that imaging plays in guiding therapeutic decisions in acute ischemic stroke patients is important.

Kochanek KD, Xu JQ, Murphy SL, Miniño AM, Kung HC (2011) Deaths: final data for 2009. Natl Vital Stat Rep 60:1–116PubMed

Go AS, Mozaffarian D, Roger VL et al (2014) Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation 129:e28–e292PubMedCrossRef

Hisham NF, Bayraktutan U (2013) Epidemiology, pathphysiology, and treatment of hypertension in ischaemic stroke patients. J Stroke Cerebrovasc Dis 22:e4–e14PubMedCrossRef

Bamford J, Sandercock P, Dennis M, Burn J, Warlow C (1991) Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 337:1521–1526PubMedCrossRef

Lee H, Yoon YE, Kim YJ et al (2015) Presence and extent of coronary calcified plaque evaluated by coronary computed tomographic angiography are independent predictors of ischemic stroke in patients with suspected coronary artery disease. Int J Cardiovasc Imaging. doi:10.1007/s10554-015-0709-8

Yoon YE, Chang HJ, Cho I et al (2011) Incidence of subclinical coronary atherosclerosis in patients with suspected embolic stroke using cardiac computed tomography. Int J Cardiovasc Imaging 27:1035–1044PubMedCrossRef

Bivard A, Lin L, Parsonsb MW (2013) Review of stroke thrombolytics. J Stroke 15:90–98PubMedPubMedCentralCrossRef

Appireddy RM, Demchuk AM, Goyal M, Menon BK, Eesa M, Choi P, Hill MD (2015) Endovascular therapy for ischemic stroke. J Clin Neurol 11:1–8PubMedPubMedCentralCrossRef

Jauch EC, Saver JL, Adams HP Jr et al (2013) 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 44:870–947PubMedCrossRef

10.

Saqqur M, Uchino K, Demchuk AM et al (2007) Site of arterial occlusion identified by transcranial Doppler predicts the response to intravenous thrombolysis for stroke. Stroke 38:948–954PubMedCrossRef

11.

Furlan A, Higashida R, Wechsler L et al (1999) Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA 282:2003–2011PubMedCrossRef

12.

Smith WS, Sung G, Starkman S et al (2005) Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial. Stroke 36:1432–1438PubMedCrossRef

13.

Penumbra Pivotal Stroke Trial Investigators (2009) The penumbra pivotal stroke trial: safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease. Stroke 40:2761–2768CrossRef

14.

Jahromi AS, Cina CS, Liu Y, Clase CM (2005) Sensitivity and specificity of color duplex ultrasound measurement in the estimation of internal carotid artery stenosis: a systematic review and meta-analysis. Vasc Surg 41:968–972CrossRef

15.

North American Symptomatic Carotid Endarterectomy Trial Collaborators (2000) The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis. N Engl J Med 342:1693–1700CrossRef

16.

North American Symptomatic Carotid Endarterectomy Trial Collaborators (1998) Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. N Engl J Med 339:1415–1425CrossRef

17.

Chen Q, Liu Y, Pei L, Ke D, Li G, Deng W, Yao W (2009) Characteristics of carotid artery disease (CAD) and presenting cerebrovascular symptoms in an aged group. Int J Cardiovasc Imaging 25:127–132PubMedCrossRef

18.

Ohyama M, Mizushige K, Ohyama H, Takahashi T, Hosomi N, Ichihara S, Kohno M (2002) Carotid turbulent flow observed by convergent color Doppler flowmetry in silent cerebral infarction. Int J Cardiovasc Imaging 18:119–124PubMedCrossRef

19.

The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333:1581–1587CrossRef

20.

Hacke W, Kaste M, Fieschi C et al (1995) Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA 274:1017–1025PubMedCrossRef

21.

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. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet 355:1670–1674PubMedCrossRef

22.

Hill MD, Rowley HA, Adler F et al (2003) Selection of acute ischemic stroke patients for intra-arterial thrombolysis with pro-urokinase by using ASPECTS. Stroke 34:1925–1931PubMedCrossRef

23.

Hill MD, Demchuk AM, Tomsick TA, Palesch YY, Broderick JP (2006) Using the baseline CT scan to select acute stroke patients for IV-IA therapy. AJNR Am J Neuroradiol 27:1612–1616PubMed

24.

