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01-12-2018 | Review Article

Imaging of acute ischemic stroke

Authors: Scott Rudkin, Russell Cerejo, Ashis Tayal, Michael F. Goldberg

Published in: Emergency Radiology | Issue 6/2018

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.

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

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

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 CrossRef

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 CrossRefPubMed

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

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

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRef

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRef

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 CrossRefPubMed

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 26:1012–1021PubMedPubMedCentral

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 25:520–528CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRef

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRef

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 CrossRef

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 CrossRefPubMed

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

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 CrossRef

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

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 CrossRef

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

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 CrossRefPubMed

78.

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

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 CrossRefPubMedPubMedCentral

80.

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

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 CrossRefPubMed

Title: Imaging of acute ischemic stroke
Authors: Scott Rudkin
Russell Cerejo
Ashis Tayal
Michael F. Goldberg
Publication date: 01-12-2018
Publisher: Springer Berlin Heidelberg
Published in: Emergency Radiology / Issue 6/2018
Print ISSN: 1070-3004
Electronic ISSN: 1438-1435
DOI: https://doi.org/10.1007/s10140-018-1623-x

At a glance: The STEP trials

Springer Medicine

Imaging of acute ischemic stroke

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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