The possibilities of an improved magnetic resonance imaging protocol in the diagnosis of acute ischemic stroke
https://doi.org/10.18705/2782-3806-2025-5-1-40-49
EDN: UANCOB
Abstract
Background. The most important advantage that imaging provides to a patient with ischemic stroke is the rapid identification of those patients who are most likely to benefit from emergency treatment. This group includes patients who suffer from severe neurological symptoms due to occlusion of the main artery, and those who are candidates for recanalization using intravenous thrombolysis or intraarterial intervention to remove a blood clot. Objective. To develop an improved protocol (set of pulse sequences) of magnetic resonance imaging for patients in the acute period of ischemic stroke.
Materials and methods. The experience of clinical use of brain MRI at the Almazov National Medical Research Centre in patients with ischemic stroke is analyzed.
Results. The most sensitive in the diagnosis of ischemic changes in the most acute stage of development is the DWI regime. The DWI exceeds the value on FLAIR, which indicates greater information content on ADC maps.
Conclusion. The developed improved protocol of MR examination of patients in the acute period of ischemic stroke makes it possible to identify the ischemic zone in a short time. The scan time is about 9 minutes, which is comparable to the time of a comprehensive CT scan, and taking into account the average patient’s 5-minute laying time, the relative differences in the «laying+scanning» CT and «laying+scanning» MRI time are only 30 %.
About the Authors
R. Kh. Aldatov
Federal State Government Institution «Polyclinic № 4 of the Federal Customs Service»
Russian Federation
Russian Federation
Aldatov Ruslan Kh., Candidate of Medical Sciences, Head of the Department
141 Moskovsky Prospekt, building 1, Saint Petersburg, 196105
V. A. Fokin
Almazov National Medical Research Centre
Russian Federation
Russian Federation
Fokin Vladimir A., Doctor of Medical Sciences, Professor of the Department
Saint Petersburg
G. E. Trufanov
Almazov National Medical Research Centre
Russian Federation
Russian Federation
Trufanov Gennady E., Doctor of Medical Sciences, Professor, Head of the Department of Radiological Diagnostics and Medical Imaging; Chief Researcher of the Radiology Research Department
Saint Petersburg
А. М. Klimovich
Almazov National Medical Research Centre
Russian Federation
Russian Federation
Klimovich Anastasia M., resident of the Department of Radiation Diagnostics and medical imaging
Saint Petersburg
M. L. Pospelova
Almazov National Medical Research Centre
Russian Federation
Russian Federation
Pospelova Maria L., MD, Associate Professor, Associate Professor of the Department of Neurology with Clinic, Dean of the Faculty of Pre-University Education and Youth Science of the Institute of Medical Education; head of the Research Institute of Neuroclinical Oncology of the World-Class Research Centre for Personalized Medicine
Saint Petersburg
References
1. Likhachev SA, Gonchar IA, Nedz’ved’ GK. Basic therapy of ischemic stroke in patients with arterial hypertension. Meditsinskie novosti=Medical news. 2006;7:37–41.
2. Gusev EI. Neurology. National leadership. Vol. 1. / E. I. Gusev, A. N. Konovalov, V. I. Skvorcova, A. B. Gekht. Moscow: GEOTAR-Media, 2018. P. 299.
3. Yoshimura S. Endovascular Therapy for Acute Stroke with a Large Ischemic Region / S. Yoshimura, N. Sakai, H. Yamagami, et al. // N. Engl. J. Med. 2022;386(14):1303–1313.
4. Silva GS. Endovascular Treatment of Acute Ischemic Stroke / G. S. Silva, R. G. Nogueira // Continuum (Minneap Minn). 2020;26(2):310–331.
5. Krotenkova MV. The main factors determining the prognosis of recovery after ischemic stroke. / M.V. Krotenkova, A. S. Kadykov, Yu. D. Barhatov, et al. // Zhurnal nevrologii i psihiatrii im. C. C. Korsakova=The Korsakov Journal of Neurology and Psychiatry. 2019;119(5–2):333–334.
6. Stahovskaya LV, Klochihina OA, Bogatyreva MD, Chugunova SA. Analysis of epidemiological indicators of recurrent strokes in the regions of the Russian Federation (based on the results of the territorial population registry 2009–2014). Consilium Medicum. 2016;18(9):8–1.
7. Hasanova DR. Stroke. Modern approaches to diagnosis, treatment and prevention: methodological recommendations. / D. R. Hasanovа, V. I. Danilov. 2nd ed., revised and additional. Moskva: GEOTAR-Media, 2018. P. 30–33.