Mak HK, Yau KK, Khong PL et al (2003) Hypodensity of > 1/3 middle cerebral artery territory versus Alberta Stroke Programme Early CT Score (ASPECTS): comparison of two methods of quantitative evaluation of early CT changes in hyperacute ischemic stroke in the community setting. Stroke 34:1194–1196PubMedCrossRef

25.

Lev MH, Farkas J, Gemmete JJ et al (1999) Acute stroke: improved nonenhanced CT detection—benefits of soft-copy interpretation by using variable window width and center level settings. Radiology 213:150–155PubMedCrossRef

26.

Chalela JA, Kidwell CS, Nentwich LM et al (2007) Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet 369:293–298PubMedPubMedCentralCrossRef

27.

Barber PA, Darby DG, Desmond PM et al (1999) Identification of major ischemic change. Diffusion weighted imaging versus computed tomography. Stroke 30:2059–2065PubMedCrossRef

28.

Lansberg MG, Albers GW, Beaulieu C, Marks MP (2000) Comparison of diffusion-weighted MRI and CT in acute stroke. Neurology 54:1557–1561PubMedCrossRef

29.

Leys D, Pruvo JP, Godefroy O, Rondepierre P, Leclerc X (1992) Prevalence and significance of hyperdense middle cerebral artery in acute stroke. Stroke 23:317–324PubMedCrossRef

30.

Agarwal P, Kumar S, Hariharan S, Eshkar N, Verro P, Cohen B, Sen S (2004) Hyperdense middle cerebral artery sign: can it be used to select intra-arterial versus intravenous thrombolysis in acute ischemic stroke? Cerebrovasc Dis 17:182–190PubMedCrossRef

31.

Riedel CH, Jensen U, Rohr A, Tietke M, Alfke K, Ulmer S, Jasnsen O (2010) Assesssment of thrombus in acute middle cerebral artery occlusion using thin-slice nonenhanced computed tomography reconstructions. Stroke 41:1659–1664PubMedCrossRef

32.

Riedel CH, Zimmermann P, Jensen-Kondering U, Stingele R, Deuschl G, Jansen O (2011) The importance of size: successful recanalization by intravenous thrombolysis in acute anterior stroke depends on thrombus length. Stroke 42:1775–1777PubMedCrossRef

33.

Barber PA, Demchuk AM, Hudon ME, Pexman JH, Hill MD, Buchan AM (2001) Hyperdense sylvian fissure MCA “dot” sign: a CT marker of acute ischemia. Stroke 32:84–88PubMedCrossRef

34.

Lev MH, Farkas J, Rodriguez VR et al (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 25:520–528PubMedCrossRef

35.

Bash S, Villablanca JP, Jahan R et al (2005) Intracranial vascular stenosis and occlusive disease: evaluation with CT angiography, MR angiography, and digital subtraction angiography. AJNR Am J Neuroradiol 26:1012–1021PubMed

36.

Tan IY, Demchuk AM, Hopyan J et al (2009) CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct. AJNR Am J Neuroradiol 30:525–531PubMedCrossRef

37.

Smith WS, Lev MH, English JD et al (2009) Significance of large vessel intracranial occlusion causing acute ischemic stroke and TIA. Stroke 40:3834–3840PubMedPubMedCentralCrossRef

38.

Cipriano LE, Steinberg ML, Gazelle GS, González RG (2009) Comparing and predicting the costs and outcomes of patients with major and minor stroke using the Boston Acute Stroke Imaging Scale neuroimaging classification system. Am J Neuroradiol 30:703–739PubMedCrossRef

39.

Gonzalez RG, Furie KL, Goldmacher GV et al (2013) Good outcome rate of 35% in IV-tPA-treated patients with computed tomography angiography confirmed severe anterior circulation occlusive stroke. Stroke 44:3109–3113PubMedPubMedCentralCrossRef

40.

Lewandowski CA, Frankel M, Tomsick TA et al (1999) Combined intravenous and intra-arterial r-TPA versus intra-arterial therapy of acute ischemic stroke: Emergency Management of Stroke (EMS) Bridging Trial. Stroke 30:2598–2605PubMedCrossRef

41.

IMS Study Investigators (2004) Combined intravenous and intra-arterial recanalization for acute ischemic stroke: the Interventional Management of Stroke Study. Stroke 35:904–911CrossRef

42.

