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==Overview==
==Overview==
When a stroke has been diagnosed, various other studies may be performed to determine the underlying etiology. With the current treatment and diagnosis options available, it is of particular importance to determine whether there is a peripheral source of [[embolus|emboli]]. Test selection may vary, since the cause of stroke varies with age, [[comorbidity]] and the clinical presentation. An [[angiogram]] of the cerebral vasculature (if a bleed is thought to have originated from an [[aneurysm]] or [[arteriovenous malformation]])
When a stroke has been diagnosed, various other studies may be performed to determine the underlying etiology. With the current treatment and diagnosis options available, it is of particular importance to determine whether there is a peripheral source of [[embolus|emboli]]. Test selection may vary, since the cause of ischemic stroke varies with age, [[comorbidity]] and the clinical presentation. Other imaging findings which may help identify the underlying cause may include CT angiography, MR angiography, digital subtraction angiography, positron emission tomography and SPECT scan.
 
==Other Imaging Studies==
Other imaging studies which may help diagnose the cause and risk factors of ischemic stroke may include:<ref name="pmid23907247">{{cite journal| author=Wintermark M, Sanelli PC, Albers GW, Bello J, Derdeyn C, Hetts SW et al.| title=Imaging recommendations for acute stroke and transient ischemic attack patients: A joint statement by the American Society of Neuroradiology, the American College of Radiology, and the Society of NeuroInterventional Surgery. | journal=AJNR Am J Neuroradiol | year= 2013 | volume= 34 | issue= 11 | pages= E117-27 | pmid=23907247 | doi=10.3174/ajnr.A3690 | pmc=4072500 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23907247  }} </ref>
 
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+
! style="background: #4479BA; width: 250px;" | {{fontcolor|#FFF|Other imaging studies}}
! style="background: #4479BA; width: 450px;" | {{fontcolor|#FFF|Rationale}}
 
