Advancements in Radiology Imaging for Stroke Management

Abstract

Neuroimaging has become an integral component in the diagnosis and management of acute ischemic stroke (AIS), with recent advancements leading to a paradigm shift towards tissue- and imaging-based approaches for treatment decisions. This review explores the commonly utilized imaging modalities, including computed tomography (CT), magnetic resonance imaging (MRI), and advanced perfusion imaging techniques. Noncontrast head CT remains the preferred initial imaging modality for suspected stroke, providing high sensitivity for detecting intracranial hemorrhage and early ischemic changes. CT angiography enables rapid evaluation of extra- and intracranial occlusive diseases, while CT perfusion assesses cerebral tissue perfusion, estimating the ischemic core and penumbra. MRI, particularly diffusion-weighted imaging, exhibits high sensitivity, specificity, and accuracy in detecting early ischemia. MR angiography and perfusion provide insights into vascular pathology and tissue viability. Ultrasonography offers real-time assessment of cerebral blood flow, while positron emission tomography and single-photon emission computed tomography visualize pathophysiological changes and abnormalities in glucose and oxygen metabolism. Digital subtraction angiography remains the gold standard for luminal imaging. The integration of artificial intelligence and machine learning in stroke imaging interpretation is expanding, serving as decision support tools. Illustrative clinical scenarios demonstrate the application of neuroimaging in evaluating intracerebral hemorrhage, determining eligibility for reperfusion therapies, assessing large vessel occlusions, and characterizing intra- and extracranial stenoses. As treatment options advance, neurologists play a vital role in accurately interpreting neuroimaging studies to guide patient care in the rapidly evolving field of acute stroke management.