Diagnostic Radiology

Stroke Imaging and Analysis

For making treatment decisions in acute stroke, fast and accurate differentiation between ischemic and hemorrhagic stroke is crucial. In ischemic stroke, imaging modalities help to choose early initialization of brain-saving intravenous thrombolytic therapy or interventional revascularization. In hemorrhagic stroke, imaging modalities provide sound decision support to choose the adequate treatment, e.g. interventional coiling or surgical clipping and/ or evacuation of the hematoma. Comprehensive stroke imaging and image analysis, cause-guided treatment, and prognostic evaluation of stroke require a broader diagnostic approach to the disease, and are therefore not available in all emergency departments. Diagnostic radiology departments can provide specialized CT and MR imaging techniques, dedicated applications for single and multi-modal image analysis, and flexible image data handling required for a comprehensive evaluation of the disease.
With state-of-the-art CT and MR scanners, research tools for experimental diagnostic approaches, and comprehensive software for clinical and research related data handling Siemens is your ideal partner in stroke diagnostic radiology.

CT

Non-contrast and contrast-enhanced CT imaging and CT angiography (CTA) are highly efficient neuro-imaging techniques that provide rapid, basic, differential, and cause-related information on stroke. CT imaging is an established and guideline-recommended diagnostic procedure in the early investigation of acute stroke in the emergency department (ED) as well as in more subtle stroke analysis in the diagnostic radiology department. While native CT is used to localize hemorrhage and infarcted brain areas, perfusion CT techniques allow for the early demarcation of tissue at risk and CTA helps in depicting vessel occlusion. In the case of hemorrhagic stroke, the evaluation of the source of the bleeding and the vascular structures through CTA can form a basis for treatment decisions. Thus, CT imaging reliably provides information for critical therapeutic decisions and treatment monitoring in short and extended time frames.
As a technology leader, Siemens provides you with latest CT imaging technology complemented by dedicated image analyzing applications, and full integration into your IT environment - be it in emergency care or in the diagnostic radiology department.

MR

Of all available brain imaging techniques, MR imaging (MRI) offers the highest sensitivity and specificity for early visualization of ischemic stroke, detection of small lesions, and early demarcation of infarcted brain areas and tissue at risk.
A variety of imaging sequences, like diffusion-weighted (DWI) or perfusion-weighted imaging (PWI), and MR angiography (MRA), enable full coverage of stroke related imaging, including detection of hemorrhage and vascular lesions in a single diagnostic procedure. MRA can also provide decision support in helping to identify the source of the bleeding and the vascular structures in order to choose the indicated treatment. MRI is also the optimal diagnostic modality to monitor lesion development under acute therapy and rehabilitation, as well as for the evaluation and monitoring of non-acute stroke, such as in transient ischaemic attacks (TIA).
Siemens MRI scanners, imaging software, streamlined workflows, and health data management help you provide your patients with evidence-based and radiation-free stroke diagnostics and highly efficient treatment monitoring for an optimal outcome.

Biograph mMR

The simultaneous acquisition of MR imaging (MRI) and positron emission tomography (PET) data provides exceptional insights into brain anatomy, functions and metabolism. Although stroke imaging has witnessed impressive progress over recent years, a number of critical questions concerning brain tissue damage, recovery, protection, and repair remain unresolved.
With the Biograph™ mMR, the world's first combined MRI and PET system, Siemens drives diagnostic stroke imaging to the next level. Using a single molecular magnetic resonance (mMR) scan, highly detailed anatomical imaging and related molecular metabolism data can be subjected to interrelated scientific analysis.
Siemens exceptional mMR imaging technology promises unprecedented insights into stroke pathology, more comprehensive brain imaging, improved stroke morphology analysis, and further optimized patient selection for sound treatment decisions and stroke therapy monitoring.

Angiography

In the case of hemorrhagic stroke, the patient is referred to angiography to examine possible causes of hemorrhage. A hemorrhagic stroke can be caused by high blood pressure or by defective blood vessels in the brain, e.g. a ruptured aneurysm or ruptured AVM.
Digital Subtraction Angiography (DSA) is the gold standard¹ for evaluating intracranial and extracranial vessels (carotid arteries, vertebral arteries). If an anomaly like AVM or aneurysm is diagnosed the interventional radiologist may perform embolization of the pathology.

syngo.via

Accuracy, speed, and efficiency are prerequisites of stroke imaging in diagnostic radiology. They largely depend on adequate imaging software. Diagnostic applications should meet the requirements of precise image analysis, easy, yet flexible use, automation of routine tasks, and smooth integration with the IT network.
syngo.via is Siemens' software for 3D routine and advanced reading in the diagnostic radiology department. syngo.via supports you with automated case preparation, time-saving reading workflows according to diagnostic modality and disease, quick access to information wherever needed, and convenient data sharing with colleagues and clinical partners. Overall, it helps you optimize your diagnostic evaluation of stroke by optimizing the evaluation of angiography and perfusion imaging.

syngo.plaza and syngo.share

Radiological stroke diagnostics and stroke treatment evaluation are not only based on the analysis of current stroke imaging, but also rely on comparisons with earlier brain images from the patient's history.
syngo.plaza, Siemens’ proven and agile Picture Archiving and Communication system (PACS), provides you with easy and concurrent access to 2D, 3D, and 4D² images at a single workplace. A unified, intuitive user interface supports your stroke analysis with automated integration of the patient’s history and an individually defined, preconfigured case presentation depending on complexity.
syngo.share³ offers you access to clinical information and provides a comprehensive, patient-centric view of available images, reports, multi-media, and non-DICOM data from a patient.

1Source: Stroke - A Journal of Cerebral Circulation, How accurate is CT angiography in evaluating intracranial atherosclerotic disease? 2008 Apr; 39(4): 1184-8, and Journal of NeuroInterventional Surgery, Neuroimaging. 2012 May; 4(3): 219-25.

2for example with syngo.via

3syngo.share is a medical device of ITH icoserve technology for healthcare GmbH, Innsbruck, Austria. syngo.share currently is not available in all countries.