Stroke imaging plays a crucial role in the early diagnosis, classification, and management of stroke, enabling clinicians to make timely decisions that significantly improve patient outcomes. Strokes are broadly divided into two main categories: ischaemic and haemorrhagic. Imaging helps to distinguish between these types, ensuring that the correct treatment pathway is chosen as quickly as possible.
Computed Tomography (CT) scanning is often the first-line imaging modality due to its widespread availability, rapid acquisition, and ability to exclude haemorrhage. CT scans can identify areas of bleeding and large vessel occlusions, assisting clinicians in determining the cause of the stroke and guiding therapy. Although CT is widely used, it can be less sensitive in detecting early ischaemic changes, particularly within the first few hours of stroke onset. However, CT angiography (CTA) and CT perfusion techniques offer more detailed insights, allowing clinicians to visualise blood vessels, identify blockages, and assess cerebral blood flow dynamics.
Magnetic Resonance Imaging (MRI) provides superior soft-tissue contrast resolution, making it highly sensitive to acute ischaemic changes. Diffusion-weighted imaging (DWI), a specialised MRI sequence, is particularly effective at detecting acute ischaemia within minutes of onset, well before conventional CT scans show any abnormalities. This advanced capability allows clinicians to intervene early, potentially reversing or limiting damage. Additionally, MRI can help identify subtle structural changes and pinpoint smaller infarcts that might be missed on CT. Although MRI may be more time-consuming and less available in certain emergency settings, it remains a valuable tool for comprehensive evaluation.
Advanced imaging techniques continue to evolve, offering refined insights into stroke pathophysiology. Functional imaging, such as positron emission tomography (PET) and single-photon emission computed tomography (SPECT), can assess metabolic activity and blood flow, aiding in the identification of penumbra regions—areas of brain tissue that may still be salvageable with prompt reperfusion therapy. Perfusion imaging methods, whether by CT or MRI, further support this goal, helping clinicians to tailor treatments based on the individual’s specific perfusion deficits.
In recent years, rapid developments in imaging protocols, artificial intelligence, and machine learning have improved diagnostic accuracy and efficiency. Automated imaging analysis software can quickly detect subtle changes, ensuring that time-critical interventions such as thrombolysis or mechanical thrombectomy are delivered promptly. Through these continued innovations, stroke imaging is advancing the precision, speed, and quality of care that patients receive, providing clinicians with the information they need to minimise long-term disability and improve overall outcomes.
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