8. Goyal M. Challenging the Ischemic Core Concept in Acute Ischemic Stroke Imaging / M. Goyal, J. M. Ospel, B. Menon, et al. // Stroke. 2020;51(10):3147–3155.
9. Fokin VA. MRI in the diagnosis of ischemic stroke: a textbook. / V. A. Fokin, S. N. Yanishevskij, A. G. Trufanov // Voenno-medicinskaya akademiya im. S. M. Kirova. SPb: ELBI-SPb, 2012. P. 96.
10. Yang SH. Four Decades of Ischemic Penumbra and Its Implication for Ischemic Stroke / S. H. Yang, R. Liu // Transl. Stroke Res. 2021;12(6):937–945.
11. Fokin VA. Magnetic resonance imaging in the diagnosis of ischemic stroke: A textbook. / V. A. Fokin. SPb: VMedA, 2008. P. 69.
12. Subudhi A. Automated approach for detection of ischemic stroke using Delaunay Triangulation in brain MRI images / A. Subudhi, U. R. Acharya, M. Dash, et al. // Comput Biol Med. 2018; 103:116–129.
13. Honig SE. The impact of installing an MR scanner in the emergency department for patients presenting with acute stroke-like symptoms. / S. E. Honig, L. S. Babiarz, E. L. Honig, S. Mirbagheri // Clin Imaging. 2017;45:65–70.
14. Praveen GB. Ischemic stroke lesion segmentation using stacked sparse autoencoder / G. B. Praveen, A. Agrawal, P. Sundaram, S. Sardesai // Comput. Biol. Med. 2018;99:38–52.
15. Kauw F. Clinical and Imaging Predictors of Recurrent Ischemic Stroke: A Systematic Review and Meta-Analysis / F. Kauw, R. A. P. Takx, W. A. M. de Jong, et al. // Cerebrovasc. Dis. 2018:45(5–6):279–287.
16. Ciccone A. Endovascular treatment for acute ischemic stroke / A. Ciccone, L. Valvassori, M. Nichelatti // N. Engl. J. Med. 2013;368(10):904–913.
17. Wenger KJ. Fast MRI sequences for clarification of acute neurological symptoms. / K. J. Wenger, E. Hattingen // Radiologe. 2020;60(3):208–215.
18. Diomidova VN. Studying the possibilities of magnetic resonance imaging in the diagnosis of ischemic stroke / V. N. Diomidova, M. A. Fedorov, L. P. Migushkina, et al. // Dnevnik kazanskoj medicinskoj shkoly=Diary of the Kazan medical School. 2016. No. 2. P. 24–28.
19. Shin DH. Proximal hyper-intense vessel sign on initial FLAIR MRI in hyper-acute middle cerebral artery ischemic stroke: a retrospective observational study / D. H. Shin, S. K. Han, J. H. Lee // Acta. Radiol. 2021;62(7):922–931.
20. Thomalla G. Negative fluid-attenuated inversion recovery imaging identifies acute ischemic stroke at 3 hours or less / G. Thomalla, P. Rossbach, M. Rosenkranz, et al. // Ann. Neurol. 2009;65(6):724–732.
21. Clinical protocol “Reperfusion therapy of ischemic stroke”. Moscow, 2019.
22. Levashkina IM. Diffusion tensor MRI is a modern method for assessing microstructural changes in brain matter (literature review) / I. M. Levashkina, S. V. Serebryakova, A. Yu. Efimcev // Vestnik SanktPeterburgskogo universiteta. Medicina=Bulletin of St. Petersburg University. Medicine. 2016;4:39–54.
23. Maruyama D. FLAIR vascular hyperintensity with DWI for regional collateral flow and tissue fate in recanalized acute middle cerebral artery occlusion / D. Maruyama, T. Yamada, M. Murakami, et al. // Eur. J. Radiol. 2021. No. 135. Р. 109490.
24. Clinical guidelines “Ischemic stroke and transient ischemic attack”. Moscow, 2024.
Review
For citations:
Aldatov R.Kh., Fokin V.A., Trufanov G.E., Klimovich А.М., Pospelova M.L. The possibilities of an improved magnetic resonance imaging protocol in the diagnosis of acute ischemic stroke. Russian Journal for Personalized Medicine. 2025;5(1):40-49. (In Russ.) https://doi.org/10.18705/2782-3806-2025-5-1-40-49. EDN: UANCOB
Views:
85
Email this article 