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Recent developments in imaging of stroke

Department of Clinical Neurosciences, University of Edinburgh, Western General Hospitals NHS Trust, Crewe Road, Edinburgh EH4 2XU, UK

• Radiological assessment plays a crucial role in directing optimal primary treatment and secondary prevention of stroke.
  
• CT or brain MRI is required to identify the approximately 4% of patients who have a non-vascular cause of stroke, e.g. tumour.
  
• Judicious and timely use of CT is the most cost effective way of distinguishing ischaemic from haemorrhagic stroke.
  
• CT cannot reliably distinguish infarct from haemorrhage more than 8 days after stroke.
  
• In the UK, there are still far too many patients with a stroke or transient ischaemic attack not receiving a CT brain scan at all, or receiving one far too late to distinguish infarct from haemorrhage.
  
• A gradient echo MR sequence is required to identify haemorrhage reliably with MRI.
  
• MR diffusion/perfusion imaging and CT perfusion imaging are promising but experimental techniques.
  

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