Learning objectives
To review the epidemiology and pathophysiology of cerebral ischemic infarction.
To expose the magnetic resonance imaging (MRI) protocol of study of ischemic stroke and review the usefulness of the different acquisition sequences.
To establish the correlation between findings obtained in the MRI study and multimodal computed tomography (CT) images.
Background
Ischemic stroke constitutes a pathology with a great social impact due to its frequency, mortality and potential physical sequelae, with a worldwide incidence of approximately 200 cases per 100,000 inhabitants/year according to the World Health Organization. It consists of an interruption in cerebral circulation that leads to a significant decrease in blood flow, associated with a neurological deficit.
It is usually of thromboembolic etiology, produced up to 35% by occlusion of a large intracranial vessel (distal internal carotid artery, proximal middle cerebral artery or basilar...
Findings and procedure details
Radiological tests used in the assessment of cerebral ischemic infarction are mainly multimodal computed tomography (CT) and magnetic resonance imaging (MRI).
MRI has high sensitivity and specificity in the early detection of cerebral ischemia, although it is currently not considered a first-choice examination in the field of hospital emergencies due to its longer acquisition time and lower availability compared to CT.
MULTIMODAL CT
The objectives of multimodal CT in patients with acute stroke are:
Rule out intracranial hemorrhage
Differentiate dead tissue (core) from potentially salvageable...
Conclusion
An early diagnosis of ischemic stroke is essential in order to avoid both its possible physical sequelae and its associated mortality.
In this aspect MRI shows a great sensitivity and specificity, highlighting the sequences weighted in diffusion in the evaluation of its evolutionary stage.
Currently, multimodal CT is the radiological test used initially, so it is necessary to correlate the signs present in both techniques.
Personal information and conflict of interest
L. Guirado Isla; Granada/ES - nothing to disclose I. Garrido Márquez; Granada/ES - nothing to disclose P. Pérez Naranjo; Granada/ES - nothing to disclose M. Revelles Paniza; Granada/ES - nothing to disclose J. A. Miras Ventura; Granada/ES - nothing to disclose L. Díaz Rubia; Granada/ES - nothing to disclose C. Martínez Martínez; Granada/ES - nothing to disclose M. Fernandez Conesa; Granada/ES - nothing to disclose
References
Dehkharghani S, Andre J. Imaging Approaches to Stroke and Neurovascular Disease. Neurosurgery. 2017;80(5):681-700.
Allen LM, Hasso AN, Handwerker J, Farid H. Sequence-specific MR Imaging Findings That Are Useful in Dating Ischemic Stroke. RadioGraphics 2012;32(5):1285-1297.
Majda Thurnher. Brain Ischemia. Imaging in Acute Stroke [Internet]. Radiology Assistant. 2008 [Consulted in January 2020]. Available in: https://radiologyassistant.nl/neuroradiology/brain-ischemia-imaging-in-acute-stroke
Yousem DM, Grossman RI. Neurorradiología. Marban Libros S.L. Madrid; 2007.
Gilberto González R. Clinical MRI of Acute Ischemic Stroke. Journal Of Magnetic Resonance Imaging. 2012;36:259–271.
Leiva-Salinas C, Wintermark M. Imaging of acute...