DIAGNOSTIC PROCEDURES

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Stroke Imaging

Example of Diagnostic Imaging of Individual With Ischemic Stroke

stroke is a sudden event that leads to change or

loss of brain function. When a stroke is caused by
decreased blood flow to the brain, it is an ischemic
stroke. When the cause is bleeding into the brain, it is a
hemorrhagic stroke. When the bleeding is on the surface
of the brain, it is a subarachnoid hemorrhage. The
September 21, 2011, issue of JAMA includes an article on
depression and stroke.

TESTS TO DIAGNOSE STROKE

PLANE OF
IMAGE

Magnetic resonance
image (MRI)
R

Computed tomography
(CT) image
L

Area of decreased
blood flow (ischemia)

Arch Neurol. 2004;61(1):129-130.

It is important to diagnose the specific type of stroke because

each may require a different treatment. There are several tests
that can be used to diagnose the type of stroke:
A computed tomography (CT) scan uses x-rays to produce
a 2-dimensional or 3-dimensional picture of the brain.
Magnetic resonance angiography (MRA)
A noncontrast CT scan (without intravenous injection of
Occluded (blocked)
fluid) is very fast (less than 1 minute) and can accurately
blood vessel
detect blood, so it is used to look for hemorrhagic stroke or
subarachnoid hemorrhage. A computed tomography
angiography (CTA) scan uses intravenous contrast fluid to
visualize the arteries in the brain; it can help diagnose
ischemic stroke by determining its cause (such as a clot in an
IMAGE
VIEW
artery) and can provide guidance for thrombolytic treatment
(dissolving a clot).
Magnetic resonance imaging (MRI) and magnetic resonance
angiography (MRA) use the response of water molecules to
powerful magnets to produce a detailed picture of the brain
and its arteries. Although equally good as CT at finding blood, MRI is more accurate in
FOR MORE INFORMATION
the diagnosis of acute ischemic stroke and its cause. MRI and MRA can assess brain

National Institute of Neurological

damage and its reversibility as well as the risk of complications from the stroke. MRI can also
Disorders and Stroke, National
provide guidance for thrombolytic treatment but is not suitable for persons with cardiac
Institutes of Health
pacemakers or certain other metal or electronic devices implanted in their bodies.
www.ninds.nih.gov/disorders/misc
Ultrasonography uses high-frequency sound waves above the hearing threshold.
/diagnostic_tests.htm
Carotid ultrasound examines the arteries in the neck that provide blood to the brain.
National Library of Medicine
It can show blood clots, atherosclerotic plaques (blockages), and other problems that
www.nlm.nih.gov/medlineplus
can cause ischemic stroke. Transcranial Doppler measures the direction and speed of
/carotidarterydisease.html
blood flow in arteries in the brain. It can be used to find the position of an embolus
www.nlm.nih.gov/medlineplus
(a clot in the artery) or the narrowing of an artery. Both carotid ultrasound and
/stroke.html
transcranial Doppler are used to confirm the findings of CTA and MRA and measure
the effects of thrombolytic treatment.
INFORM YOURSELF
Digital cerebral angiography is the most accurate test for problems with brain
To find this and previous JAMA
arteries, such as aneurysms or clots, but it requires surgical insertion of a catheter
Patient Pages, go to the Patient
(tube) into an artery in the leg. It plays a limited role in acute stroke because it is
Page link on JAMAs Web site at
riskier, takes a longer time, and requires more equipment and professional staff than
www.jama.com. Many are available
the other imaging tests. However, digital cerebral angiography allows for a direct
in English and Spanish.
intravascular (from inside the artery) removal of an embolus, widening the artery
Sources: National Institute of Neurological Disorwith a balloon, putting in a stent (tube to keep the artery open), or injecting
ders and Stroke at the National Institutes of Health,
thrombolytic drugs to dissolve a clot. Thus, some stroke centers are using digital
National Library of Medicine
cerebral angiography for carefully selected patients.
Ryszard M. Pluta, MD, PhD, Writer
Cassio Lynm, MA, Illustrator
Robert M. Golub, MD, Editor

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JAMA, September 21, 2011Vol 306, No. 11

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