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The Egyptian Journal of Neurology, Psychiatry and Neurosurgery

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Open Access 01-12-2021 | Stroke | Review

Role of imaging in early diagnosis of acute ischemic stroke: a literature review

Authors: Mohammad Amin Akbarzadeh, Sarvin Sanaie, Mahshid Kuchaki Rafsanjani, Mohammad-Salar Hosseini

Published in: The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Issue 1/2021

Abstract

Stroke is a serious health condition that is responsible for more than 5% of total deaths. Near 20% of patients experiencing stroke die every year, resulting in the stroke being at the top of the list of preventable causes of death. Once an acute stroke is suspected, a golden hour of less than an hour is available to prevent the undesirable consequences. Since neuroimaging is mandatory in the diagnosis of stroke, the proper use of neuroimaging could help saving time and planning the right treatment for the patient. Some of the available imaging methods help us with rapid results, while others benefit us from a more accurate diagnosis. Hereby, we aim to provide a clinical review of the advantages and disadvantages of different available neuroimaging methods in approaching acute stroke to help clinicians choose the best method according to the settings.

Geisler F, Ali SF, Ebinger M, Kunz A, Rozanski M, Waldschmidt C, et al. Evaluation of a score for the prehospital distinction between cerebrovascular disease and stroke mimic patients. Int J Stroke. 2019;14(4):400–8. https://doi.org/10.1177/1747493018806194.CrossRefPubMed

Chiaramonte R, Pavone P, Vecchio M. Speech rehabilitation in dysarthria after stroke: a systematic review of the studies. Eur J Phys Rehabil Med. 2020;56(5):547–62. https://doi.org/10.23736/s1973-9087.20.06185-7.CrossRefPubMed

Campbell BCV, De Silva DA, Macleod MR, Coutts SB, Schwamm LH, Davis SM, et al. Ischaemic stroke. Nat Rev Dis Primers. 2019;5(1):70. https://doi.org/10.1038/s41572-019-0118-8.CrossRefPubMed

Feigin VL, Norrving B, Mensah GA. Global burden of stroke. Circ Res. 2017;120(3):439–48. https://doi.org/10.1161/CIRCRESAHA.116.308413.CrossRefPubMed

Yang Q, Tong X, Schieb L, Vaughan A, Gillespie C, Wiltz JL, et al. Vital signs: recent trends in stroke death rates—United States, 2000–2015. MMWR Morb Mortal Wkly Rep. 2017;66(35):933.CrossRef

Johnston SC, Mendis S, Mathers CD. Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling. Lancet Neurol. 2009;8(4):345–54.CrossRef

Almobarak A, Badi S, Elmadhoun W, Tahir H, Ahmed M. The prevalence and risk factors of stroke among Sudanese individuals with diabetes: cross-sectional survey. Brain Circ. 2020;6(1):26–30. https://doi.org/10.4103/bc.bc_15_19.CrossRefPubMedPubMedCentral

Advani R, Naess H, Kurz MW. The golden hour of acute ischemic stroke. Scand J Trauma Resusc Emerg Med. 2017;25(1):54.CrossRef

Saver JL, Smith EE, Fonarow GC, Reeves MJ, Zhao X, Olson DM, et al. The “golden hour” and acute brain ischemia: presenting features and lytic therapy in >30,000 patients arriving within 60 minutes of stroke onset. Stroke. 2010;41(7):1431–9. https://doi.org/10.1161/strokeaha.110.583815.CrossRefPubMedPubMedCentral

10.

Di Stefano V, De Angelis MV, Montemitro C, Russo M, Carrarini C, di Giannantonio M, et al. Clinical presentation of strokes confined to the insula: a systematic review of literature. Neurol Sci. 2021. https://doi.org/10.1007/s10072-021-05109-1.CrossRefPubMedPubMedCentral

11.

Purrucker JC, Hametner C, Engelbrecht A, Bruckner T, Popp E, Poli S. Comparison of stroke recognition and stroke severity scores for stroke detection in a single cohort. J Neurol Neurosurg Psychiatry. 2015;86(9):1021–8.CrossRef

12.

