Advances in stroke neuroimaging have evolved from excluding acute intracranial hemorrhage
on computed tomography (CT) to now using perfusion studies (PWI) and magnetic resonance
imaging (MRI) to possibly expand thrombolytic treatment to patients most likely to
benefit from reperfusion therapy. Advanced imaging has also helped identify those
at high risk for hemorrhage and poor outcome so appropriate treatment can occur with
fewer complications. Identifying those who can benefit from endovascular recanalization
using advanced neuroimaging techniques is particularly useful because endovascular
treatment is often initiated much later than intravenous thrombolytic treatment due
to logistical constraints. Using imaging markers of tissue injury may eventually lead
to a paradigm shift from time-based treatment eligibility in acute stroke reperfusion
treatment as the sensitivity and specificity to identify ischemic penumbra improves
and correlation with clinical outcomes becomes clearer.
Keywords
acute stroke - perfusion imaging - computed tomography - magnetic resonance imaging
- reperfusion - ischemic Penumbra
