title: Imaging recommendations for acute stroke and transient ischemic attack patients: A joint statement by the American Society of Neuroradiology, the American College of Radiology, and the Society of NeuroInterventional Surgery.
abstract: Stroke is a leading cause of death and disability worldwide. Imaging plays a critical role in evaluating patients suspected of acute stroke and transient ischemic attack, especially before initiating treatment. Over the past few decades, major advances have occurred in stroke imaging and treatment, including Food and Drug Administration approval of recanalization therapies for the treatment of acute ischemic stroke. A wide variety of imaging techniques has become available to assess vascular lesions and brain tissue status in acute stroke patients. However, the practical challenge for physicians is to understand the multiple facets of these imaging techniques, including which imaging techniques to implement and how to optimally use them, given available resources at their local institution. Important considerations include constraints of time, cost, access to imaging modalities, preferences of treating physicians, availability of expertise, and availability of endovascular therapy. The choice of which imaging techniques to employ is impacted by both the time urgency for evaluation of patients and the complexity of the literature on acute stroke imaging. Ideally, imaging algorithms should incorporate techniques that provide optimal benefit for improved patient outcomes without delaying treatment.
authors.affiliation: Departments of Radiology, Neurology, Neurosurgery, and Biomedical Engineering, University of Virginia, Charlottesville, Virginia.
authors.forename: M
authors.initials: M
authors.lastname: Wintermark
authors.forename: P C
authors.initials: PC
authors.lastname: Sanelli
authors.forename: G W
authors.initials: GW
authors.lastname: Albers
authors.forename: J
authors.initials: J
authors.lastname: Bello
authors.forename: C
authors.initials: C
authors.lastname: Derdeyn
authors.forename: S W
authors.initials: SW
authors.lastname: Hetts
authors.forename: M H
authors.initials: MH
authors.lastname: Johnson
authors.forename: C
authors.initials: C
authors.lastname: Kidwell
authors.forename: M H
authors.initials: MH
authors.lastname: Lev
authors.forename: D S
authors.initials: DS
authors.lastname: Liebeskind
authors.forename: H
authors.initials: H
authors.lastname: Rowley
authors.forename: P W
authors.initials: PW
authors.lastname: Schaefer
authors.forename: J L
authors.initials: JL
authors.lastname: Sunshine
authors.forename: G
authors.initials: G
authors.lastname: Zaharchuk
authors.forename: C C
authors.initials: CC
authors.lastname: Meltzer
mesh_terms: D002533:Cerebral Angiography / Q000592:standards*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000628:therapy; D009485:Neuroradiography / Q000592:standards*; D017410:Practice Guidelines as Topic; D015642:Radiology, Interventional / Q000592:standards*; D020521:Stroke / Q000175:diagnosis* / Q000628:therapy; D014481:United States
references.citation: Neuroimaging Clin N Am. 2005 May;15(2):409-19, xii
references.pmid: 16198949
references.citation: Stroke. 2002 Oct;33(10):2426-32
references.pmid: 12364733
references.citation: AJNR Am J Neuroradiol. 2004 Nov-Dec;25(10):1645-52
references.pmid: 15569725
references.citation: JAMA. 1995 Oct 4;274(13):1017-25
references.pmid: 7563451
references.citation: JAMA. 1998 Apr 22-29;279(16):1293-7
references.pmid: 9565011
references.citation: Stroke. 2013 Jan;44(1):243-5
references.pmid: 23111438
references.citation: Stroke. 2003 Aug;34(8):e138-40
references.pmid: 12855835
references.citation: Stroke. 2001 Sep;32(9):2021-8
references.pmid: 11546891
references.citation: Stroke. 2001 Feb;32(2):438-41
