There are two options for radiologic imaging in the setting of acute stroke - CT or MRI.[7] Regardless of the route taken, it is necessary to obtain imaging without contrast as well as vascular imaging. The CT without contrast will assess for subacute to chronic strokes, any kind of hemorrhage, and hypodense signs that may indicate a large acute stroke. The MRI, particularly the DWI, will demonstrate the same things, as well as an acute stroke within minutes to hours. The next step is either a CT or MR angiogram of the head and neck with perfusion that images from the aorta up to the brain. The purpose of the angiogram is to assess for areas of stenosis or occlusions that may explain the symptoms. The purpose of the perfusion scan is to determine the extent of tissue that has already been damaged versus the extent that is at risk of damage, the core versus the penumbra. This determines whether or not the patient is a candidate for mechanical thrombectomy. The reason the neck is imaged is to include the internal carotid arteries down to the aorta to determine if these structures are involved. If the patient gets a CT and CT angiogram, they will eventually need an MRI as well.[8]
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