Brain imaging plays a major role in the diagnosis and management of acute ischemic stroke. Marc Fisher, MD, Beth Israel Deaconess Medical Center, Boston, MA, gives an overview of the various imaging approaches for acute ischemic stroke patients. A computed tomography (CT) scan or magnetic resonance imaging (MRI) of the head is typically the first test performed. Most centers do CT scans as MRI is not readily available. To improve the detection and characterization of stroke, CT angiography (CTA) of the head and neck vessels may be performed. Additionally, CT perfusion (CTP) provides a more focused estimate of the ischemic core and penumbra. Dr Fisher highlights its potential value, particularly in the late time window for identifying thrombectomy candidates. Looking at available MRI modalities, diffusion-weighted MRI provides an accurate assessment of the extent of ischemic injury early after stroke onset and combined with perfusion MRI helps distinguish ischemic penumbra from core. This interview took place during the XXV World Congress of Neurology.

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