Postgrad Med J 86:409-418 doi:10.1136/pgmj.2010.097931
  • Review

Imaging in acute ischaemic stroke: essential for modern stroke care

Editor's Choice
  1. Nigel Hoggard2
  1. 1Radiology Department, Royal Hallamshire Hospital, Sheffield NHS Teaching Hospitals Trust, Sheffield, UK
  2. 2Academic Unit of Radiology, University of Sheffield, Sheffield, UK
  1. Correspondence to Dr Daniel J Warren, C Floor, Department of Radiology, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK; daniel.warren{at}
  • Received 26 January 2010
  • Accepted 25 April 2010


Stroke is the second most common cause of death worldwide and the third most common in the UK. ‘Time is brain’ in ischaemic stroke; early reperfusion has been shown to lead to improved clinical outcomes, yet the majority of patients with acute stroke do not attend in time for thrombolysis as it is currently licensed, hence the interest in trials extending the therapeutic window. Defining the ischaemic penumbra is of crucial importance in choosing the appropriate patients for thrombolytic therapy who attend outside the optimal therapeutic window. Integrated stroke imaging, including demonstration of potentially salvageable tissue with either MR perfusion/diffusion studies or CT perfusion, is increasingly likely to play a central role in future management strategies and widening of the potential therapeutic window. This review highlights the basic imaging findings of acute stroke and discusses the role of advanced CT and MR techniques as well as options for vascular imaging.


  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.