Neuroimaging clinics of North America
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Primary or nontraumatic spontaneous intracerebral hemorrhage (ICH) comprises approximately 15% to 20% of all stroke. ICH has a mortality of approximately 40% within the first month, and 75% mortality and morbidity rate within the first year. ⋯ Neuroimaging is critical in detection of ICH, determining the underlying cause, identification of patients at risk of hematoma expansion, and directing the treatment strategy. This article discusses the neuroimaging methods of ICH, imaging markers for clinical outcome prediction, and future research directions with attention to the latest evidence-based guidelines.
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Neuroimaging Clin. N. Am. · May 2021
ReviewComputed Tomography-Based Imaging Algorithms for Patient Selection in Acute Ischemic Stroke.
Computed tomography remains the most widely used imaging modality for evaluating patients with acute ischemic stroke. Landmark trials have used computed tomography imaging to select patients for intravenous thrombolysis and endovascular treatment. This review summarizes the most important acute ischemic stroke trials, provides an outlook of ongoing studies, and proposes possible image algorithms for patient selection. Although evaluation with anatomic computed tomography imaging techniques is sufficient in early window patients, more advanced imaging techniques should be used beyond 6 hours from symptoms onset to quantify the ischemic core and evaluate for the salvageable penumbra.
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Neuroimaging Clin. N. Am. · May 2021
ReviewExtracranial Vascular Disease: Carotid Stenosis and Plaque Imaging.
Carotid atherosclerosis is an important contributor to ischemic stroke. When imaging carotid atherosclerosis, it is essential to describe both the degree of luminal stenosis and specific plaque characteristics because both are risk factors for cerebrovascular ischemia. ⋯ By understanding the underlying histopathology, the specific plaque characteristics on each of these imaging modalities can be appreciated. This article briefly describes some of the most commonly encountered plaque features, including plaque calcification, intraplaque hemorrhage, lipid-rich necrotic core, and plaque ulceration.
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Neuroimaging Clin. N. Am. · May 2021
ReviewSubarachnoid Hemorrhage of Unknown Cause: Distribution and Role of Imaging.
Subarachnoid hemorrhage of unknown cause represents approximately 10% to 15% of nontraumatic subarachnoid hemorrhages. The key factors in determining the management strategy for a presumed nonaneurysmal subarachnoid hemorrhage are the distribution, location, and amount of subarachnoid blood. ⋯ The extent of the workup required in determining the cause of hemorrhage depends on the distribution of blood. The authors review the potential causes, differential diagnoses, and acute and long-term follow-up strategies in patients with subarachnoid hemorrhage of unknown cause.
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Neuroimaging Clin. N. Am. · May 2021
ReviewHigh-Resolution Magnetic Resonance Vessel Wall Imaging for the Evaluation of Intracranial Vascular Pathology.
Intracranial vessel wall imaging (IVWI) is an advanced MR imaging technique that allows for direct visualization of the walls of intracranial blood vessels and detection of subtle pathologic vessel wall changes before they become apparent on conventional luminal imaging. When performed correctly, IVWI can increase diagnostic confidence, aid in the differentiation of intracranial vasculopathies, and assist in patient risk stratification and prognostication. This review covers the essential technical underpinnings of IVWI and presents emerging clinical research highlighting its utility for the evaluation of multiple intracranial vascular pathologies.