Currently, with the knowledge of the role of collateral circulation in the development of cerebral ischaemia, traditional therapeutic windows are being prolonged, with time not being the only criterion. Instead, a more personalised approach is applied to select additional patients who might benefit from active treatment. This review briefly describes the current knowledge of the pathophysiology of the development of early ischaemic changes, the capabilities of MRI to depict such changes, and the basics of the routinely used imaging techniques broadly available for the assessment of individual phases of cerebral ischaemia, and summarises the possible clinical use of routine MR imaging, including patient selection for active treatment and assessment of the outcome on the basis of imaging.

• Keywords
• DWI-ASPECTS, DWI-FLAIR mismatch, Ischaemic stroke,
• MeSH
• Cerebral Infarction MeSH
• Stroke * diagnostic imaging   therapy   MeSH
• Diffusion Magnetic Resonance Imaging methods   MeSH
• Brain Edema * MeSH
• Ischemic Stroke * MeSH
• Brain Ischemia * diagnostic imaging   therapy   MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

PURPOSE: Ischemic lesion volume (ILV) is an important radiological predictor of functional outcome in patients with anterior circulation stroke. Our aim was to assess the agreement between automated ILV measurements on NCCT using the Brainomix software and manual ILV measurements on diffusion-weighted imaging (DWI). METHODS: This was a prospective single-center observational study of patients with CT angiography (CTA) proven anterior circulation occlusion treated with endovascular thrombectomy (May 2018 to May 2019). NCCT ILV was measured automatically by the Brainomix software. DWI ILV was measured manually. The McNemar's test was used to test sensitivity and specificity. The Somer's delta was used to test the differences between concordant and discordant ASPECTS regions. The Bland-Altman plot was calculated to compare the differences between Brainomix and DWI ILVs. RESULTS: Forty-five patients were included. Median Brainomix ILV was 23 ml (interquartile range [IQR], 15-39 ml), and median DWI ILV was 11.5 ml (IQR, 7-32 ml) in the TICI 2b-3 group. In the TICI 0-2a, the NCCT ILV was 39 ml (IQR, 18-62 ml) and DWI ILV was 30 (IQR, 11-105 ml). The DWI ILVs in patients with good clinical outcome (mRS 0-2) was significantly lower compared with patients with mRS ≥ 3 (10 mL vs 59 mL, p = 0.002). Similar trend was observed for Brainomix ILV measurements (21 mL vs 39 mL, p = 0.012). There was a high correlation and accuracy in the detection of follow-up ischemic changes in particular ASPECTS regions. CONCLUSION: NCCT ILV measured automatically by the Brainomix software might be considered a valuable radiological outcome measure.

• Keywords
• Automatic, Computed tomography, Final ischemia, Software,
• MeSH
• Computed Tomography Angiography methods   MeSH
• Diffusion Magnetic Resonance Imaging MeSH
• Ischemic Stroke diagnostic imaging   surgery   MeSH
• Humans MeSH
• Cerebral Angiography methods   MeSH
• Prospective Studies MeSH
• Radiographic Image Interpretation, Computer-Assisted methods   MeSH
• Aged MeSH
• Sensitivity and Specificity MeSH
• Software MeSH
• Machine Learning * MeSH
• Thrombectomy * MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Observational Study MeSH