IMS II Trial Investigators (2007) The Interventional Management of Stroke (IMS) II Study. Stroke 38:2127–2135CrossRef

43.

Broderick JP, Palesch YY, Demchuk et al (2013) Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med 368:893–903PubMedPubMedCentralCrossRef

44.

Ciccone A, Valvassori L, Nichelatti M, Sgoifo A, Ponzio M, Sterzi R, Boccardi E (2013) Endovascular treatment for acute ischemic stroke. N Engl J Med 368:904–913PubMedPubMedCentralCrossRef

45.

Kidwell CS, Jahan R, Gornbein J J et al (2013) A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med 368:914–923PubMedPubMedCentralCrossRef

46.

Nogueira RG, Lutsep HL, Gupta R, Jovin TG, Albers GW, Walker GA, Liebeskind DS, Smith WS (2012) Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet 380:1231–1240PubMedPubMedCentralCrossRef

47.

Saver JL, Jahan R, Levy EI, Jovin TG, Baxter B, Nogueira RG, Clark W, Budzik R, Zaidat OO (2012) Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet 380:1241–1249PubMedCrossRef

48.

Berkhemer OA, Fransen PS, Beumer D et al (2015) A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372:11–20PubMedCrossRef

49.

Campbell BC, Mitchell PJ, Kleinig TJ et al (2015) Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 372:1009–1018PubMedCrossRef

50.

Goyal M, Demchuk AM, Menon BK et al (2015) Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 372:1019–1030PubMedCrossRef

51.

Saver JL, Goyal M, Bonafe A et al (2015) Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 372:2285–2295PubMedCrossRef

52.

Jovin TG, Chamorro A, Cobo E et al (2015) Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 372:2297–2306CrossRef

53.

Lima FO, Furie KL, Silva GS et al (2010) The pattern of leptomeningeal collaterals on CT angiography is a strong predictor of long-term functional outcome in stroke patients with large vessel intracranial occlusion. Stroke 41:2316–2322PubMedCrossRef

54.

Maas MB, Lev MH, Singhal AB et al (2009) Collateral vessels on CT angiography predict outcome in acute ischemic stroke. Stroke 40:3001–3005PubMedPubMedCentralCrossRef

55.

Menon BK, Smith EE, Modi J et al (2011) Regional leptomeningeal score on CT angiography predicts clinical and imaging outcomes in patients with acute anterior circulation occlusions. Am J Neuroradiol 32:1640–1645PubMedCrossRef

56.

Souza LC, Yoo AJ, Chaudhry ZA et al (2012) Malignant CTA collateral profile is highly specific for large admission DWI infarct core and poor outcome in acute stroke. Am J Neuroradiol 33:1331–1336PubMedPubMedCentralCrossRef

57.

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 275:510–520PubMedCrossRef

58.

Coutts SB, Lev MH, Eliasziw M et al (2004) ASPECTS on CTA source images versus unenhanced CT: added value in predicting final infarct extent and clinical outcome. Stroke 35:2472–2476PubMedCrossRef

59.

Schramm P, Schellinger PD, Fiebach JB, Heiland S, Jansen O, Knauth M, Hacke W, Sartor K (2002) Comparison of CT and CT angiography source images with diffusion-weighted imaging in patients with acute stroke within 6 hours after onset. Stroke 33:2426–2432PubMedCrossRef

60.

Yoo AJ, Hu R, Hakimelahi R, Lev MH, Nogueira RG, Hirsch JA, González RG, Schaefer PW (2012) CT angiography source images acquired with a fast-acquisition protocol overestimate infarct core on diffusion weighted images in acute ischemic stroke. J Neuroimaging 22:329–335PubMedPubMedCentralCrossRef

61.

North American Symptomatic Carotid Endarterectomy Trial Collaborators (1991) Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325:445–453CrossRef

62.

Yadav JS, Wholey MH, Kuntz RE et al (2004) Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351:1493–1501PubMedCrossRef

63.

Manninen AL, Isokangas JM, Karttunen A, Siniluoto T, Nieminen MT (2012) A comparison of radiation exposure between diagnostic CTA and DSA examinations of cerebral and cervicocerebral vessels. Am J Neuroradiol 33:2038–2042PubMedCrossRef

64.

Nolz R, Wibmer A, Beitzke D, Gentzsch S, Willfort-Ehringer A, Lammer J, Thurnher M, Schoder M (2012) Carotid artery stenting and follow-up: value of 64-MSCT angiography as complementary imaging method to color-coded duplex sonography. Eur J Radiol 81:89–94PubMedCrossRef

65.

