Neurosurgery’s Editor’s Choice: Imaging Approaches to Stroke and Neurovascular Disease

Imaging maintains a critical and growing role in the care of stroke patients, broadly spanning diagnosis, prognostication, therapy selection, and treatment monitoring. Current radiological approaches to the evaluation of neur-ovascular disease comprise primarily 2 modalit-ies—computed tomography (CT) and magnetic resonance imaging (MRI)—each a seminal technological advancement in biomedicine with ever-expanding potential as noninvasive or minimally invasive probes of brain perfusion, metabolism, and tissue viability.

While stroke remains a widely used, but imprecise term, describing an acute clinical scenario, this review will focus principally on the imaging of acute ischemic brain infarction. A standardized approach to imaging selection and interpretation will be emphasized, underscoring (1) modality selection; (2) technical elements of CT and MRI approaches to neurovascular imaging; (3) the staging of brain ischemia; and (4) advanced brain imaging for prognostication and treatment selection in acute stroke patients. Where possible, relevant patient-specific factors and hardware demands will be discussed, with the objective of facilitating communication and optimizing imaging utilization in such patients.

From Imaging Approaches to Stroke and Neurovascular Disease by Seena Dehkharghani, MD and Jalal Andre, MD

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