Magnetic resonance imaging in the assessment of acute stroke

Introduction: Stroke is the second leading underlying cause of death globally and the leading cause of disability in adults. Stroke diagnosis should be performed quickly and efficiently to eliminate other potential causes of neurological deficits and to assess the time since the onset of clinical symptoms. Computed tomography (CT) and magnetic resonance imaging (MRI) are essential methods of detecting and evaluating stroke type and treatmentoptions. Diffusion and perfusion MR imaging is recommended for early stroke diagnosis, as well as for the selection of patients for recanalization therapy, and is considered effective in assessing treatment outcomes. The objectives of this study were to demonstrate the diagnostic value of diffusion and perfusion imaging in the diagnosis of acute ischemic stroke, analyze the role of magnetic resonance imaging in the selection of patients with acute stroke for recanalization therapy, and assess the effect of acute stroke complicity.Material and methods: The research is designed as a systematic review of the primary scientific research literature, which was published in English in relevant scientific databases (PubMed, Google Scholar, Medline) from 2014 to 2021.Results: 14 scientific research papers were singled out and the general characteristics of the study were analyzed (country, authors, year of publication, title of the study, type of study, study objectives, research methods, results and conclusion). A quality assessment of the included studies with cohort design and randomized controlled studies was performed, and most belong to the category of high-quality studies with a smaller number of medium-quality studies. The overall percentage of detected AIS cases in isolated studies using the DWI and/or PWI sequence was 90.8%. At the same time, the outcome of recanalization therapy was assessed using MRI studies (the number of patients who developed adverse events with functional data outcome 30 or 90 days after the procedure was observed). Comparison of MRI and CT imaging protocols provided data on the total percentage of detected acute stroke cases using CT imaging protocols (68.9%) and MRI imaging protocols (88.5%), which is why MRI is considered a superior method.Conclusion: Although CT is a suitable method for visualizing bleeding and also for early differentiation of hemorrhagic from ischemic stroke, if MRI imaging is available, it is recommended to use DWI, PWI, MRA sequences for a more accurate diagnosis of stroke in the acute phase.

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DIFFUSE-WEIGHTED MAGNETIC RESONANCE IMAGING (DW-MRI) FOR CRYPTOGENIC STROKE DIAGNOSIS IN YOUNG ADULT FEMALE: A CASE REPORT

Berkala Ilmiah Kedokteran Duta Wacana ◽

10.21460/bikdw.v5i1.165 ◽

2020 ◽

Vol 5 (1) ◽

pp. 10

Author(s):

Lothar Matheus Manson Vanende Silalahi

Keyword(s):

Magnetic Resonance Imaging ◽

Risk Factors ◽

Ischemic Stroke ◽

Magnetic Resonance ◽

Ischaemic Stroke ◽

Acute Stroke ◽

Cryptogenic Stroke ◽

Resonance Imaging ◽

Stroke Diagnosis ◽

Weighted Magnetic Resonance Imaging

Background: Ischaemic stroke is caused by various aetiology. Cryptogenic stroke diagnosis is established when no aetiologies are discovered although clinical manifestations are consistent with acute stroke. Diffusion-weighted magnetic resonance imaging (DW-MRI) is one neuroimaging modalities which could be useful in exploring aetiology instead of excluding intracranial haemorrhage. There are many conflicting pieces of evidence of the benefit using DW-MRI to confirm the presence or the absence of brain lesions. Objective: To report a clinical case of ischemic stroke with negative evaluation on advanced neuroimaging studies (DW-MRI). Case Description: A female, 35 years old, presented to the emergency unit with a 6 hours history of prickling sensation before admission. There were no risk factors of stroke, and no other neurological symptoms. The neurologic examination reveals left hemihypesthesia, with normal results on laboratory examination for stroke risk factors and negative ischemic lesion on brain DW-MRI. Explorative examination on cardiac aetiologies was negative. Patient was given a standard regimen for acute stroke management despite the negative results and established as a cryptogenic stroke case. Conclusion: Diagnosis of ischemic stroke should rely mainly on clinical findings, with consideration of cryptogenic stroke when there is no aetiology found after thorough examination. Nevertheless, comprehensive examination on cardiac function and coagulation tests should be performed whenever possible to determine the cause of ischaemic stroke.