Cloud GC, Markus HS (2003) Diagnosis and management of vertebral artery stenosis. Q J Med 96:27–54CrossRef

66.

Marquardt L, Kuker W, Chandratheva A, Geraghty O, Rothwell PM (2009) Incidence and prognosis of > or = 50% symptomatic vertebral or basilar artery stenosis: prospective population-based study. Brain 132(Pt 4):982–988PubMed

67.

Deipolyi AR, Hamberg LM, Gonzalez RG, Hirsch JA, Hunter GJ (2015) Diagnostic yield of emergency department arch-to-vertex CT angiography in patients with suspected acute stroke. Am J Neuroradiol 36(2):265–268PubMedCrossRef

68.

Fiebach JB, Schellinger PD, Jansen O et al (2002) CT and diffusion-weighted MR imaging in randomized order: diffusion-weighted imaging results in higher accuracy and lower interrater variability in the diagnosis of hyperacute ischemic stroke. Stroke 33:2206–2210PubMedCrossRef

69.

Mullins ME, Schaefer PW, Sorensen AG et al (2002) CT and conventional and diffusion-weighted MR imaging in acute stroke: study in 691 patients at presentation to the emergency department. Radiology 224:353–360PubMedCrossRef

70.

Gonzalez RG, Schaefer PW, Buonanno FS et al (1999) Diffusion-weighted MR imaging: diagnostic accuracy in patients imaged within 6 hours of stroke symptom onset. Radiology 210:155–162PubMedCrossRef

71.

Chemmanam T, Campbell BC, Christensen S et al (2010) Ischemic diffusion lesion reversal is uncommon and rarely alters perfusion–diffusion mismatch. Neurology 75:1040–1047PubMedCrossRef

72.

Oppenheim C, Stanescu R, Dormont D, Crozier S, Marro B, Samson Y, Rancurel G, Marsault C (2000) False-negative diffusion-weighted MR findings in acute ischemic stroke. AJNR Am J Neuroradiol 21:1434–1440PubMed

73.

Warach S, Kidwell CS (2004) The redefinition of TIA: the uses and limitations of DWI in acute ischemic cerebrovascular syndromes. Neurology 62:359–360PubMedCrossRef

74.

Yoo AJ, Verduzco LA, Schaefer PW et al (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 40:2046–2054PubMedPubMedCentralCrossRef

75.

Sanak D, Nosal V, Horak D et al (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 48:632–639PubMedCrossRef

76.

Sims JR, Gharai LR, Schaefer PW, Vangel M, Rosenthal ES, Lev MH, Schwamm LH (2009) ABC/2 for rapid clinical estimate of infarct, perfusion, and mismatch volumes. Neurology 72:2104–2110PubMedPubMedCentralCrossRef

77.

Lansberg MG, Lee J, Christensen S et al (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 42:1608–1614PubMedPubMedCentralCrossRef

78.

Puig J, Blasco G, Daunis-I-Estadella J et al (2013) Increased corticospinal tract fractional anisotropy can discriminate stroke onset within the first 4.5 hours. Stroke 44:1162–1165PubMedCrossRef

79.

Puig J, Blasco G, Daunis-I-Estadella J et al (2013) Decreased corticospinal tract fractional anisotropy predicts long-term motor outcome after stroke. Stroke 44:2016–2018PubMedCrossRef

80.

Perkins CJ, Kahya E, Roque CT, Roche PE, Newman GC (2001) Fluid-attenuated inversion recovery and diffusion- and perfusion-weighted MRI abnormalities in 117 consecutive patients with stroke symptoms. Stroke 32:2774–2781PubMedCrossRef

81.

Aoki J, Kimura K, Iguchi Y, Shibazaki K, Sakai K, Iwanaga T (2010) FLAIR can estimate the onset time in acute ischemic stroke patients. J Neurol Sci 293:39–44PubMedCrossRef

82.

Thomalla G, Rossbach P, Rosenkranz M, Siemonsen S, Krützelmann A, Fiehler J, Gerloff C (2009) Negative fluid-attenuated inversion recovery imaging identifies acute ischemic stroke at 3 hours or less. Ann Neurol 65:724–732PubMedCrossRef

83.