Brunser AM, Hoppe A, Illanes S, Díaz V, Muñoz P, Cárcamo D, et al. Accuracy of diffusion-weighted imaging in the diagnosis of stroke in patients with suspected cerebral infarct. Stroke. 2013;44(4):1169–71.CrossRef

13.

Xing C, Arai K, Lo EH, Hommel M. Pathophysiologic cascades in ischemic stroke. Int J Stroke. 2012;7(5):378–85.CrossRef

14.

Alqahtani SA, Stemer AB, McCullough MF, Bell RS, Mai J, Liu A-H, et al. Endovascular management of stroke patients with large vessel occlusion and minor stroke symptoms. Cureus. 2017;9(6):e1355.PubMedPubMedCentral

15.

Tziotzios C, Dawson J, Walters M. Stroke in practice: from diagnosis to evidence-based management. Boca Raton: CRC Press; 2017.CrossRef

16.

Umemura T, Kawamura T, Hotta N. Pathogenesis and neuroimaging of cerebral large and small vessel disease in type 2 diabetes: a possible link between cerebral and retinal microvascular abnormalities. J Diabetes Investig. 2017;8(2):134–48.CrossRef

17.

Younger DS. Stroke due to vasculitis in children and adults. Neurol Clin. 2019;37(2):279–302.CrossRef

18.

Perera KS, Vanassche T, Bosch J, Swaminathan B, Mundl H, Giruparajah M, et al. Global survey of the frequency of atrial fibrillation-associated stroke: embolic stroke of undetermined source Global Registry. Stroke. 2016;47(9):2197–202.CrossRef

19.

Majersik JJ, Skalabrin EJ. Single-gene stroke disorders. Seminars in neurology. New York: Thieme Medical Publishers Inc.; 2006.

20.

Rosenberg RN, Pascual JM. Rosenberg’s molecular and genetic basis of neurological and psychiatric disease, vol. 2. Cambridge: Academic press; 2020.

21.

Zhao X-J, Larkin TM, Lauver MA, Ahmad S, Ducruet AF. Tissue plasminogen activator mediates deleterious complement cascade activation in stroke. PLoS ONE. 2017;12(7):e0180822.CrossRef

22.

Gerriets T, Walberer M, Ritschel N, Tschernatsch M, Mueller C, Bachmann G, et al. Edema formation in the hyperacute phase of ischemic stroke. J Neurosurg. 2009;111(5):1036–42.CrossRef

23.

Wang P, Shao B-Z, Deng Z, Chen S, Yue Z, Miao C-Y. Autophagy in ischemic stroke. Prog Neurobiol. 2018;163:98–117.CrossRef

24.

Endres M, Dirnagl U, Moskowitz MA. The ischemic cascade and mediators of ischemic injury. Handb Clin Neurol. 2008;92:31–41.CrossRef

25.

Rodrigo R, Fernández-Gajardo R, Gutiérrez R, Manuel Matamala J, Carrasco R, Miranda-Merchak A, et al. Oxidative stress and pathophysiology of ischemic stroke: novel therapeutic opportunities. CNS Neurol Disord-Drug Targets (Formerly Curr Drug Targets-CNS Neurol Disord). 2013;12(5):698–714.

26.

Guo Y, Li P, Guo Q, Shang K, Yan D, Du S, et al. Pathophysiology and biomarkers in acute ischemic stroke—a review. Trop J Pharm Res. 2013;12(6):1097–105.CrossRef

27.

Kamalian S, Lev MH. Stroke imaging. Radiol Clin N Am. 2019;57(4):717–32. https://doi.org/10.1016/j.rcl.2019.02.001.CrossRefPubMed

28.

Chugh C. Acute ischemic stroke: management approach. Indian J Crit Care Med Peer-rev. 2019;23(Suppl 2):S140.

29.

Alonso de Leciñana M, Egido JA, Casado I, Ribó M, Dávalos A, Masjuan J, et al. Guidelines for the treatment of acute ischaemic stroke. Neurologia (Barcelona, Spain). 2014;29(2):102–22. https://doi.org/10.1016/j.nrl.2011.09.012.CrossRef

30.

