Ces radiol. 2019, 73(3):150-159 | DOI: 10.55095/CesRadiol2019/022

Diagnostic approach to ischaemic stroke - a review of imaging methods and their application in clinical practiceReview article

Petra Cimflová^1,2, Kateřina Vališ^1,2, Ondřej Volný^2,3,4, Jan Vinklárek^2,3, Michal Haršány^2,3, Robert Mikulík^2,3

¹ Klinika zobrazovacích metod, FN u svaté Anny Brno a LF Masarykovy univerzity Brno

² Mezinárodní centrum klinického výzkumu, FN u svaté Anny Brno

³ I. neurologická klinika, FN u svaté Anny Brno a LF Masarykovy univerzity Brno

⁴ Departments of Clinical Neurosciences, Calgary Stroke Program, Cumming School of Medicine, University of Calgary, Calgary, Canada

Imaging methods play a crucial role in stroke diagnostics. Computed tomography (CT) remains the most used imaging method in stroke management. MRI is important in diagnoses of stroke in vertebrobasilar circulation, in patients with unknown stroke symptom onset and in diagnostics of stroke mimics. Non-contrast CT is compulsory in all patients with suspected acute stroke to exclude other pathologies (e.g. hemorrhage, tumor) and to assess the age and the extent of ischemic changes. CT angiography is required in all patients indicated for mechanical thrombectomy to detect and localize the arterial occlusion. The main goal of perfusion analysis is to identify the ischemic core and distinguish it from ischemic penumbra. To have a reliable interpretation of ischemic changes on CT, it is important to set up correct postprocessing. Nowadays, multiple software packages are available which enable automatic analysis of ASPECTS, collateral status and perfusion. The main benefits of automatic postprocessing are a decrease in variability of the assessment and faster triage of patients indicated for mechanical thrombectomy.

Keywords: ischemic stroke, computed tomography, CT angiography, CT perfusion, magnetic resonance, automatic software analysis

Accepted: September 15, 2019; Published: September 1, 2019  Show citation