Thomalla G, Fiebach JB, Ostergaard L, WAKE-UP investigators et al (2014) A multicenter, randomized, double-blind, placebo-controlled trial to test efficacy and safety of magnetic resonance imaging-based thrombolysis in wake-up stroke (WAKE-UP). Int J Stroke 9:829–836PubMedCrossRef

84.

Wu O, Latour LL, Song SS, Thornell B, Davis L, Furie KL, Warach S, Schwamm LH (2012) MR WITNESS: a phase IIA safety study of intravenous thrombolysis with alteplase in MRI-selected patients. In: International stroke conference

85.

Sanossian N, Saver JL, Alger JR, Kim D, Duckwiler GR, Jahan R, Vinuela F, Ovbiagele B, Liebeskind DS (2009) Angiography reveals that fluid-attenuated inversion recovery vascular hyperintensities are due to slow flow, not thrombus. AJNR Am J Neuroradiol 30:564–568PubMedPubMedCentralCrossRef

86.

Cheng B, Ebinger M, Kufner A et al (2012) Hyperintense vessels on acute stroke fluid-attenuated inversion recovery imaging: associations with clinical and other MRI findings. Stroke 43:2957–2961PubMedPubMedCentralCrossRef

87.

Gawlitza M, Gragert J, Quäschling U, Hoffmann KT (2014) FLAIR-hyperintense vessel sign, diffusion–perfusion mismatch and infarct growth in acute ischemic stroke without vascular recanalisation therapy. J Neuroradiol 41:227–233PubMedCrossRef

88.

Girot M, Gauvrit JY, Cordonnier C, Pruvo JP, Verdelho A, Leys D, Leclerc X (2007) Prognostic value of hyperintense vessel signals on fluid-attenuated inversion recovery sequences in acute cerebral ischemia. Eur Neurol 57:75–79PubMedCrossRef

89.

Kim SJ, Ha YS, Ryoo S, Noh HJ, Ha SY, Bang OY, Kim GM, Chung CS, Lee KH (2012) Sulcal effacement on fluid attenuation inversion recovery magnetic resonance imaging in hyperacute stroke: association with collateral flow and clinical outcomes. Stroke 43:386–392PubMedCrossRef

90.

Schellinger PD, Chalela JA, Kang DW, Latour LL, Warach S (2005) Diagnostic and prognostic value of early MR Imaging vessel signs in hyperacute stroke patients imaged < 3 hours and treated with recombinant tissue plasminogen activator. AJNR Am J Neuroradiol 26:618–624PubMed

91.

Haacke EM, Xu Y, Cheng YC, Reichenbach JR (2004) Susceptibility weighted imaging (SWI). Magn Reson Med 52:612–618PubMedCrossRef

92.

Santhosh K, Kesavadas C, Thomas B, Gupta AK, Thamburaj K, Kapilamoorthy TR (2009) Susceptibility weighted imaging: a new tool in magnetic resonance imaging of stroke. Clin Radiol 64:74–83PubMedCrossRef

93.

Rovira A, Orellana P, Alvarez-Sabin Arenillas JF, Aymerich X, Grive E, Molina C, Rovira-Gols A (2004) Hyperacute ischemic stroke: middle cerebral artery susceptibility sign at echo-planar gradient-echo MR imaging. Radiology 232:466–473PubMedCrossRef

94.

Cho KH, Kim JS, Kwon SU, Cho AH, Kang DW (2005) Significance of susceptibility vessel sign on T2*-weighted gradient echo imaging for identification of stroke subtypes. Stroke 36:2379–2383PubMedCrossRef

95.

Hermier M, Nighoghossian N (2004) Contribution of susceptibility-weighted imaging to acute stroke assessment. Stroke 35:1989–1994PubMedCrossRef

96.

Kao HW, Tsai FY, Hasso AN (2012) Predicting stroke evolution: comparison of susceptibility-weighted MR imaging with MR perfusion. Eur Radiol 22:1397–1403PubMedCrossRef

97.

Luo S, Yang L, Wang L (2014) Comparison of susceptibility-weighted and perfusion-weighted magnetic resonance imaging in the detection of penumbra in acute ischemic stroke. J Neuroradiol 42:255–260

98.

