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    Acute Stroke Imaging Research Roadmap | American Journal of Neuroradiology  
    



















    































    
  
  




    
    

  

      


    

      

  
  
  

    

  

    

  

                
    

      

  

    

  
      
  
  

    


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OtherRESEARCH PERSPECTIVES

  
      

  
      
Acute Stroke Imaging Research Roadmap
  
    	
Max Wintermark, Gregory W. Albers, Andrei V. Alexandrov, Jeffry R. Alger, Roland Bammer, Jean-Claude Baron, Stephen Davis, Bart M. Demaerschalk, Colin P. Derdeyn, Geoffrey A. Donnan, James D. Eastwood, Jochen B. Fiebach, Marc Fisher, Karen L. Furie, Gregory V. Goldmakher, Werner Hacke, Chelsea S. Kidwell, Stephan P. Kloska, Martin Köhrmann, Walter Koroshetz, Ting-Yim Lee, Kennedy R. Lees, Michael H. Lev, David S. Liebeskind, Leif Ostergaard, William J. Powers, James Provenzale, Peter Schellinger, Robert Silbergleit, Alma Gregory Sorensen, Joanna Wardlaw, Ona Wu and Steven Warach

  
    	
American Journal of Neuroradiology May 2008,  29 (5) e23-e30; 

  
  
  



  


  
  



			

		

	
	
 	
	  
  

		
		

			

			  

  
      
  
  

    
  


  
  



  
      
  
  

    

  

    

  
        
Article Figures & Data

    
  
  

    
Tables
  • Table 1: 
    Recommended Acquisition Protocols for Perfusion-Weighted (PWI) and Diffusion-Weighted (DWI) MR Imaging
    PWIDWI
    SequenceSingle-shot gradient-echo echoplanar imagingSingle-shot diffusion-weighted spin-echo echoplanar imaging
    Image acquisition parametersTR≤1500 ms*TR≥4000 ms but can be as high as needed to fit all slices
    TE=35 to 45 ms @ 1.5TTE minimum (partial Fourier)
    TE=25 to 30 ms @ 3Tb=0 and 1000 sec/mm2
    flip angle α=60 to 90° @ 1.5T, 60° @ 3.0T(at least 3 orthogonal directions) eddy current correction (dual-spin echo or postprocessing)
    Parallel imaging and coil selected at the discretion of the site
    Image acquisition duration90 to 120 seconds image acquisition started 10 seconds before initiation of injection to achieve at least 10 to 12 baseline images and also record slow uptake in stroke regions90 to 260 seconds
    Coverage and slice thicknessWhole brain coverage using ≥12 slices slice thickness 5 mm gap 0 to 1 mm* matrix size 128×128* phase-encoding along A/P direction field of view ≈24 cmWhole brain coverage using ≥12 slices slice thickness 5 mm gap 0 to 1 mm matrix size 128×128 phase-encoding along A/P direction field of view ≈24 cm
    Slice orientationParallel to hard palateParallel to hard palate (ideally perpendicular to the scanner bore)
    Contrast materialStandard gadolinium-based contrast material…
    Contrast volumeSingle dose (for half-molar agent, ≈20 mL for 100 kg person) followed by 20 to 40 mL saline flush…
    Injection rate4 to 6 mL per second (power injector required) same injection rate for contrast and saline…
    IV access18 to 20 gauge IV line right antecubital vein preferred…
    MiscellaneousPWI can be performed before or after MR-angiography…
    • MRI scanner: 1.5T or 3T (MRI scanners with 512 image limit per series should be excluded).
    • * Interslice gap can be increased and matrix size can be decreased to achieve whole-brain coverage (TR can also be optimized to afford entire brain coverage but should be ≤1500 to 2000 ms).
  • Table 2. 
    Recommended Acquisition Protocol for Perfusion-CT (PCT)
    Image acquisition rate2 phases:
    1st phase: 1 image per second, duration=30 to 45 seconds
    2nd phase: 1 image per 2 to 3 seconds, duration=30 to 45 seconds
    Total duration of the acquisition at least 70 to 90 seconds
    Gantry rotation1 second per gantry rotation (up to every 3 seconds with “shuttle” or “toggle table” mode)
    Image acquisition parameters80 kVp, 100 mAs
    Coverage and slice thicknessMaximal coverage possible based on CT scanner configuration(minimal coverage of 20 mm slab per contrast bolus injection preferable; two boluses is suggested to double coverage for all CT scanners with under 4 cm detector length unless precluded by contrast dose considerations)focus on supratentorial compartment/anterior circulation5- to 10-mm-thick slicesfield of view ≈24 cm
    Slice orientationParallel to hard palatelowest slice through the proximal middle/anterior cerebral artery (above the orbits)
    Contrast material350 to 370 mg/mL iodinated contrast material high concentration, low/iso osmolar contrast preferred follow local guidelines for contrast-induced nephropathy prevention
    Contrast volume35 to 50 mL, followed by 20 to 40 mL saline flush
    Injection rate4 to 6 mL per second (power injector required) same injection rate for contrast and saline
    IV access18 to 20 gauge IV lineright antecubital vein preferred (for anatomical reasons, reduces pooling of contrast, lowers the risk of extravasation and minimizes streak artifact at thoracic inlet in CTA portion)
    MiscellaneousPCT can be performed before or after CTA
  


  
  



  




  


  
  



  
      
  
  

    
  


  
  



  
      
  
  

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Acute Stroke Imaging Research Roadmap
  
    	
Max Wintermark, Gregory W. Albers, Andrei V. Alexandrov, Jeffry R. Alger, Roland Bammer, Jean-Claude Baron, Stephen Davis, Bart M. Demaerschalk, Colin P. Derdeyn, Geoffrey A. Donnan, James D. Eastwood, Jochen B. Fiebach, Marc Fisher, Karen L. Furie, Gregory V. Goldmakher, Werner Hacke, Chelsea S. Kidwell, Stephan P. Kloska, Martin Köhrmann, Walter Koroshetz, Ting-Yim Lee, Kennedy R. Lees, Michael H. Lev, David S. Liebeskind, Leif Ostergaard, William J. Powers, James Provenzale, Peter Schellinger, Robert Silbergleit, Alma Gregory Sorensen, Joanna Wardlaw, Ona Wu, Steven Warach

  
    	
American Journal of Neuroradiology May 2008, 29 (5) e23-e30; 

  
  
  



  


  
  



  
      
  
  

    

  
    
  
  
    
  
  
    
  


  


  
  



  
      
  
  

    
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