Acute Stroke Multimodal Imaging: Present and Potential Applications toward Advancing Care

Abstract

In the past few decades, the field of acute ischemic stroke (AIS) has experienced significant advances in clinical practice. A core driver of this success has been the utilization of acute stroke imaging with an increasing focus on advanced methods including multimodal imaging. Such imaging techniques not only provide a richer understanding of AIS in vivo, but also, in doing so, provide better informed clinical assessments in management and treatment toward achieving best outcomes. As a result, advanced stroke imaging methods are now a mainstay of routine AIS practice that reflect best practice delivery of care. Furthermore, these imaging methods hold great potential to continue to advance the understanding of AIS and its care in the future.

Keywords

acute ischemic stroke - stroke - imaging - perfusion

^* Co-First authors.

• References

• 1 Powers WJ, Derdeyn CP, Biller J. , et al; 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: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015; 46 (10) 3020-3035
• 2 Mair G, Wardlaw JM. Imaging of acute stroke prior to treatment: current practice and evolving techniques. Br J Radiol 2014; 87 (1040): 20140216
• 3 Saver JL, Gornbein J, Starkman S. Graphic reanalysis of the two NINDS-tPA trials confirms substantial treatment benefit. Stroke 2010; 41 (10) 2381-2390
• 4 Rose JC, Mayer SA. Optimizing blood pressure in neurological emergencies. Neurocrit Care 2006; 4 (01) 98
• 5 Jones TH, Morawetz RB, Crowell RM. , et al. Thresholds of focal cerebral ischemia in awake monkeys. J Neurosurg 1981; 54 (06) 773-782
• 6 Hacke W, Donnan G, Fieschi C. , et al; ATLANTIS Trials Investigators; ECASS Trials Investigators; NINDS rt-PA Study Group Investigators. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 2004; 363 (9411): 768-774
• 7 Jauch EC, Saver JL, Adams Jr HP. , et al; American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical Cardiology. 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 2013; 44 (03) 870-947
• 8 Lansberg MG, Albers GW, Beaulieu C, Marks MP. Comparison of diffusion-weighted MRI and CT in acute stroke. Neurology 2000; 54 (08) 1557-1561
• 9 Thomalla G, Rossbach P, Rosenkranz M. , et al. Negative fluid-attenuated inversion recovery imaging identifies acute ischemic stroke at 3 hours or less. Ann Neurol 2009; 65 (06) 724-732
• 10 Rimmele DL, Thomalla G. Wake-up stroke: clinical characteristics, imaging findings, and treatment option - an update. Front Neurol 2014; 5: 35
• 11 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 2000; 355 (9216): 1670-1674
• 12 Tarpley J, Franc D, Tansy AP, Liebeskind DS. Use of perfusion imaging and other imaging techniques to assess risks/benefits of acute stroke interventions. Curr Atheroscler Rep 2013; 15 (07) 336
• 13 Tomsick T, Brott T, Barsan W. , et al. Prognostic value of the hyperdense middle cerebral artery sign and stroke scale score before ultraearly thrombolytic therapy. AJNR Am J Neuroradiol 1996; 17 (01) 79-85
• 14 Tomsick T, Brott T, Barsan W, Broderick J, Haley EC, Spilker J. Thrombus localization with emergency cerebral CT. AJNR Am J Neuroradiol 1992; 13 (01) 257-263
• 15 Bash S, Villablanca JP, Jahan R. , et al. Intracranial vascular stenosis and occlusive disease: evaluation with CT angiography, MR angiography, and digital subtraction angiography. AJNR Am J Neuroradiol 2005; 26 (05) 1012-1021
• 16 Josephson SA, Dillon WP, Smith WS. Incidence of contrast nephropathy from cerebral CT angiography and CT perfusion imaging. Neurology 2005; 64 (10) 1805-1806
• 17 Krol AL, Dzialowski I, Roy J. , et al. Incidence of radiocontrast nephropathy in patients undergoing acute stroke computed tomography angiography. Stroke 2007; 38 (08) 2364-2366
• 18 Ang TE, Bivard A, Levi C. , et al. Multi-modal CT in acute stroke: wait for a serum creatinine before giving intravenous contrast? No!. Int J Stroke 2015; 10 (07) 1014-1017
• 19 Qureshi AI, Isa A, Cinnamon J. , et al. Magnetic resonance angiography in patients with brain infarction. J Neuroimaging 1998; 8 (02) 65-70
• 20 Muir KW, Buchan A, von Kummer R, Rother J, Baron JC. Imaging of acute stroke. Lancet Neurol 2006; 5 (09) 755-768
• 21 Tansy AP, Liebeskind DS. Imaging acute ischemic stroke: mapping present and future clinical practice. Curr Atheroscler Rep 2015; 17 (09) 50
• 22 Albers GW. Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3 (DEFUSE 3). Available at: https://clinicaltrials.gov/ct2/show/NCT02586415?term=DEFUSE+3&rank=1 . Accessed March 3, 2017
• 23 Albers GW, Thijs VN, Wechsler L. , et al; DEFUSE Investigators. Magnetic resonance imaging profiles predict clinical response to early reperfusion: the diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study. Ann Neurol 2006; 60 (05) 508-517
• 24 Lansberg MG, Straka M, Kemp S. , et al; DEFUSE 2 study investigators. MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): a prospective cohort study. Lancet Neurol 2012; 11 (10) 860-867
• 25 Amiri H, Bluhmki E, Bendszus M. , et al. European Cooperative Acute Stroke Study-4: Extending the time for thrombolysis in emergency neurological deficits ECASS-4: ExTEND. Int J Stroke 2016; 11 (02) 260-267
• 26 Ma H, Parsons MW, Christensen S. , et al; EXTEND investigators. A multicentre, randomized, double-blinded, placebo-controlled Phase III study to investigate EXtending the time for Thrombolysis in Emergency Neurological Deficits (EXTEND). Int J Stroke 2012; 7 (01) 74-80
• 27 Copen WA, Rezai Gharai L, Barak ER. , et al. Existence of the diffusion-perfusion mismatch within 24 hours after onset of acute stroke: dependence on proximal arterial occlusion. Radiology 2009; 250 (03) 878-886
• 28 Turk A. POSITIVE: PerfusiOn Imaging Selection of Ischemic STroke PatIents for EndoVascular ThErapy. Available at: https://clinicaltrials.gov/ct2/show/study/NCT01852201 . Accessed March 3, 2017
• 29 Jovin TG, Nogueira RG. Trevo and Medical Management Versus Medical Management Alone in Wake Up and Late Presenting Strokes (DAWN). Available at: https://clinicaltrials.gov/ct2/show/NCT02142283 . Accessed March 5, 2017
• 30 Deibler AR, Pollock JM, Kraft RA, Tan H, Burdette JH, Maldjian JA. Arterial spin-labeling in routine clinical practice, part 1: technique and artifacts. AJNR Am J Neuroradiol 2008; 29 (07) 1228-1234
• 31 Paolini S, Burdine J, Verenes M. , et al. Rapid short MRI sequence useful in eliminating stroke mimics among acute stroke patients considered for intravenous thrombolysis. J Neurol Disord 2013; 1: 137