• Josep Munuera, Gerard Blasco, María Hernández-Pérez, Pepus Daunis-I-Estadella, Antoni Dávalos, David S Liebeskind, Max Wintermark, Andrew Demchuk, Bijoy K Menon, Götz Thomalla, Kambiz Nael, Salvador Pedraza, and Josep Puig.
• Diagnostic Imaging Institute (IDI), Germans Trias i Pujol University Hospital, Badalona, Spain.
• J. Neurol. Neurosurg. Psychiatr. 2017 Jan 1; 88 (1): 62-69.

AbstractVascular neuroimaging plays a decisive role in selecting the best therapy in patients with acute ischaemic stroke. However, compared with the arterial system, the role of veins has not been thoroughly studied. In this review, we present the major venous imaging-based biomarkers in ischaemic stroke. First, the presence of hypodense veins in the monophasic CT angiography ipsilateral to the arterial occlusion. Second, the asymmetry of venous drainage in the pathological cerebral hemisphere on CT and MRI dynamic angiography. Finally, the presence of hypodense veins on T2* -based MRI. From the physiological point of view, the venous imaging-based biomarkers would detect the alteration of brain perfusion (flow), as well as the optimisation of extraction oxygen mechanisms (misery perfusion). Several studies have correlated the venous imaging-based biomarkers with grade of collateral circulation, the ischaemic penumbra and clinical functional outcome. Although venous imaging-based biomarkers still have to be validated, growing evidence highlights a potential complementary role in the acute stroke clinical decision-making process.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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