|-
| style="padding: 5px 5px; background: #F5F5F5;" |'''CT angiography''' <ref name="pmid19797189">{{cite journal| author=Latchaw RE, Alberts MJ, Lev MH, Connors JJ, Harbaugh RE, Higashida RT et al.| title=Recommendations for imaging of acute ischemic stroke: a scientific statement from the American Heart Association. | journal=Stroke | year= 2009 | volume= 40 | issue= 11 | pages= 3646-78 | pmid=19797189 | doi=10.1161/STROKEAHA.108.192616 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19797189  }} </ref><ref name="pmid9194426">{{cite journal| author=Shrier DA, Tanaka H, Numaguchi Y, Konno S, Patel U, Shibata D| title=CT angiography in the evaluation of acute stroke. | journal=AJNR Am J Neuroradiol | year= 1997 | volume= 18 | issue= 6 | pages= 1011-20 | pmid=9194426 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9194426  }} </ref><ref name="pmid11779922">{{cite journal| author=Verro P, Tanenbaum LN, Borden NM, Sen S, Eshkar N| title=CT angiography in acute ischemic stroke: preliminary results. | journal=Stroke | year= 2002 | volume= 33 | issue= 1 | pages= 276-8 | pmid=11779922 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11779922  }} </ref><ref name="pmid24287390">{{cite journal| author=Nour M, Liebeskind DS| title=Imaging of cerebral ischemia: from acute stroke to chronic disorders. | journal=Neurol Clin | year= 2014 | volume= 32 | issue= 1 | pages= 193-209 | pmid=24287390 | doi=10.1016/j.ncl.2013.07.005 | pmc=3864615 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24287390  }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* To determine the qualitative cerebral blood flow volume  to the area surrounding the infarct tissue and can  determine the risk of future infarct
* May help identify underlying vascular pathology such as calcifications and degree of stenosis of the vessel
* To diagnose the basilar artery thrombosis and acute large intracranial thrombus
|-
| style="padding: 5px 5px; background: #F5F5F5;" |'''MR angiography'''<ref name="pmid23907247">{{cite journal| author=Wintermark M, Sanelli PC, Albers GW, Bello J, Derdeyn C, Hetts SW et al.| title=Imaging recommendations for acute stroke and transient ischemic attack patients: A joint statement by the American Society of Neuroradiology, the American College of Radiology, and the Society of NeuroInterventional Surgery. | journal=AJNR Am J Neuroradiol | year= 2013 | volume= 34 | issue= 11 | pages= E117-27 | pmid=23907247 | doi=10.3174/ajnr.A3690 | pmc=4072500 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23907247  }} </ref><ref name="pmid16934921">{{cite journal| author=Verro P, Tanenbaum LN, Borden N, Eshkar N, Sen S| title=Clinical application of CT angiography in acute ischemic stroke. | journal=Clin Neurol Neurosurg | year= 2007 | volume= 109 | issue= 2 | pages= 138-45 | pmid=16934921 | doi=10.1016/j.clineuro.2006.07.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16934921  }} </ref><ref name="pmid24287390">{{cite journal| author=Nour M, Liebeskind DS| title=Imaging of cerebral ischemia: from acute stroke to chronic disorders. | journal=Neurol Clin | year= 2014 | volume= 32 | issue= 1 | pages= 193-209 | pmid=24287390 | doi=10.1016/j.ncl.2013.07.005 | pmc=3864615 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24287390  }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* May be useful in patients with underlying vascular pathology or arterial dissection.
*Advantageous over CTA in determining direction and flow of blood.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |'''Digital subtraction angiography'''<ref name="pmid23907247">{{cite journal| author=Wintermark M, Sanelli PC, Albers GW, Bello J, Derdeyn C, Hetts SW et al.| title=Imaging recommendations for acute stroke and transient ischemic attack patients: A joint statement by the American Society of Neuroradiology, the American College of Radiology, and the Society of NeuroInterventional Surgery. | journal=AJNR Am J Neuroradiol | year= 2013 | volume= 34 | issue= 11 | pages= E117-27 | pmid=23907247 | doi=10.3174/ajnr.A3690 | pmc=4072500 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23907247  }} </ref><ref name="pmid25807127">{{cite journal| author=Lange MC, Bruch TP, Pedrozo JC, Maranha L, Sakae TM, Pacheco R et al.| title=The use of neurovascular ultrasound versus digital subtraction angiography in acute ischemic stroke. | journal=Arq Neuropsiquiatr | year= 2015 | volume= 73 | issue= 3 | pages= 218-22 | pmid=25807127 | doi=10.1590/0004-282X20140231 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25807127  }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Diagnose collateral blood flow in cases of ischemic stroke
*May be used to diagnose basilar artery thrombosis
|-
| style="padding: 5px 5px; background: #F5F5F5;" |'''Positron emission tomography'''<ref name="pmid18854664">{{cite journal| author=Heiss WD, Sobesky J| title=Comparison of PET and DW/PW-MRI in acute ischemic stroke. | journal=Keio J Med | year= 2008 | volume= 57 | issue= 3 | pages= 125-31 | pmid=18854664 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18854664  }} </ref><ref name="pmid21640299">{{cite journal| author=Copen WA, Schaefer PW, Wu O| title=MR perfusion imaging in acute ischemic stroke. | journal=Neuroimaging Clin N Am | year= 2011 | volume= 21 | issue= 2 | pages= 259-83, x | pmid=21640299 | doi=10.1016/j.nic.2011.02.007 | pmc=3135980 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21640299  }} </ref><ref name="pmid242873902">{{cite journal| author=Nour M, Liebeskind DS| title=Imaging of cerebral ischemia: from acute stroke to chronic disorders. | journal=Neurol Clin | year= 2014 | volume= 32 | issue= 1 | pages= 193-209 | pmid=24287390 | doi=10.1016/j.ncl.2013.07.005 | pmc=3864615 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24287390  }}</ref>
 
