11 Mar 25. Featured Paper

Link to paper on Stroke

Authors

Liebeskind DS & Wardlaw JM

INTRODUCTION

The last year has demonstrated a shift in the stroke imaging landscape, where the greatest challenges have emerged not from hardware limitations or lack of innovation but from methodological inconsistencies in published studies. Journals have increasingly featured studies on stroke imaging that omit critical details about imaging definitions, metrics, and the use of independent core labs. For example, some studies describe ischemic core volumes or perfusion thresholds but fail to explain how these were defined or validated. In the context of large-core ischemic stroke trials, different methodologies for defining ischemic core and infarct patterns have been used, yet details are often missing. This key problem was pointed out 18 years ago – to see that such a lack of transparency continues to undermine the reproducibility of results and their applicability to clinical practice is not justifiable on any level.

Adding to these challenges is the considerable geographic variability in stroke imaging and treatment protocols. Thrombolysis decisions, use of perfusion imaging, and definitions of successful reperfusion based on the eTICI scale vary widely across institutions and regions.³ Some centers prioritize noncontrast CT for rapid assessment, while others employ multimodal MRI-based workflows. Without standardized reporting, it becomes difficult to compare outcomes between studies, especially in multicenter or international trials. Importantly, there should be no differences between the methods actually used in a study or trial and the methods described in published reports or regulatory submissions. Such alignment ensures consistency and credibility, particularly for drug, device, or procedural technique approvals. The BRAINS guideline gives a specific imaging focus to STROBE observational reporting guidelines and aims to address these domain gaps by providing a structured checklist to ensure uniformity in reporting, enabling meaningful comparisons and advancing clinical translation (full list of reporting guidelines and descriptions of why and how to use these will be made available on the Equator Network (www.equator-network.org).