references.pmid: 11157179
references.citation: Radiology. 1999 Feb;210(2):519-27
references.pmid: 10207439
references.citation: Lancet Neurol. 2011 Nov;10(11):978-86
references.pmid: 21978972
references.citation: Eur J Vasc Endovasc Surg. 2002 Jul;24(1):43-52
references.pmid: 12127847
references.citation: Neurology. 1976 Dec;26(12):1111-8
references.pmid: 186726
references.citation: Lancet Neurol. 2009 Dec;8(12):1095-102
references.pmid: 19850525
references.citation: Radiology. 1999 Jan;210(1):155-62
references.pmid: 9885601
references.citation: Stroke. 1998 May;29(5):935-8
references.pmid: 9596238
references.citation: AJNR Am J Neuroradiol. 2011 Jan;32(1):41-8
references.pmid: 20947643
references.citation: AJNR Am J Neuroradiol. 2002 Jan;23(1):93-101
references.pmid: 11827880
references.citation: Stroke. 2002 Jan;33(1):276-8
references.pmid: 11779922
references.citation: Stroke. 2006 May;37(5):1211-6
references.pmid: 16574931
references.citation: Stroke. 1999 Oct;30(10):2059-65
references.pmid: 10512907
references.citation: Nervenarzt. 2012 Oct;83(10):1241-51
references.pmid: 23015193
references.citation: Cochrane Database Syst Rev. 2009 Oct 07;(4):CD007424
references.pmid: 19821415
references.citation: AJNR Am J Neuroradiol. 1997 Jun-Jul;18(6):1011-20
references.pmid: 9194426
references.citation: Int J Stroke. 2010 Apr;5(2):68-73
references.pmid: 20446939
references.citation: Stroke. 2009 Jun;40(6):2276-93
references.pmid: 19423857
references.citation: Radiology. 1995 May;195(2):445-9
references.pmid: 7724764
references.citation: Neurology. 1999 Jun 10;52(9):1784-92
references.pmid: 10371524
references.citation: Stroke. 2006 Aug;37(8):2086-93
references.pmid: 16794209
references.citation: Stroke. 2005 Jun;36(6):1153-9
references.pmid: 15914768
references.citation: Stroke. 2007 Mar;38(3):948-54
references.pmid: 17290031
references.citation: Neurology. 2009 Mar 31;72(13):1127-33
references.pmid: 19092109
references.citation: Circulation. 2006 Jul 18;114(3):187-90
references.pmid: 16847163
references.citation: AJNR Am J Neuroradiol. 2003 Jun-Jul;24(6):1123-9
references.pmid: 12812937
references.citation: AJNR Am J Neuroradiol. 2006 Jan;27(1):35-9
references.pmid: 16418352
references.citation: Stroke. 2008 Apr;39(4):1184-8
references.pmid: 18292376
references.citation: Stroke. 1999 Aug;30(8):1528-33
references.pmid: 10436095
references.citation: Stroke. 2008 May;39(5):1647-52
references.pmid: 18322260
references.citation: Stroke. 2013 Mar;44(3):870-947
references.pmid: 23370205
references.citation: AJNR Am J Neuroradiol. 2013 May;34(5):965-70, S1
references.pmid: 23124643
references.citation: Stroke. 2011 Jul;42(7):1923-8
references.pmid: 21546490
references.citation: AJNR Am J Neuroradiol. 2001 Sep;22(8):1534-42
references.pmid: 11559501
references.citation: Stroke. 2003 Feb;34(2):575-83
references.pmid: 12574579
references.citation: Cerebrovasc Dis. 2008;25(5):457-507
references.pmid: 18477843
references.citation: Radiology. 2004 Oct;233(1):101-12
references.pmid: 15333770
references.citation: Neuroimaging Clin N Am. 2005 May;15(2):421-40, xii
references.pmid: 16198950
references.citation: Radiology. 2001 Jul;220(1):179-85
references.pmid: 11425993
references.citation: Stroke. 2000 May;31(5):1081-9
references.pmid: 10797169
references.citation: Cerebrovasc Dis. 2012;34(3):221-8
references.pmid: 23006669
references.citation: Ann Neurol. 2006 Nov;60(5):508-17
references.pmid: 17066483
references.citation: Neurology. 2010 Jul 13;75(2):177-85
references.pmid: 20625171
references.citation: Stroke. 2006 Jul;37(7):1710-4
references.pmid: 16763186
references.citation: Lancet Neurol. 2009 Feb;8(2):141-50
references.pmid: 19097942
references.citation: Magn Reson Med. 1991 Jun;19(2):311-5