Liao XL, Wang CX, Wang YL, Wang CJ, Zhao XQ, Zhang LQ, et al. Implementation and outcome of thrombolysis with alteplase 3 to 4.5 h after acute stroke in Chinese patients. CNS Neurosci Ther. 2013;19(1):43–7. https://doi.org/10.1111/cns.12031.CrossRefPubMed

31.

Merino JG, Warach S. Imaging of acute stroke. Nat Rev Neurol. 2010;6(10):560.CrossRef

32.

Chrzan R, Gleń A, Urbanik A. Hyperdense middle cerebral artery sign as the only radiological manifestation of hyperacute ischemic stroke in computed tomography. Neurol Neurochir Pol. 2017;51(1):33–7.CrossRef

33.

Nakano S, Iseda T, Kawano H, Yoneyama T, Ikeda T, Wakisaka S. Correlation of early CT signs in the deep middle cerebral artery territories with angiographically confirmed site of arterial occlusion. AJNR Am J Neuroradiol. 2001;22(4):654–9.PubMedPubMedCentral

34.

Weimar C. Stroke of undetermined cause: workup and secondary prevention. Curr Opin Neurol. 2016;29(1):4–8. https://doi.org/10.1097/wco.0000000000000280.CrossRefPubMed

35.

Ifergan H, Amelot A, Ismail M, Gaudron M, Cottier JP, Narata AP. Stroke-mimics in stroke-units. Evaluation after changes imposed by randomized trials. Arq Neuropsiquiatr. 2020;78(2):88–95. https://doi.org/10.1590/0004-282x20190154.CrossRefPubMed

36.

Quenardelle V, Lauer-Ober V, Zinchenko I, Bataillard M, Rouyer O, Beaujeux R, et al. Stroke mimics in a stroke care pathway based on MRI screening. Cerebrovasc Dis (Basel, Switzerland). 2016;42(3–4):205–12. https://doi.org/10.1159/000445956.CrossRef

37.

Psychogios K, Kargiotis O, Safouris A, Magoufis G, Gelagoti M, Bonakis A, et al. Perfusion imaging averting intravenous thrombolysis in stroke mimics. Neurol Sci. 2021;42(6):2591–4. https://doi.org/10.1007/s10072-021-05090-9.CrossRefPubMed

38.

Provost C, Soudant M, Legrand L, Ben Hassen W, Xie Y, Soize S, et al. Magnetic resonance imaging or computed tomography before treatment in acute ischemic stroke. Stroke. 2019;50(3):659–64. https://doi.org/10.1161/strokeaha.118.023882.CrossRefPubMed

39.

Zhang W, Cheng J, Zhang Y, Wang K, Jin H. Analysis of CT and MRI combined examination for the diagnosis of acute cerebral infarction. J Coll Physicians Surg Pak. 2019;29(9):898–9. https://doi.org/10.29271/jcpsp.2019.09.898.CrossRefPubMed

40.

Malhotra K, Liebeskind D. Overview of neuroimaging of stroke. In: Welch KM, Caplan LR, Siesjo BK, Weir B, Reis DJ, editors. Primer on cerebrovascular diseases. Amsterdam: Elsevier; 2017. p. 676–85.CrossRef

41.

Wang Y, Zhou Z, Ding S. FLAIR vascular hyperintensity-DWI mismatch most likely to benefit from recanalization and good outcome after stroke. Medicine. 2020;99(2):e18665. https://doi.org/10.1097/md.0000000000018665.CrossRefPubMedPubMedCentral

42.

Boss SM, Moustafa RR, Moustafa MA, El Sadek A, Mostafa MM, Aref HM. Lesion homogeneity on diffusion-weighted imaging is a marker of outcome in acute ischemic stroke. Egypt J Neurol Psychiatry Neurosurg. 2019;55(1):59. https://doi.org/10.1186/s41983-019-0101-z.CrossRef

43.