Alvarez-Linera J, Benito-Leon J, Escribano J, Campollo J, Gesto R (2003) Prospective evaluation of carotid artery stenosis: elliptic centric contrast-enhanced MR angiography and spiral CT angiography compared with digital subtraction angiography. Am J Neuroradiol 24:1012–1019PubMed

99.

Jaff MR, Goldmakher GV, Lev MH, Romero JM (2008) Imaging of the carotid arteries: the role of duplex ultrasonography, magnetic resonance arteriography, and computerized tomographic arteriography. Vasc Med 13:281–292PubMedCrossRef

100.

Yu S, Yan L, Yao Y et al (2012) Noncontrast dynamic MRA in intracranial arteriovenous malformation (AVM), comparison with time of flight (TOF) and digital subtraction angiography (DSA). Magn Reson Imaging 30:869–877PubMedPubMedCentralCrossRef

101.

Liu Q, Huang J, Degnan AJ, Chen S, Gillard JH, Teng Z, Lu J (2013) Comparison of high-resolution MRI with CT angiography and digital subtraction angiography for the evaluation of middle cerebral artery atherosclerotic steno-occlusive disease. Int J Cardiovasc Imaging 29:1491–1498PubMedCrossRef

102.

Symon L (2007) The ischaemic penumbra: the beginning. In: Donnan GA, Baron JC, Davis SM, Sharp FR (eds) The ischemic penumbra. Informa Healthcare, New York, pp 1–6

103.

Astrup J, Siesjo BK, Symon L (1981) Thresholds in cerebral ischemia—the ischemic penumbra. Stroke 12:723–725PubMedCrossRef

104.

Donnan GA, Baron JC, Davis SM, Sharp FR (eds) (2007) The ischaemic penumbra. New York, Informa Healthcare, pp 7–20

105.

Konstas AA, Goldmakher GV, Lee TY, Lev MH (2009) Theoretic basis and technical implementation of CT perfusion in acute ischemic stroke, part 1: Theoretic basis. Am J Neuroradiol 30:662–668PubMedCrossRef

106.

Mouridsen K, Christensen S, Gyldensted L, Ostergaard L (2006) Automated selection of arterial input function using cluster analysis. Magn Reson Med 55:524–531PubMedCrossRef

107.

Grandin CB (2003) Assessment of brain perfusion with MRI: methodology and application to acute stroke. Neuroradiology 45:755–766PubMedCrossRef

108.

Wintermark M, Sesay M, Barbier E et al (2005) Comparative overview of brain perfusion imaging techniques. Stroke 36:e83–e99PubMedCrossRef

109.

Yoo AJ, Pulli B, Gonzalez RG (2011) Imaging-based treatment selection for intravenous and intra-arterial stroke therapies: a comprehensive review. Expert Rev Cardiovasc Ther 9:857–876PubMedPubMedCentralCrossRef

110.

Konstas AA, Wintermark M, Lev MH (2011) CT perfusion imaging in acute stroke. Neuroimaging Clin N Am 21:215–238PubMedCrossRef

111.

Dani KA, Thomas RG, Chappell FM, Shuler K, MacLeod MJ, Muir KW, Wardlaw JM (2011) Computed tomography and magnetic resonance perfusion imaging in ischemic stroke: definitions and thresholds. Ann Neurol 70:384–401PubMedCrossRef

112.

Kamalian S, Kamalian S, Maas MB et al (2011) CT cerebral blood flow maps optimally correlate with admission diffusion-weighted imaging in acute stroke but thresholds vary by postprocessing platform. Stroke 42:1923–1928PubMedPubMedCentralCrossRef

113.

Schaefer PW, Souza L, Kamalian S, Hirsch JA, Yoo AJ, Kamalian S, Gonzalez RG, Lev MH (2015) Stroke 46:419–424PubMedPubMedCentralCrossRef

114.

Campbell BC, Christensen S, Levi CR, Desmond PM, Donnan GA, David SM, Parsons MW (2011) Cerebral blood flow is the optimal CT perfusion parameter for assessing infarct core. Stroke 42:3435–3440PubMedCrossRef

115.

Olivot JM, Mlynash M, Thijs VN, Kemp S, Lansberg MG, Wechsler L, Bammer R, Marks MP, Albers GW (2009) Optimal Tmax threshold for predicting penumbral tissue in acute stroke. Stroke 40:469–475PubMedPubMedCentralCrossRef

116.