references.pmid: 1881320
references.citation: J Comput Assist Tomogr. 2004 Jan-Feb;28(1):55-62
references.pmid: 14716233
references.citation: Clin Radiol. 2002 Nov;57(11):957-68
references.pmid: 12409105
references.citation: JAMA. 2001 Dec 12;286(22):2830-8
references.pmid: 11735758
references.citation: AJNR Am J Neuroradiol. 1998 Jun-Jul;19(6):1061-6
references.pmid: 9672012
references.citation: Lancet. 2005 Jul 2-8;366(9479):29-36
references.pmid: 15993230
references.citation: Stroke. 2006 May;37(5):1227-31
references.pmid: 16574922
references.citation: Stroke. 2000 Jul;31(7):1667-71
references.pmid: 10884471
references.citation: Ann Neurol. 2002 Apr;51(4):417-32
references.pmid: 11921048
references.citation: Stroke. 2007 Oct;38(10):2738-44
references.pmid: 17717319
references.citation: Stroke. 2011 May;42(5):1270-5
references.pmid: 21474799
references.citation: Radiology. 2001 Apr;219(1):95-100
references.pmid: 11274542
references.citation: Lancet. 2000 May 13;355(9216):1670-4
references.pmid: 10905241
references.citation: N Engl J Med. 2013 Mar 7;368(10):914-23
references.pmid: 23394476
references.citation: J Neurol. 2000 Oct;247(10):760-6
references.pmid: 11127530
references.citation: Stroke. 2001 Dec 1;32(12):2774-81
references.pmid: 11739972
references.citation: Ann Neurol. 2002 Jan;51(1):28-37
references.pmid: 11782981
references.citation: Stroke. 2006 Apr;37(4):979-85
references.pmid: 16514093
references.citation: Ann Neurol. 2000 Nov;48(5):713-22
references.pmid: 11079534
references.citation: Int J Stroke. 2012 Jun;7(4):311-20
references.pmid: 22510216
references.citation: N Engl J Med. 2013 Mar 7;368(10):904-13
references.pmid: 23387822
references.citation: Neuroimaging Clin N Am. 2005 Aug;15(3):575-87, x
references.pmid: 16360590
references.citation: Arch Neurol. 2000 Jul;57(7):1000-8
references.pmid: 10891982
references.citation: Int J Stroke. 2007 Feb;2(1):53-4
references.pmid: 18705990
references.citation: Ann Intern Med. 1995 Mar 1;122(5):360-7
references.pmid: 7847648
references.citation: Neurology. 2005 Aug 23;65(4):513-7
references.pmid: 16116107
references.citation: J Neuroimaging. 2012 Oct;22(4):e20-33
references.pmid: 22985169
references.citation: Ann Neurol. 1995 Feb;37(2):231-41
references.pmid: 7847864
references.citation: Neuroradiology. 1996 Jan;38(1):31-3
references.pmid: 8773271
references.citation: Stroke. 2011 May;42(5):1237-43
references.pmid: 21393591
references.citation: AJNR Am J Neuroradiol. 2005 Jan;26(1):104-12
references.pmid: 15661711
references.citation: Stroke. 1999 Jun;30(6):1174-80
references.pmid: 10356095
references.citation: Ann Neurol. 1997 Aug;42(2):164-70
references.pmid: 9266725
references.citation: AJNR Am J Neuroradiol. 1994 Jan;15(1):9-15; discussion 16-8
references.pmid: 8141071
references.citation: Stroke. 2009 Feb;40(2):469-75
references.pmid: 19109547
references.citation: Circulation. 1996 Sep 1;94(5):1167-74
references.pmid: 8790069
references.citation: Stroke. 2006 Mar;37(3):911-4
references.pmid: 16469961
references.citation: Lancet. 2007 Jan 27;369(9558):293-8
references.pmid: 17258669
references.citation: AJNR Am J Neuroradiol. 2000 Sep;21(8):1441-9
references.pmid: 11003276
references.citation: Stroke. 2006 Jan;37(1):263-6
references.pmid: 16339467
references.citation: Eur Radiol. 2005 Mar;15(3):434-40
references.pmid: 15696293
references.citation: J Cereb Blood Flow Metab. 2011 Sep;31(9):1836-51
references.pmid: 21731034
references.citation: Eur Radiol. 2005 Mar;15(3):416-26
references.pmid: 15657788
references.citation: Ann Neurol. 2002 Apr;51(4):415-6
references.pmid: 11921047
references.citation: Cerebrovasc Dis. 2011;31(3):238-45
references.pmid: 21178348
references.citation: Br J Radiol. 1974 Sep;47(561):530-65
references.pmid: 4425509
