Introduction
Acute ischemic stroke is common and often treatable. Imaging by computed tomography (CT) and MRI is valuable for stroke treatment, in addition, for diagnosis, and for identification of the pathogenesis. But how they are used also depends on practical considerations. The approach to imaging the patient with acute stroke used at the Massachusetts General Hospital (MGH) is described. It is a distillation of our experience and a critical review of the literature and was developed through collaborations among the Acute Stroke Service, the Neuroradiology Division, and the Neurointerventional Program at the MGH. The focus is on rapid diagnosis, the guidance of treatment using intravenously administered tissue-type plasminogen activator (tPA), and intra-arterial treatments (IATs).
Patients With Ischemic Stroke
Stroke is highly heterogeneous, but it is useful to categorize patients into hemorrhagic and ischemic stroke and the latter into those with mild, moderate, and severe symptoms (Table 1). The data in Table 1 are from the Screening Technology and Outcomes Project in Stroke (STOPStroke) study, a prospective, multiyear, observational study of patients with consecutive ischemic stroke at MGH and University of California, San Francisco.1 Most patients diagnosed with ischemic stroke have mild symptoms (National Institutes of Health Stroke Scale [NIHSS], <5) and have a high likelihood of a good outcome, and treatment is not usually given. Approximately 10% of patients have moderate symptoms (NIHSS, 6–10). About half of these patients had good outcomes without treatment, which increases to ≈75% with intravenously administered tPA treatment. About a third of patients with ischemic stroke present with a severe stroke syndrome, and the odds of a poor outcome are high, >85%, if a major artery is occluded, and therapy is not instituted rapidly.
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Clinical Status, Treatment, and Imaging
Most patients with a severe stroke syndrome (NIHSS, >10) have a major anterior circulation occlusion, most commonly of a middle …
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- Article
- Introduction
- Patients With Ischemic Stroke
- MGH Stroke Imaging Algorithm
- Imaging of Patients With Stroke Not Eligible for Thrombolytic Therapy
- Imaging of Patients With Stroke Eligible for Intravenously Administered tPA
- Imaging of Patients With Stroke Considered for Intra-arterial Therapy
- Estimating the Penumbra
- Time, Imaging, and Opportunities for Expanding Stroke Therapy
- Conclusions
- Disclosures
- References
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- Supplemental Materials
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- Current State of Acute Stroke Imaging