Mui K, Yoo AJ, Verduzco L, Copen WA, Hirsch JA, Gonzalez RG, Schaefer PW (2011) Cerebral blood flow thresholds for tissue infarction in patients with acute ischemic stroke treated with intra-arterial revascularization therapy depend on timing of reperfusion. AJNR Am J Neuroradiol 32:846–851PubMedCrossRef

117.

Lassen NA (1985) Normal average value of cerebral blood flow in younger adults is 50 ml/100 g/min. J Cereb Blood Flow Metab 5:347–349PubMedCrossRef

118.

Frackowiak RS, Lenzi GL, Jones T, Heather JD (1980) Quantitative measurement of regional cerebral blood flow and oxygen metabolism in man using 15O and positron emission tomography: theory, procedure, and normal values. J Comput Assist Tomogr 4:727–736PubMedCrossRef

119.

Mishra NK, Albers GW, Davis SM, Donnan GA, Furlan AJ, Hacke W, Lees KR (2010) Mismatch based delayed thrombolysis: a meta-analysis. Stroke 41:e25–e33PubMedCrossRef

120.

Lansberg MG, Straka M, Kemp S et al (2012) MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): a prospective cohort study. Lancet Neurol 11:860–867PubMedPubMedCentralCrossRef

121.

Hillis AE, Ulatowski JA, Barker PB, Torbey M, Ziai W, Beauchamp NJ, Oh S, Wityk RJ (2003) A pilot randomized trial of induced blood pressure elevation: effects on function and focal perfusion in acute and subacute stroke. Cerebrovasc Dis 16:236–346PubMedCrossRef

122.

Aviv RI, d’Esterre CD, Murphy BD et al (2009) Hemorrhagic transformation of ischemic stroke: prediction with CT perfusion. Radiology 250:867–877PubMedCrossRef

123.

Souza LC, Payabvash S, Wang Y et al (2012) Admission CT perfusion is an independent predictor of hemorrhagic transformation in acute stroke with similar accuracy to DWI. Cerebrovasc Dis 33:8–15PubMedPubMedCentralCrossRef

124.

Payabvash S, Kamalian S, Fung S et al (2010) Predicting language improvement in acute stroke patients presenting with aphasia: a multivariate logistic model using location-weighted atlas-based anlaysis of admission CT perfusion scans. Am J Neuroradiol 31:1661–1668PubMedPubMedCentralCrossRef

125.

Payabvash S, Souza LC, Kamalian S et al (2012) Location-weighted CTP analysis predicts early motor improvement in stroke: a preliminary study. Neurology 8:1853–1859CrossRef

126.

Hopyan J, Ciarallo A, Dowlatshahi D et al (2010) Certainty of stroke diagnosis: incremental benefit with CT perfusion over noncontrast CT and CT angiography. Radiology 255:142–153PubMedCrossRef

127.

Gonzalez RG, Copen WA, Schaefer PW et al (2013) The Massachusetts General Hospital acute stroke imaging algorithm: an experience and evidence based approach. J Neurointerv Surg 5:i7–i12PubMedPubMedCentralCrossRef

128.

Powers WJ, Derdeyn CP, Biller J et al (2015) 2015 AHA/ASA focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. doi:10.1161/STR.0000000000000074

129.

Wintermark M, Sanelli PC, Albers GW et al (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–E127PubMedPubMedCentralCrossRef

Title: Acute ischemic stroke imaging: a practical approach for diagnosis and triage
Authors: Joseph Yeen Young
Pamela Whitney Schaefer
Publication date: 01-01-2016
Publisher: Springer Netherlands
Published in: The International Journal of Cardiovascular Imaging / Issue 1/2016
Print ISSN: 1569-5794
Electronic ISSN: 1875-8312
DOI: https://doi.org/10.1007/s10554-015-0757-0

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Acute ischemic stroke imaging: a practical approach for diagnosis and triage

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2016

High resolution FDG-microPET of carotid atherosclerosis: plaque components underlying enhanced FDG uptake

Defining the optimal systolic phase targets using absolute delay time for reconstructions in dual-source coronary CT angiography

Simultaneous carotid PET/MR: feasibility and improvement of magnetic resonance-based attenuation correction

Advanced MRI for carotid plaque imaging

Intravascular ultrasound and optical coherence tomography imaging of coronary atherosclerosis

The impact of gender on cardiovascular system calcification in very elderly patients with severe aortic stenosis

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page