Venous imaging-based biomarkers in acute ischaemic stroke

Josep Munuera, Gerard Blasco, María Hernández-Pérez, Pepus Daunis-I-Estadella, Antoni Dávalos, David S. Liebeskind, Max Wintermark, Andrew Demchuk, Bijoy K. Menon, Götz Thomalla, Kambiz Nael, Salvador Pedraza, Josep Puig

Research output: Contribution to journalReview articlepeer-review

20 Scopus citations


Vascular neuroimaging plays a decisive role in selecting the best therapy in patients with acute ischaemic stroke. However, compared with the arterial system, the role of veins has not been thoroughly studied. In this review, we present the major venous imaging-based biomarkers in ischaemic stroke. First, the presence of hypodense veins in the monophasic CT angiography ipsilateral to the arterial occlusion. Second, the asymmetry of venous drainage in the pathological cerebral hemisphere on CT and MRI dynamic angiography. Finally, the presence of hypodense veins on T2∗ -based MRI. From the physiological point of view, the venous imaging-based biomarkers would detect the alteration of brain perfusion (flow), as well as the optimisation of extraction oxygen mechanisms (misery perfusion). Several studies have correlated the venous imaging-based biomarkers with grade of collateral circulation, the ischaemic penumbra and clinical functional outcome. Although venous imaging-based biomarkers still have to be validated, growing evidence highlights a potential complementary role in the acute stroke clinical decision-making process.

Original languageEnglish (US)
Pages (from-to)62-69
Number of pages8
JournalJournal of Neurology, Neurosurgery and Psychiatry
Issue number1
StatePublished - Jan 1 2017


  • MRI

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Psychiatry and Mental health


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