State-of-the-Art Imaging in Acute Ischemic Cerebral Infarction

Abstract

BACKGROUND: In order to take advantage of the latest treatment options and keeping in mind that „time is brain` in stroke management , the goal of imaging is to diagnose as early as possible, obtain accurate information about the cerebrovascular system and brain tissue perfusion, select the correct therapy and improve the outcome of one of the most debilitating and costly to society diseases. LEARNING POINTS: to describe the basics of CT and MR techniques used to evaluate stroke; to determine an imaging protocol for acute stroke evaluation; to recognize the significance of a penumbra for therapy and prognosis after acute stroke. MAIN BODY: Overall evaluation can be performed with computed tomography (CT) and/ or magnetic resonance (MR) . Native CT can be performed rapidly to identify the early signs of ischemia and to exclude haemorrhage. CT angiography and CT perfusion, may display intravascular thrombosis and the penumbra . These tests are easy to perform on most spiral CT devices and are increasingly used in patients with IMI to decide on the type and volume of the necessary intervention. Although acute attacks can be seen at the start of the conventional MR I , diffusion is the most sensitive series for the detection of hyper acute ischemia. Gradient-echo MR sequences can be useful for detecting bleeding; t he neck and intracranial vessels can be assessed with MR angiography, and the presence of „mismatch` between the diffusion and perfusion can predict the existence of the penumbra. CONCLUSION: Imaging technology has advanced rapidly in the past two decades, and current imaging techniques can be used to identify hyperacute stroke and guide therapy by providing information about the functional status of ischemic brain tissue. Both CT and MR imaging are useful for the comprehensive evaluation of acute stroke and can provide important and necessary information for therapy planning.