Magnetic resonance imaging

Magnetic resonance imaging (MRI) is probably more sensitive than CT for detecting stroke, particularly lacunar strokes and those occurring in the posterior fossa. However, even MRI scans can be normal in clinically definite stroke.34 Certain MRI techniques, such as diffusion weighted imaging, are very sensitive at highlighting the "culprit" lesion, which may be useful when several areas of abnormality are shown.

The differentiation between ischaemic and haemorrhagic strokes on MRI in the first few days is less easy for the nonexpert than with CT, but MRI (specifically gradient echo sequences) can help diagnose intracerebral haemorrhage months or even years after the event when CT shows only a hypodense area indistinguishable from an infarct. However, physicians in many countries do not have urgent access to MRI and it is currently a difficult technique to use safely and satisfactorily in many acutely ill patients; consequently, CT scanning is likely to remain the principal imaging technique for stroke patients for the foreseeable future.

Where available, MRI, including the use of specific sequences such as diffusion weighted imaging and MR angiography, may add significantly to the understanding of stroke mechanisms.

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