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Imaging in acute ischaemic stroke: pearls and pitfalls
  1. James Caldwell1,
  2. Manraj K S Heran2,
  3. Ben McGuinness1,
  4. P Alan Barber3,4
  1. 1 Department of Neuroradiology, Auckland City Hospital, Auckland, New Zealand
  2. 2 Department of Neuroradiology, Vancouver General Hospital, Vancouver, Canada
  3. 3 Department of Neurology, Auckland City Hospital, Auckland, New Zealand
  4. 4 Centre for Brain Research, University of Auckland, Auckland, New Zealand
  1. Correspondence to Dr James Caldwell, Department of Neuroradiology, Auckland District Health Board, 2 Park Rd, Grafton, Auckland 1142, New Zealand; jamesrc{at}


Prompt and accurate diagnosis is the foundation of acute ischaemic stroke care. Multiple positive endovascular thrombectomy trials in ischaemic stroke patients with large vessel occlusions have further emphasised this but also added complexity to treatment decisions. CT angiography is now routine for patients who present with an acute stroke syndrome around the world. Members of the neurology and stroke teams (rather than radiologists) are often the first doctors to lay eyes on the CT images and are best equipped to integrate the clinical picture with the imaging findings. A sound understanding of acute stroke imaging is therefore essential for clinicians who work with acute stroke patients. This review describes some pearls we have gleaned from our own experience in acute stroke imaging as well as some potential follies to be avoided.

  • Neuroradiology
  • stroke

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  • Contributors All the authors on this paper have contributed to writing and reviewing it.

  • Competing interests None declared.

  • Patient consent The article only uses deidentified radiology images and patients cannot be identified.

  • Provenance and peer review Not commissioned. Externally peer reviewed. This paper was reviewed by Bejoy Thomas, Kerala, India, and William Whiteley, Edinburgh, UK.

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