Oliveira-Filho J, WJ K. Initial assessment and management of acute stroke. UpToDate. Waltham: UpToDate Retrieved January. 2010.

44.

Mullins ME, Schaefer PW, Sorensen AG, Halpern EF, Ay H, He J, et al. CT and conventional and diffusion-weighted MR imaging in acute stroke: study in 691 patients at presentation to the emergency department. Radiology. 2002;224(2):353–60. https://doi.org/10.1148/radiol.2242010873.CrossRefPubMed

45.

van Gelderen P, de Vleeschouwer MHM, DesPres D, Pekar J, van Zijl PCM, Moonen CTW. Water diffusion and acute stroke. Magn Reson Med. 1994;31(2):154–63. https://doi.org/10.1002/mrm.1910310209.CrossRefPubMed

46.

Almandoz JED, Romero JM. Advanced CT imaging in the evaluation of hemorrhagic stroke. Neuroimaging Clin. 2011;21(2):197–213.CrossRef

47.

Zerna C, Thomalla G, Campbell BC, Rha J-H, Hill MD. Current practice and future directions in the diagnosis and acute treatment of ischaemic stroke. Lancet. 2018;392(10154):1247–56.CrossRef

48.

Liebeskind DS, Alexandrov AV. Advanced multimodal CT/MRI approaches to hyperacute stroke diagnosis, treatment, and monitoring. Ann N Y Acad Sci. 2012;1268:1.CrossRef

49.

Kang DW, Jeong HG, Kim DY, Yang W, Lee SH. Prediction of stroke subtype and recanalization using susceptibility vessel sign on susceptibility-weighted magnetic resonance imaging. Stroke. 2017;48(6):1554–9. https://doi.org/10.1161/strokeaha.116.016217.CrossRefPubMedPubMedCentral

50.

Wardlaw JM, Mielke O. Early signs of brain infarction at CT: observer reliability and outcome after thrombolytic treatment—systematic review. Radiology. 2005;235(2):444–53. https://doi.org/10.1148/radiol.2352040262.CrossRefPubMed

51.

Lövblad KO, Altrichter S, Mendes Pereira V, Vargas M, Marcos Gonzalez A, Haller S, et al. Imaging of acute stroke: CT and/or MRI. J Neuroradiol. 2015;42(1):55–64. https://doi.org/10.1016/j.neurad.2014.10.005.CrossRefPubMed

52.

Guberina N, Dietrich U, Radbruch A, Goebel J, Deuschl C, Ringelstein A, et al. Detection of early infarction signs with machine learning-based diagnosis by means of the Alberta Stroke Program Early CT score (ASPECTS) in the clinical routine. Neuroradiology. 2018;60(9):889–901. https://doi.org/10.1007/s00234-018-2066-5.CrossRefPubMed

53.

Barber PA, Demchuk AM, Zhang J, Buchan AM. 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 (Lond, Engl). 2000;355(9216):1670–4. https://doi.org/10.1016/s0140-6736(00)02237-6.CrossRef

54.

Pallesen LP, Gerber J, Dzialowski I, van der Hoeven EJ, Michel P, Pfefferkorn T, et al. Diagnostic and prognostic impact of pc-ASPECTS applied to perfusion CT in the Basilar Artery International Cooperation Study. J Neuroimaging. 2015;25(3):384–9. https://doi.org/10.1111/jon.12130.CrossRefPubMed

55.

Lansberg MG, Albers GW, Beaulieu C, Marks MP. Comparison of diffusion-weighted MRI and CT in acute stroke. Neurology. 2000;54(8):1557–61. https://doi.org/10.1212/wnl.54.8.1557.CrossRefPubMed

56.

Allen LM, Hasso AN, Handwerker J, Farid H. Sequence-specific MR imaging findings that are useful in dating ischemic stroke. Radiographics. 2012;32(5):1285–97. https://doi.org/10.1148/rg.325115760 (discussion 97-9).CrossRefPubMed

57.

Menon BK, d’Esterre CD, Qazi EM, Almekhlafi M, Hahn L, Demchuk AM, et al. Multiphase CT angiography: a new tool for the imaging triage of patients with acute ischemic stroke. Radiology. 2015;275(2):510–20.CrossRef

58.