references.citation: Stroke. 2007 Oct;38(10):2627-8
references.pmid: 17702956
references.citation: AJNR Am J Neuroradiol. 2005 May;26(5):1012-21
references.pmid: 15891154
references.citation: Neurology. 2005 Oct 25;65(8):1175-8
references.pmid: 16247042
references.citation: J Am Coll Radiol. 2011 Aug;8(8):532-8
references.pmid: 21807345
references.citation: Neurology. 2001 Apr 24;56(8):1009-15
references.pmid: 11320170
references.citation: AJNR Am J Neuroradiol. 1997 Jun-Jul;18(6):1001-10
references.pmid: 9194425
references.citation: Lancet Neurol. 2008 Apr;7(4):299-309
references.pmid: 18296121
references.citation: Radiology. 2012 Feb;262(2):593-604
references.pmid: 22187626
references.citation: N Engl J Med. 1995 Dec 14;333(24):1581-7
references.pmid: 7477192
references.citation: Brain. 2011 Nov;134(Pt 11):3408-16
references.pmid: 22075524
references.citation: Stroke. 2007 Mar;38(3):967-73
references.pmid: 17272772
references.citation: Stroke. 2005 Jan;36(1):66-73
references.pmid: 15569863
references.citation: Radiology. 2004 Oct;233(1):79-86
references.pmid: 15340177
references.citation: Neuroimaging Clin N Am. 2005 May;15(2):245-58, ix
references.pmid: 16198938
references.citation: J Comput Assist Tomogr. 2006 Jan-Feb;30(1):105-10
references.pmid: 16365583
references.citation: Stroke. 2004 Feb;35(2):502-6
references.pmid: 14739410
references.citation: JAMA. 2004 Oct 20;292(15):1823-30
references.pmid: 15494579
references.citation: J Neurol Neurosurg Psychiatry. 2008 Aug;79(8):913-6
references.pmid: 18187478
references.citation: Stroke. 2007 Oct;38(10):2633-9
references.pmid: 17702958
references.citation: Stroke. 2005 May;36(5):980-5
references.pmid: 15790950
references.citation: Lancet Neurol. 2012 Oct;11(10):860-7
references.pmid: 22954705
references.citation: Lancet Neurol. 2012 Apr;11(4):307-14
references.pmid: 22405630
references.citation: Radiology. 2013 May;267(2):543-50
references.pmid: 23264345
references.citation: Stroke. 2004 Jul;35(7):1652-8
references.pmid: 15155964
references.citation: AJNR Am J Neuroradiol. 2005 Feb;26(2):246-51
references.pmid: 15709120
references.citation: Stroke. 2011 Jun;42(6):1608-14
references.pmid: 21493916
references.citation: Ann Neurol. 2007 Jun;61(6):533-43
references.pmid: 17431875
references.citation: Stroke. 2002 Sep;33(9):2206-10
references.pmid: 12215588
references.citation: Stroke. 2011 Mar;42(3):693-9
references.pmid: 21233472
references.citation: N Engl J Med. 2013 Mar 7;368(10):893-903
references.pmid: 23390923
references.citation: Lancet Neurol. 2008 Mar;7(3):256-67
references.pmid: 18275927
references.citation: Neurocrit Care. 2012 Dec;17(3):421-8
references.pmid: 22878870
references.citation: Stroke. 2011 May;42(5):1255-60
references.pmid: 21493917
references.citation: J Cereb Blood Flow Metab. 2009 Jun;29(6):1138-45
references.pmid: 19367294
references.citation: Lancet. 2010 May 15;375(9727):1695-703
references.pmid: 20472172
references.citation: Stroke. 2008 Dec;39(12):3316-22
references.pmid: 18927461
references.citation: Neurology. 1998 Apr;50(4):864-70
references.pmid: 9566364
references.citation: Arch Neurol. 2003 Dec;60(12):1730-4
references.pmid: 14676047
references.citation: JAMA. 2004 Oct 20;292(15):1883-5
references.pmid: 15494587
references.citation: N Engl J Med. 2008 Sep 25;359(13):1317-29
references.pmid: 18815396
references.citation: Stroke. 2009 Nov;40(11):3646-78
references.pmid: 19797189
references.citation: Radiology. 1996 May;199(2):403-8
references.pmid: 8668785
references.citation: Stroke. 2002 Aug;33(8):2003-8
references.pmid: 12154253
references.citation: AJNR Am J Neuroradiol. 2011 Feb;32(2):359-64
references.pmid: 21051518
references.citation: AJNR Am J Neuroradiol. 2008 Mar;29(3):520-5
references.pmid: 18065505