Stroke protocol (MRI)

MRI protocol for stroke assessment is a group of MRI sequences put together to best approach brain ischaemia.

CT is still the choice as the first imaging modality in acute stroke institutional protocols, not only because the availability and the easy and fast access to a CT scanner, but also due the better sensitivity for intracerebral haemorrhage (ICH) diagnosis 1. Some institutions also apply a quick MRI stroke protocol for code stroke patients assessment within the narrow time window for thrombolytic therapy.

Note: This article is intended to outline some general principles of protocol design. The specifics will vary depending on MRI hardware and software, radiologist's and referrer's preference, institutional protocols, patient factors (e.g. allergy) and time constraints. 

Sequences

A good protocol involves at least:

  • T1 weighted
  • T2 weighted
    • plane: axial
    • sequence: T2 FSE
    • purpose: 
      • loss of normal signal void in large arteries may be visible immediately
      • after 6-12 hours infarcted tissue becomes high signal 2
      • sulcal effacement and mass effect develop and become maximal in the first few days
  • FLAIR
    • plane: axial
    • sequence: FLAIR
    • purpose: 
      • after 6-12 hours infarcted tissue becomes high signal 2
      • sulcal effacement and mass effect develop and become maximal in the first few days
  • diffusion-weighted imaging (DWI)
    • plane: axial
    • sequence: DWI: B=0, B=1000 and ADC 
    • purpose: 
      • early identification of ischemic stroke: diffusion restriction may be seen within minutes following the onset of ischaemia 3
      • correlates well with infarct core
      • differentiation of acute from chronic stroke
  • susceptibility weighted imaging (SWI)
  • MRA
MRI protocols
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rID: 37793
Synonyms or Alternate Spellings:
  • MRI protocol for stroke assessment

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