Advanced imaging application for acute ischemic stroke

With the approval of intravenous recombinant tissue plasminogen activator (r-TPA) in 1995, acute ischemic stroke therapy is increasingly being administered. Currently the approach to imaging these patients is very simplistic. Typically, noncontrast head computed tomography (CT) is the only study performed prior to treatment. Advanced imaging using CT or magnetic resonance imaging (MRI) can play a very important role in the triage and classification of patients with acute ischemic stroke. With knowledge of the location and size of the occlusion as well as the collateral circulation, the best treatment can be selected, minimizing any morbidity from treatment and maximizing the chance of success. The identification and stratification of patients according to their imaging and clinical features will further individualize treatment and allow tailored therapy. This review will discuss rapid imaging techniques that are easily available and the rationale for their use.