Curative treatment of stroke is

now available (tPA) but

should be given early.

So, we have to design an

imaging algorithm that can

catch the diagnosis of stroke

very early.

1. Dense artery sign: (30-50% of cases): It represents thrombosis within the artery

2. Insular ribbon sign.

3. Basal ganglia sign.

4. Poor grey / white matter interface.

5. Localized sulcal effacement.

these are explained by arrest of oxidativecellular metabolism resulting into lack of ATP.

The cell membrane ATP dependent transportof water stops resulting in trapping of waterinside the cells resulting in edema.

What about

salvageable brain?

Assessment of tissue perfusion is important

because some patients who passed the time

window or those with wake up stroke (WUS)

still can benefit from treatment if there is

salvageable brain.

MTTCBFCBV

Large left MCA penumbra (Salvageable brain)

Large left MCA infarct

Right MCA ischemia with basal ganglia

core of infarct and large penumbra

CBVCBFMTT

Infarct corePenumbra

CBF

MTT

CBV

CBF

MTT

CBV

DWI: Can show the infarct very early.

10min to 10 days

The FLAIR imaging can offer many

diagnostic values in cases of infarcts.

1. Hyperintense artery sign.

2. Indicator of collateral flow.

(Azizyan, Sanossian,

Mogensen, & Liebeskind,

2011)

(Azizyan, Sanossian,

Mogensen, & Liebeskind,

2011)

Tha and Terae et al., 2009