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Acute Stroke Diagnosis with Magnetic Resonance Imaging

Methods in Neurosciences - Paradigms of Neural Injury ◽

10.1016/s1043-9471(96)80105-4 ◽

1996 ◽

pp. 209-242

Author(s):

Stephen C. Jones ◽

Neng C. Huang ◽

Michael J. Quast ◽

Alejandro D. Perez-Trepechio ◽

Gilbert R. Hillman ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Acute Stroke ◽

Resonance Imaging ◽

Stroke Diagnosis

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Toward an Intravoxel Incoherent Motion 2-in-1 Magnetic Resonance Imaging Sequence for Ischemic Stroke Diagnosis? An Initial Clinical Experience With 1.5T Magnetic Resonance

Journal of Computer Assisted Tomography ◽

10.1097/rct.0000000000001243 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Aude Pavilla ◽

Giulio Gambarota ◽

Alessandro Arrigo ◽

Hervé Saint-Jalmes ◽

Mehdi Mejdoubi

Keyword(s):

Magnetic Resonance Imaging ◽

Ischemic Stroke ◽

Magnetic Resonance ◽

Clinical Experience ◽

Intravoxel Incoherent Motion ◽

Resonance Imaging ◽

Magnetic Resonance Imaging Sequence ◽

Imaging Sequence ◽

Stroke Diagnosis ◽

Initial Clinical Experience

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Acute Ischemic Stroke Lesion Measurement on Diffusion-weighted Imaging–Important Considerations in Designing Acute Stroke Trials With Magnetic Resonance Imaging

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2006.11.003 ◽

2007 ◽

Vol 16 (2) ◽

pp. 64-70 ◽

Cited By ~ 27

Author(s):

Carly S. Rivers ◽

Joanna M. Wardlaw ◽

Paul A. Armitage ◽

Mark E. Bastin ◽

Peter J. Hand ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Ischemic Stroke ◽

Magnetic Resonance ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Diffusion Weighted Imaging ◽

Resonance Imaging ◽

Diffusion Weighted ◽

Stroke Lesion

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Cost Analysis of the Addition of Hyperacute Magnetic Resonance Imaging for Selection of Patients for Endovascular Stroke Therapy

Interventional Neurology ◽

10.1159/000472158 ◽

2017 ◽

Vol 6 (3-4) ◽

pp. 183-190 ◽

Cited By ~ 1

Author(s):

Seby John ◽

Nicolas R. Thompson ◽

Terry Lesko ◽

Nancy Papesh ◽

Nancy Obuchowski ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Magnetic Resonance ◽

Direct Costs ◽

Stroke Therapy ◽

Resonance Imaging ◽

Mri Protocol ◽

Selection Of Patients ◽

Selection Of ◽

Endovascular Stroke Therapy

Background and Purpose: Patient selection is important to determine the best candidates for endovascular stroke therapy. In application of a hyperacute magnetic resonance imaging (MRI) protocol for patient selection, we have shown decreased utilization with improved outcomes. A cost analysis comparing the pre- and post-MRI protocol time periods was performed to determine if the previous findings translated into cost opportunities. Materials and Methods: We retrospectively identified individuals considered for endovascular stroke therapy from January 2008 to August 2012 who were ≤8 h from stroke symptoms onset. Patients prior to April 30, 2010 were selected based on results of the computed tomography/computed tomography angiography alone (pre-hyperacute), whereas patients after April 30, 2010 were selected based on results of MRI (post-hyperacute MRI). Demographic, outcome, and financial information was collected. Log-transformed average daily direct costs were regressed on time period. The regression model included demographic and clinical covariates as potential confounders. Multiple imputation was used to account for missing data. Results: We identified 267 patients in our database (88 patients in pre-hyperacute MRI period, 179 in hyperacute MRI protocol period). Patient length of stay was not significantly different in the hyperacute MRI protocol period as compared to the pre-hyperacute MRI period (10.6 vs. 9.9 days, p < 0.42). The median of average daily direct costs was reduced by 24.5% (95% confidence interval 14.1-33.7%, p < 0.001). Conclusions: Use of the hyperacute MRI protocol translated into reduced costs, in addition to reduced utilization and better outcomes. MRI selection of patients is an effective strategy, both for patients and hospital systems.

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Features of magnetic resonance imaging in patients with recurrent stroke

East European Journal of Neurology ◽

10.33444/2411-5797.2015.1(1).4-7 ◽

2015 ◽

pp. 4-7

Author(s):

V. Lipko

Keyword(s):

Magnetic Resonance Imaging ◽

Ischemic Stroke ◽

Magnetic Resonance ◽

Acute Stroke ◽

Recurrent Stroke ◽

Cerebral Atrophy ◽

Resonance Imaging ◽

Recurrent Strokes ◽

Mixed Origin ◽

Lesion Localization

We have conducted an analyzed the data of MRI lesion localization of 100 patients: 30 were patients with recurrent strokes, 35 patients with first ischemic stroke; 35 patients with discirculatory encephalopathy of mixed origin. The data were obtained from 1¬1,5T MRI tomography. We evaluated the location of cerebral atrophy changes, lacunar infarctions, the nidi of acute stroke and the localization of postischemic lesions among the tested patients. We have discovered that with the progression of the disease overall cerebral changes progress significantly. The localization of lacunar infarcts significantly (p <0.05) follows the location of lesions of gliosis and leukoaraiosis. The frequency distribution of acute ischemic lesions corresponds to the location postishemic changes.

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