Eastman AL, Muraliraj V, Sperry JL, Minei JP. CTA-based screening reduces time to diagnosis and stroke rate in blunt cervical vascular injury. J Trauma. 2009;67(3):551–6. https://doi.org/10.1097/TA.0b013e3181b84408 (discussion 5-6).CrossRefPubMed

59.

Wardlaw JM, Stevenson MD, Chappell F, Rothwell PM, Gillard J, Young G, et al. Carotid artery imaging for secondary stroke prevention. Stroke. 2009;40(11):3511–7. https://doi.org/10.1161/STROKEAHA.109.557017.CrossRefPubMed

60.

Liebeskind DS, Kosinski AS, Saver JL, Feldmann E, Investigators S. Computed tomography angiography in the stroke outcomes and neuroimaging of intracranial atherosclerosis (SONIA) study. Interv Neurol. 2013;2(4):153–9.CrossRef

61.

Liebeskind DS, Kosinski AS, Lynn MJ, Scalzo F, Fong AK, Fariborz P, et al. Noninvasive fractional flow on MRA predicts stroke risk of intracranial stenosis. J Neuroimaging. 2015;25(1):87–91. https://doi.org/10.1111/jon.12101.CrossRefPubMed

62.

Kilburg C, McNally JS, de Havenon A, Taussky P, Kalani MYS, Park MS. Advanced imaging in acute ischemic stroke. Neurosurg Focus. 2017;42(4):E10.CrossRef

63.

Latchaw RE, Alberts MJ, Lev MH, Connors JJ, Harbaugh RE, Higashida RT, et al. Recommendations for imaging of acute ischemic stroke: a scientific statement from the American Heart Association. Stroke. 2009;40(11):3646–78.CrossRef

64.

Myung JW, Kim JH, Cho J, Park I, Kim HY, Beom JH. Contrast-induced acute kidney injury in radiologic management of acute ischemic stroke in the emergency setting. AJNR Am J Neuroradiol. 2020;41(4):632–6. https://doi.org/10.3174/ajnr.A6472.CrossRefPubMedPubMedCentral

65.

Hopyan JJ, Gladstone DJ, Mallia G, Schiff J, Fox AJ, Symons SP, et al. Renal safety of CT angiography and perfusion imaging in the emergency evaluation of acute stroke. AJNR Am J Neuroradiol. 2008;29(10):1826–30. https://doi.org/10.3174/ajnr.A1257.CrossRefPubMedPubMedCentral

66.

Connolly F, Röhl JE, Guthke C, Wengert O, Valdueza JM, Schreiber SJ. Emergency room use of “fast-track” ultrasound in acute stroke: an observational study. Ultrasound Med Biol. 2019;45(5):1103–11. https://doi.org/10.1016/j.ultrasmedbio.2019.01.001.CrossRefPubMed

67.

Buskens E, Nederkoorn PJ, Buijs-Van Der Woude T, Mali WP, Kappelle LJ, Eikelboom BC, et al. Imaging of carotid arteries in symptomatic patients: cost-effectiveness of diagnostic strategies. Radiology. 2004;233(1):101–12. https://doi.org/10.1148/radiol.2331030863.CrossRefPubMed

68.

Purkayastha S, Sorond F. Transcranial Doppler ultrasound: technique and application. Semin Neurol. 2012;32(4):411–20. https://doi.org/10.1055/s-0032-1331812.CrossRefPubMed

69.

de Riva N, Budohoski KP, Smielewski P, Kasprowicz M, Zweifel C, Steiner LA, et al. Transcranial Doppler pulsatility index: what it is and what it isn’t. Neurocrit Care. 2012;17(1):58–66. https://doi.org/10.1007/s12028-012-9672-6.CrossRefPubMed

70.

Robba C, Cardim D, Sekhon M, Budohoski K, Czosnyka M. Transcranial Doppler: a stethoscope for the brain-neurocritical care use. J Neurosci Res. 2018;96(4):720–30. https://doi.org/10.1002/jnr.24148.CrossRefPubMed

71.

