Principles and Practical Application of Brain MRI in Acute Ischemic Stroke

  • Bum Joon Kim
Part of the Stroke Revisited book series (STROREV)


Various pathomechanisms can cause acute ischemic stroke, and the treatment strategy differs according to the stroke mechanism. Therefore, rapid and accurate diagnosis of ischemic stroke is important. Furthermore, in the hyperacute stage, selecting appropriate patients who may benefit from reperfusion therapy is important. Despite several practical issues, multimodal MRI is useful for accurate diagnosis of acute ischemic stroke, for the evaluation of risks and benefits of reperfusion therapy, and finally for patient selection who may benefit from each treatment. The high sensitivity and specificity of diffusion-weighted image (DWI) helps in distinguishing acute ischemic stroke from stroke mimics. Furthermore, the lesion pattern on DWI reflects the underlying pathomechanism. The lesion mismatch between perfusion-weighted image (PWI) and DWI is thought to represent the potential salvageable tissue by reperfusion therapy. Signal changes of fluid-attenuated inversion recovery (FLAIR) image within DWI lesions may be a surrogate marker of tissue clock reflecting infarction age and might indicate the risk of hemorrhage after reperfusion treatment. Clot sign on gradient echo (GRE) image may reflect the nature of clot, and the location, length, and morphology of clot on GRE may provide predictive information on recanalization. Understanding the clinical implication of various findings of each sequences of multimodal MRI and comprehensively incorporating them into therapeutic decision-making may be a reasonable approach for expanding the indication of reperfusion treatment for acute ischemic stroke patients.


  1. 1.
    Baird AE, Warach S. Magnetic resonance imaging of acute stroke. J Cereb Blood Flow Metab. 1998;18:583–609.CrossRefPubMedGoogle Scholar
  2. 2.
    Campbell BC, Tu HT, Christensen S, et al. Assessing response to stroke thrombolysis: validation of 24-hour multimodal magnetic resonance imaging. Arch Neurol. 2012;69:46–50.CrossRefPubMedGoogle Scholar
  3. 3.
    Kang DW, Chalela JA, Ezzeddine MA, et al. Association of ischemic lesion patterns on early diffusion-weighted imaging with toast stroke subtypes. Arch Neurol. 2003;60:1730–4.CrossRefPubMedGoogle Scholar
  4. 4.
    Kim BJ, Sohn H, Sun BJ, et al. Imaging characteristics of ischemic strokes related to patent foramen ovale. Stroke. 2013;44:3350–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Nagakane Y, Christensen S, Ogata T, et al. Moving beyond a single perfusion threshold to define penumbra: a novel probabilistic mismatch definition. Stroke. 2012;43:1548–55.CrossRefPubMedGoogle Scholar
  6. 6.
    Song TJ, Kim J, Song D, et al. Association of cerebral microbleeds with mortality in stroke patients having atrial fibrillation. Neurology. 2014;83:1308–15.CrossRefPubMedGoogle Scholar
  7. 7.
    Khatri R, McKinney AM, Swenson B, et al. Blood-brain barrier, reperfusion injury, and hemorrhagic transformation in acute ischemic stroke. Neurology. 2012;79:S52–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Bang OY, Buck BH, Saver JL, et al. Prediction of hemorrhagic transformation after recanalization therapy using T2*-permeability magnetic resonance imaging. Ann Neurol. 2007;62:170–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Ahn SH, Lee J, Kim YJ, et al. Isolated MCA disease in patients without significant atherosclerotic risk factors: a high-resolution magnetic resonance imaging study. Stroke. 2015;46:697–703.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Singapore 2017

Authors and Affiliations

  1. 1.Department of NeurologyKyung Hee University Hospital, Kyung Hee University College of MedicineSeoulSouth Korea

Personalised recommendations