Evidence-Based Vascular Neuroimaging

      The fact that an opinion has been widely held is no evidence whatever that it is not utterly absurd.—Bertrand RussellThe practice of medicine has traditionally relied heavily on physicians’ personal experiences and observations from retrospective or case control studies. During the past century, there has been a gradual shift and recognition that the science and practice of medicine should instead be grounded in scientifically sound evidence. The current shift to “value-based” health care model means the evidentiary basis of studies is increasingly scrutinized, and sophisticated hierarchies of evidence have been proposed.
      As the scientific thinking continues to evolve, a new generation of clinicians is adapting by learning to incorporate the statistical reasoning and critical thinking in their treatment decisions. However, despite improved access to information and rapid dissemination of knowledge, a huge gap in evidence and clinical practice remains. New studies are published frequently, and keeping abreast with up-to-date information may be overwhelming to a busy clinician. In addition, randomized controlled trials and studies are performed with fairly narrow selection criteria, and therefore, while the information obtained from these studies can provide general guidelines, these are not always applicable to unique clinical settings.
      This issue of “Evidence-Based Neuroimaging” is our attempt at curating complex, state-of-the-art evidence on the imaging of neurovascular diseases. This compilation of articles covers a broad range of neurovascular pathologic conditions with special emphasis on ischemic stroke and brain aneurysms, where breathtaking advances have occurred in the last two decades. These have significant implications for the role that imaging plays in patient management. It is our hope that these articles, contributed by national experts, summarize contemporary evidence and provide useful guidelines for use and interpretation of various neuroimaging techniques. Where appropriate, the authors also identify the gaps in current knowledge and the potential areas for value of imaging to be established through future studies.
      We are grateful to the entire editorial team at the Neuroimaging Clinics and wish to extend our special thanks to John Vassallo and Karen Justine Solomon for their hard work and professionalism. We truly appreciate Dr Suresh Mukherji’s invitation to edit this exciting issue and, as always, his vision and expert suggestions.
      Over the course of the past few months, we have truly enjoyed editing this issue and hope that the readers will find this work useful in their day-to-day practice.


      Ajay Malhotra:
      To my family, especially my parents, for encouraging curiosity and a questioning mind.
      Dheeraj Gandhi:To my lovely wife, Bobby. And to my amazing daughters, Shreya and Diya, … my greatest gifts.