Research Topic

Imaging in acute stroke – new options and state of the art

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Acute stroke remains one of the most common medical urgencies affecting 1 in 6 during their lifetime or app 30/100.000 inhabitants in Europe every year. New acute treatment options, including i.v. thrombolytic therapy and endovascular therapy, have improved outcome after acute cerebrovascular incidents. ...

Acute stroke remains one of the most common medical urgencies affecting 1 in 6 during their lifetime or app 30/100.000 inhabitants in Europe every year. New acute treatment options, including i.v. thrombolytic therapy and endovascular therapy, have improved outcome after acute cerebrovascular incidents. Further, attention has increased on transient ischaemic attack (TIA) based on emerging evidence documenting a massive treatment effect of early secondary prevention.
10 - 15 years ago doing a subacute plain CT in all patients presenting with acute symptoms of stroke represented a high standard of care, now early MRI, ultrasound and advanced CT have been implemented into clinical practice.

Multi-slice techniques have developed CT massively as well as the new multimodal techniques including angiography and perfusion studies. However, the quality of these options vary extremely obscuring the discussion as e.g. a 16 slice CT-perfusion study with limited brain coverage can basically not be compared to a 320 slice whole brain perfusion CT. CT is quick and offers the best opportunity of monitoring the patient, however the early sensitivity for parenchymal changes is generally regarded inferior to that of MRI; however direct comparative studies are very scarce.
MRI is superior in detecting ischaemia, however, movement artefacts often limit the diagnostic value in acute clinical practice. New advanced MRI sequences such as diffuser tensor imaging are feasible using3T scanners but remain widely undescribed in this area. Subacute MRI is used with increasing frequency in patients with symptoms of TIA and a substantial variation in the frequency of DWI-defects have been reported between centres. 7 T MRI in acute stroke is a new and promising area.
Ultrasound has a large potential also in repeated examinations, however, it is highly observer-dependent and >10% of patients do not have the required acoustic temporal bone-window.

This Research Topic will cover existing evidence from the 3 modalities CT, MRI and ultrasound in acute stroke imaging, both emerging evidence and state of the art, with focus on today’s – not yesterday’s technique.


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