Diagnosis of acute ischemic stroke: what general radiologist should know

Congress:

ECR 2020

Poster Number:

C-04552

Type:

Educational Exhibit

Keywords:

Not applicable, Ischaemia / Infarction, Technical aspects, MR-Diffusion/Perfusion, CT-Angiography, CT, Neuroradiology brain, Interventional vascular, Neuro

Authors:

F. Giordano¹, A. manto², B. Carotenuto³, A. Serino⁴, M. Marseglia⁵, M. Ventra⁶; ¹Mercato San Severino/IT, ²Nocera inferiore (sa)/IT, ³Boscoreale/IT, ⁴Nocera Inferiore, SA/IT, ⁵Napoli/IT, ⁶Nocera Inferiore/IT

DOI:

10.26044/ecr2020/C-04552

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-04552

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Learning objectives

To understand the pathophysiological mechanisms underlying the acute ischemic event. To illustrate the CT protocol and main imaging findings in the diagnosis of acute ischemic stroke. To interpret the results of the imaging modalities as to determine the best therapeutic planning and the prognosis of the patient with acute ischemic stroke.

Background

Acute ischemic stroke is the third leading cause of mortality and the first cause of disability in the world. Ischemic stroke is a syndrome caused by the sudden reduction of arterial supply to the cerebral tissue. Generally, it is caused by the occlusion of an intracranial artery.In the ischemic territory it is possible to recognize severely hypoperfused brain tissue which has been damaged irreversibly (ischemic core) and the hypoperfused but still vital brain tissue (ischemic penumbra).This occurs thanks to a series of hemodynamic and metabolic...

Findings and procedure details

CT Protocol A diagnostic protocol of a patient with suspected acute ischemic stroke of the anterior circle, occurring within 6 hours must include a unenhanced CT scan and a multiphase CT-angiography. In case of unknown onset or onset > 6 hours the diagnostic protocol requiresthe use of advanced techniques such as perfusion-CT. The time for the execution of the entire protocol, processing and interpretation of the results must be approximately 15 minutes. Unenhanced CT Unenhanced CT allows to: recognizestroke mimics like hemorrhagic lesion, neoplasms, AVM,...

Conclusion

Given the unavailability in the different hospitals of dedicated neuroradiology units, it is necessary that general radiologists know the correct diagnostic procedure and the findings of radiological imaging so as to direct the patient to the most appropriate therapy Fig9. A correct diagnostic procedure combined with a detailed evaluation of the imaging significantly changes the outcome of the patient with acute ischemic stroke allowing to select those elegible to IVTand / or MT.

Personal information and conflict of interest

A. Manto; Nocera inferiore (sa)/IT - nothing to disclose F. Giordano; Mercato San Severino/IT - nothing to disclose B. Carotenuto; Boscoreale/IT - nothing to disclose A. Serino; Nocera Inferiore, SA/IT - nothing to disclose M. Marseglia; Naples/IT - nothing to disclose M. Ventra; Nocera Inferiore/IT - nothing to disclose

References

1) CT Protocol for Acute Stroke: Tips and Tricks for General Radiologists Enrique Marco de Lucas, Radiographics 2008 Oct 1 2008 https://doi.org/10.1148/rg.286085502 2) European Stroke Organisation (ESO) – European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischaemic Stroke,Endorsed by Stroke Alliance for Europe (SAFE) Guillaume Turc et al.European Stroke Journal 2019, Vol. 4(1) 6–12 3)2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke.A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association 4) Nogueira...