Neuroimaging within an Evolving Stroke Care Paradigm: A Year in Review - Updates from the March 2026 Brain Attack Coalition Meeting.
Authors
Affiliations (2)
Affiliations (2)
- From the Division of Neuroradiology (V.S.Y.), Johns Hopkins University School of Medicine, Baltimore, MD, USA and Division of Neuroradiology (M.L.J.), University of Virginia, Charlottesville, VA, USA. [email protected].
- From the Division of Neuroradiology (V.S.Y.), Johns Hopkins University School of Medicine, Baltimore, MD, USA and Division of Neuroradiology (M.L.J.), University of Virginia, Charlottesville, VA, USA.
Abstract
Neuroimaging is a central component of the acute stroke care workflow. At the March 2026 Brain Attack Coalition (BAC), discussion centered on changes in practice within modern stroke systems and accessibility of imaging. The primary focus of this discussion was addressing the core imaging requirements of Primary Stroke Centers (PSC). Additional points of discussion include the role of perfusion imaging, growing evidence of neuroimaging's utility in distal medium vessel occlusion (DMVO) stroke, pediatric neuroimaging considerations, and the role of artificial intelligence (AI) within the stroke imaging workflow to support timely care delivery for afflicted patients. This State of Practice reflects a multidisciplinary expert consensus process convened by the BAC in March 2026, including representatives from neuroradiology, neurology, interventional specialties, and the NIH. The BAC reviewed the latest literature and how those impact the prior BAC recommendations. A point of emphasis was the feasibility of imaging across environments of different resource levels. These deliberations reached consensus through exhaustive evaluation of workflow efficiency, equity of access, and clinical applicability. AI was arguably the most deliberated topic, where discussion mainly focused on which components of imaging could be expedited. Noncontrast CT and CT angiography are considered essential at PSCs. Use of advanced imaging, such as perfusion imaging and MRI, is strongly recommended but not required in order to account for resource variability across centers. Imaging remains a central component of the stroke workflow but must facilitate treatment decisions while maintaining flexibility in modality choice based on institutional capabilities. Emerging tools such as AI show promise and can provide supportive value but must be implemented with caution. Overall, the consensus of the BAC was to focus on feasibility and access across centers with respect to mandatory imaging capabilities, while also recognizing the utility of advanced imaging and potentially AI as well.