Schlachetzki F, Herzberg M, Hölscher T, Ertl M, Zimmermann M, Ittner KP, et al. Transcranial ultrasound from diagnosis to early stroke treatment—part 2: prehospital neurosonography in patients with acute stroke—The Regensburg Stroke Mobile Project. Cerebrovasc Dis. 2012;33(3):262–71.CrossRef

72.

Giannoni MF, Vicenzini E, Sbarigia E, Di Piero V, Lenzi GL, Speziale F. Early ultrasound imaging of carotid arteries in the acute ischemic cerebrovascular patients. Perspect Med. 2012;1(1–12):108–11.CrossRef

73.

Markus HS, MacKinnon A. Asymptomatic embolization detected by Doppler ultrasound predicts stroke risk in symptomatic carotid artery stenosis. Stroke. 2005;36(5):971–5. https://doi.org/10.1161/01.STR.0000162717.62684.40.CrossRefPubMed

74.

Prabhakaran S. Imaging markers of stroke risk in asymptomatic carotid artery stenosis. Brain Circ. 2015;1(1):38–46. https://doi.org/10.4103/2394-8108.166373.CrossRef

75.

Tang Y, Wang M-Y, Wu T-T, Zhang J-Y, Yang R, Zhang B, et al. The role of carotid stenosis ultrasound scale in the prediction of ischemic stroke. Neurol Sci. 2020;41(5):1193–9. https://doi.org/10.1007/s10072-019-04204-8.CrossRefPubMedPubMedCentral

76.

Mahmoodpoor A, Akbarzadeh MA, Sanaie S, Hosseini MS. Role of telehealth in outbreaks—where the classical healthcare systems fail. Infect Control Hosp Epidemiol. 2020;41(8):992–4. https://doi.org/10.1017/ice.2020.120.CrossRefPubMed

77.

Birns J, Bhalla A, Rudd A. Telestroke: a concept in practice. Age Ageing. 2010;39(6):666–7. https://doi.org/10.1093/ageing/afq125.CrossRefPubMed

78.

Hubert GJ, Corea F, Schlachetzki F. The role of telemedicine in acute stroke treatment in times of pandemic. Curr Opin Neurol. 2021;34(1):22–6. https://doi.org/10.1097/wco.0000000000000887.CrossRefPubMed

79.

Agarwal S, Warburton EA. Teleneurology: is it really at a distance? J Neurol. 2011;258(6):971–81. https://doi.org/10.1007/s00415-011-5920-5.CrossRefPubMed

80.

Laghari FJ, Hammer MD. Telestroke imaging: a review. J Neuroimaging. 2017;27(1):16–22. https://doi.org/10.1111/jon.12402.CrossRefPubMed

81.

Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet (Lond, Engl). 2016;387(10029):1723–31. https://doi.org/10.1016/s0140-6736(16)00163-x.CrossRef

82.

Pedragosa A, Alvarez-Sabín J, Rubiera M, Rodriguez-Luna D, Maisterra O, Molina C, et al. Impact of telemedicine on acute management of stroke patients undergoing endovascular procedures. Cerebrovasc Dis (Basel, Switzerland). 2012;34(5–6):436–42. https://doi.org/10.1159/000345088.CrossRef

Title: Role of imaging in early diagnosis of acute ischemic stroke: a literature review
Authors: Mohammad Amin Akbarzadeh
Sarvin Sanaie
Mahshid Kuchaki Rafsanjani
Mohammad-Salar Hosseini
Publication date: 01-12-2021
Publisher: Springer Berlin Heidelberg
Keywords: Stroke
Computed Tomography
Computed Tomography
CT Angiography
Magnetic Resonance Imaging
Magnetic Resonance Imaging
Published in: The Egyptian Journal of Neurology, Psychiatry and Neurosurgery / Issue 1/2021
Electronic ISSN: 1687-8329
DOI: https://doi.org/10.1186/s41983-021-00432-y

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Role of imaging in early diagnosis of acute ischemic stroke: a literature review

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