| style="padding: 5px 5px; background: #F5F5F5;" |
* May help determine the extent of irreversible tissue damage and pneumbra
|-
| style="padding: 5px 5px; background: #F5F5F5;" |'''SPECT scan'''<ref name="pmid9886360">{{cite journal| author=Ueda T, Sakaki S, Yuh WT, Nochide I, Ohta S| title=Outcome in acute stroke with successful intra-arterial thrombolysis and predictive value of initial single-photon emission-computed tomography. | journal=J Cereb Blood Flow Metab | year= 1999 | volume= 19 | issue= 1 | pages= 99-108 | pmid=9886360 | doi=10.1097/00004647-199901000-00011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9886360  }}</ref><ref name="pmid14748205">{{cite journal| author=Mahagne MH, David O, Darcourt J, Migneco O, Dunac A, Chatel M et al.| title=Voxel-based mapping of cortical ischemic damage using Tc 99m L,L-ethyl cysteinate dimer SPECT in acute stroke. | journal=J Neuroimaging | year= 2004 | volume= 14 | issue= 1 | pages= 23-32 | pmid=14748205 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14748205  }}</ref><ref name="pmid8248766">{{cite journal| author=Friedman PJ, Davis G, Allen B| title=Semi-quantitative SPECT scanning in acute ischaemic stroke. | journal=Scand J Rehabil Med | year= 1993 | volume= 25 | issue= 3 | pages= 99-105 | pmid=8248766 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8248766  }}</ref><ref name="pmid24287390">{{cite journal| author=Nour M, Liebeskind DS| title=Imaging of cerebral ischemia: from acute stroke to chronic disorders. | journal=Neurol Clin | year= 2014 | volume= 32 | issue= 1 | pages= 193-209 | pmid=24287390 | doi=10.1016/j.ncl.2013.07.005 | pmc=3864615 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24287390  }}</ref>
|style="padding: 5px 5px; background: #F5F5F5;" |
* May help determine the risk of reperfusion injury and hemorrhage after ischemic stroke
* Identify penumbral tissue and irreversible damage
* May have predictive value in determining functional recovery of neurons after ischemic stroke
|-
| style="padding: 5px 5px; background: #F5F5F5;" |'''Arterial spin labelling MR perfusion'''<ref name=cde>https://radiopaedia.org/articles/arterial-spin-labelling-asl-mr-perfusion Accessed on November 17, 2016</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* May help diagnose the presence of collateral blood flow
* Does not use contrast material as MR perfusion
* The most common parameter observed is cerebral blood flow
|-
|}
'''For AHA/ASA 2018 guidelines for other imaging studies in patients with ischemic stroke, please''' [[AHA/ASA guideline recommendations for of Early management of acute ischemic stroke#Parenchymal Brain Imaging|click here]]


==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Latest revision as of 16:06, 12 January 2023

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

Overview

When a stroke has been diagnosed, various other studies may be performed to determine the underlying etiology. With the current treatment and diagnosis options available, it is of particular importance to determine whether there is a peripheral source of emboli. Test selection may vary, since the cause of ischemic stroke varies with age, comorbidity and the clinical presentation. Other imaging findings which may help identify the underlying cause may include CT angiography, MR angiography, digital subtraction angiography, positron emission tomography and SPECT scan.

Other Imaging Studies

Other imaging studies which may help diagnose the cause and risk factors of ischemic stroke may include:[1]

Other imaging studies Rationale
CT angiography [2][3][4][5]
  • To determine the qualitative cerebral blood flow volume to the area surrounding the infarct tissue and can determine the risk of future infarct
  • May help identify underlying vascular pathology such as calcifications and degree of stenosis of the vessel
  • To diagnose the basilar artery thrombosis and acute large intracranial thrombus
MR angiography[1][6][5]
  • May be useful in patients with underlying vascular pathology or arterial dissection.
  • Advantageous over CTA in determining direction and flow of blood.
Digital subtraction angiography[1][7]
  • Diagnose collateral blood flow in cases of ischemic stroke
  • May be used to diagnose basilar artery thrombosis
Positron emission tomography[8][9][10]
  • May help determine the extent of irreversible tissue damage and pneumbra
SPECT scan[11][12][13][5]
  • May help determine the risk of reperfusion injury and hemorrhage after ischemic stroke
  • Identify penumbral tissue and irreversible damage
  • May have predictive value in determining functional recovery of neurons after ischemic stroke
Arterial spin labelling MR perfusion[14]
  • May help diagnose the presence of collateral blood flow
  • Does not use contrast material as MR perfusion
  • The most common parameter observed is cerebral blood flow

For AHA/ASA 2018 guidelines for other imaging studies in patients with ischemic stroke, please click here

