Choice of neuroimaging in perioperative acute stroke management

Fast examination time, wide availability, lack of contraindications, and high accuracy make noncontrast CT imaging the diagnostic study of choice for initial evaluation of preoperative stroke; it also has a role in excluding patients who will not benefit from intravenous thrombolysis. Multimodal CT can depict early ischemic changes, demonstrate hypoperfusion/ischemic penumbra, and locate vascular lesions. When combined with clinical scenarios, CT information often is sufficient to help decide appropriate treatment. MRI can provide more precise information but is more time consuming and should be the method of choice for follow-up, rather than initial imaging in patients who have perioperative stroke.