Magnetic Resonance Imaging of Stroke

Magnetic resonance imaging (MRI) provides a powerful (neuro)imaging modality for the diagnosis and outcome prediction after (acute) stroke. Since MRI allows noninvasive, longitudinal, and three-dimensional assessment of vessel occlusion (with magnetic resonance angiography (MRA)), tissue injury (with T₁-, T₂-, T₂*-, and/or diffusion-weighted MRI), and hemodynamics (with perfusion MRI), it offers a valuable tool for (pre)clinical and experimental studies on stroke pathology, treatment, and recovery. Combined MRI protocols that inform of different aspects of stroke pathophysiology enable the delineation of irreversibly damaged tissue and, potentially salvageable, tissue at risk of infarction, based on concepts like the perfusion-diffusion mismatch, or by predictive modeling of infarct probability. These approaches can aid in the selection of patients who could respond favorably to thrombolysis or thrombectomy. Furthermore, structural and functional MRI of the progression of affected tissue may contribute to the monitoring and characterization of effects of (experimental) therapeutic interventions aimed at improving outcome after stroke.