References

  1. ↑ 1.0 1.1 1.2 Wintermark M, Sanelli PC, Albers GW, Bello J, Derdeyn C, Hetts SW; et al. (2013). "Imaging recommendations for acute stroke and transient ischemic attack patients: A joint statement by the American Society of Neuroradiology, the American College of Radiology, and the Society of NeuroInterventional Surgery". AJNR Am J Neuroradiol. 34 (11): E117–27. doi:10.3174/ajnr.A3690. PMC 4072500. PMID 23907247.
  2. ↑ Latchaw RE, Alberts MJ, Lev MH, Connors JJ, Harbaugh RE, Higashida RT; et al. (2009). "Recommendations for imaging of acute ischemic stroke: a scientific statement from the American Heart Association". Stroke. 40 (11): 3646–78. doi:10.1161/STROKEAHA.108.192616. PMID 19797189.
  3. ↑ Shrier DA, Tanaka H, Numaguchi Y, Konno S, Patel U, Shibata D (1997). "CT angiography in the evaluation of acute stroke". AJNR Am J Neuroradiol. 18 (6): 1011–20. PMID 9194426.
  4. ↑ Verro P, Tanenbaum LN, Borden NM, Sen S, Eshkar N (2002). "CT angiography in acute ischemic stroke: preliminary results". Stroke. 33 (1): 276–8. PMID 11779922.
  5. ↑ 5.0 5.1 5.2 Nour M, Liebeskind DS (2014). "Imaging of cerebral ischemia: from acute stroke to chronic disorders". Neurol Clin. 32 (1): 193–209. doi:10.1016/j.ncl.2013.07.005. PMC 3864615. PMID 24287390.
  6. ↑ Verro P, Tanenbaum LN, Borden N, Eshkar N, Sen S (2007). "Clinical application of CT angiography in acute ischemic stroke". Clin Neurol Neurosurg. 109 (2): 138–45. doi:10.1016/j.clineuro.2006.07.002. PMID 16934921.
  7. ↑ Lange MC, Bruch TP, Pedrozo JC, Maranha L, Sakae TM, Pacheco R; et al. (2015). "The use of neurovascular ultrasound versus digital subtraction angiography in acute ischemic stroke". Arq Neuropsiquiatr. 73 (3): 218–22. doi:10.1590/0004-282X20140231. PMID 25807127.
  8. ↑ Heiss WD, Sobesky J (2008). "Comparison of PET and DW/PW-MRI in acute ischemic stroke". Keio J Med. 57 (3): 125–31. PMID 18854664.
  9. ↑ Copen WA, Schaefer PW, Wu O (2011). "MR perfusion imaging in acute ischemic stroke". Neuroimaging Clin N Am. 21 (2): 259–83, x. doi:10.1016/j.nic.2011.02.007. PMC 3135980. PMID 21640299.
  10. ↑ Nour M, Liebeskind DS (2014). "Imaging of cerebral ischemia: from acute stroke to chronic disorders". Neurol Clin. 32 (1): 193–209. doi:10.1016/j.ncl.2013.07.005. PMC 3864615. PMID 24287390.
  11. ↑ Ueda T, Sakaki S, Yuh WT, Nochide I, Ohta S (1999). "Outcome in acute stroke with successful intra-arterial thrombolysis and predictive value of initial single-photon emission-computed tomography". J Cereb Blood Flow Metab. 19 (1): 99–108. doi:10.1097/00004647-199901000-00011. PMID 9886360.
  12. ↑ Mahagne MH, David O, Darcourt J, Migneco O, Dunac A, Chatel M; et al. (2004). "Voxel-based mapping of cortical ischemic damage using Tc 99m L,L-ethyl cysteinate dimer SPECT in acute stroke". J Neuroimaging. 14 (1): 23–32. PMID 14748205.
  13. ↑ Friedman PJ, Davis G, Allen B (1993). "Semi-quantitative SPECT scanning in acute ischaemic stroke". Scand J Rehabil Med. 25 (3): 99–105. PMID 8248766.
  14. ↑ https://radiopaedia.org/articles/arterial-spin-labelling-asl-mr-perfusion Accessed on November 17, 2016


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