Effect of Intravenous Thrombolysis on MRI Parameters and Functional Outcome in Acute Stroke &lt;6 Hours

Röther, Joachim; Schellinger, Peter D.; Gass, Achim; Siebler, Mario; Villringer, Arno; Fiebach, Jochen B.; Fiehler, Jens; Jansen, Olav; Kucinski, Thomas; Schoder, Volker; Szabo, Kristina; Jungehülsing, Gerhard Jan; Hennerici, Michael G.; Zeumer, H.; Sartor, Klaus; Weiller, Cornelius; Hacke, Werner

doi:10.1161/01.str.0000030109.12281.23

Cited by 320 publications

(246 citation statements)

References 53 publications

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“…This also illustrates the dynamic nature of the core-penumbra. Because several studies have reported that ischemic lesions were undetected with DWI 29,30 or that severe reductions in ADC normalized over time depending on the duration and severity of ischemia, 31 it is likely that serial measurements may be needed to improve MRI sensitivity to better estimate tissue injury. Recent reviews report existence of 'mini-core' and 'mini-penumbra' (interdigitation) and their spatiotemporal dynamics in IHC, 2 which HRS could detect noninvasively from MRI ( Figure 2).…”

Section: Discussionmentioning

confidence: 99%

Automated Core–Penumbra Quantification in Neonatal Ischemic Brain Injury

Ghosh

Yuan

Turenius

et al. 2012

J Cereb Blood Flow Metab

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Neonatal hypoxic-ischemic brain injury (HII) and arterial ischemic stroke (AIS) result in irreversibly injured (core) and salvageable (penumbral) tissue regions. Identification and reliable quantification of salvageable tissue is pivotal to any effective and safe intervention. Magnetic resonance imaging (MRI) is the current standard to distinguish core from penumbra using diffusionperfusion mismatch (DPM). However, subtle MR signal variations between core-penumbral regions make their visual delineation difficult. We hypothesized that computational analysis of MRI data provides a more accurate assessment of core and penumbral tissue evolution in HII/AIS. We used two neonatal rat-pup models of HII/AIS (unilateral and global hypoxic-ischemia) and clinical data sets from neonates with AIS to test our noninvasive, automated computational approach, Hierarchical Region Splitting (HRS), to detect and quantify ischemic core-penumbra using only a single MRI modality (T2-or diffusion-weighted imaging, T2WI/DWI). We also validated our approach by comparing core-penumbral images (from HRS) to DPM with immunohistochemical validation of HII tissues. Our translational and clinical data results showed that HRS could accurately and reliably distinguish the ischemic core from penumbra and their spatiotemporal evolution, which may aid in the vetting and execution of effective therapeutic interventions as well as patient selection.

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Section: Discussionmentioning

confidence: 99%

Automated Core–Penumbra Quantification in Neonatal Ischemic Brain Injury

Ghosh

Yuan

Turenius

et al. 2012

J Cereb Blood Flow Metab

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“…Furthermore, major reperfusion and lesser infarct growth predicted better neurological outcome after stroke (41). Thus, a major predictor for recovery is early effective reperfusion (41)(42)(43).…”

Section: Discussionmentioning

confidence: 99%

Significance of the perfusion‐diffusion mismatch in chronic cerebral ischemia

Surikova

Meisel

Siebler

et al. 2006

Magnetic Resonance Imaging

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Purpose: To determine whether the perfusion deficit could predict brain infarction in patients with chronic cerebral ischemia who experienced recurring episodes of neurological symptoms and showed a perfusion-diffusion mismatch on magnetic resonance (MR) images. Materials and Methods:In 53 consecutive patients (38 males and 15 females, 62 Ϯ 13 years old) with ischemia in the middle cerebral artery (MCA) territory, lesion volumetry was performed on parametric maps of the time-to-peak, the cerebral blood volume, and diffusion-weighted (DW) images. The infarct lesions were assessed on follow-up T2-weighted (T2W) MR images after eight days. Cerebrovascular changes were determined by time-of-flight (TOF) MR angiography (MRA). Inferential and correlation statistics were used. Results:Patients with chronic ischemic brain disease (N ϭ 39) who presented with a severe perfusion-diffusion mismatch in the presence of a normal cerebral blood volume had no or small brain infarctions as found on follow-up T2W images. MRA revealed widespread abnormalities of the basal cerebral arteries compatible with brain perfusion abnormalities. In contrast, in acute stroke patients (N ϭ 14) the deficit of cerebral perfusion predicted the infarct lesion in the T2W images. Conclusion:Our results suggest that in chronic cerebral ischemia the normal blood volume was maintained despite the depression of cerebral perfusion and recurring minor insults.

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“…However, a few groups have observed changes in the fMRI response, which correlate with the clinical literature. Stimulation of the impaired limbs produced activation in the intact sensorimotor cortex, and formerly unresponsive regions in the peri-infarcted tissue (Abo et al, 2001;Dijkhuizen et al, 2001;Rother et al, 2002). Interestingly, when repetitive fMRI sessions were performed in the same animals, three types of responders were characterized: those that retained, those that lost, and those that exhibited only a transient loss of the bloodoxygen-level-dependent response that was independent of infarct size measurements (Weber et al, 2008).…”

Section: Functional Mrimentioning

confidence: 99%

Use of Magnetic Resonance Imaging to Predict Outcome after Stroke: A Review of Experimental and Clinical Evidence

Farr

Wegener

2010

J Cereb Blood Flow Metab

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Despite promising results in preclinical stroke research, translation of experimental data into clinical therapy has been difficult. One reason is the heterogeneity of the disease with outcomes ranging from complete recovery to continued decline. A successful treatment in one situation may be ineffective, or even harmful, in another. To overcome this, treatment must be tailored according to the individual based on identification of the risk of damage and estimation of potential recovery. Neuroimaging, particularly magnetic resonance imaging (MRI), could be the tool for a rapid comprehensive assessment in acute stroke with the potential to guide treatment decisions for a better clinical outcome. This review describes current MRI techniques used to characterize stroke in a preclinical research setting, as well as in the clinic. Furthermore, we will discuss current developments and the future potential of neuroimaging for stroke outcome prediction.

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Effect of Intravenous Thrombolysis on MRI Parameters and Functional Outcome in Acute Stroke <6 Hours

Cited by 320 publications

References 53 publications

Automated Core–Penumbra Quantification in Neonatal Ischemic Brain Injury

Automated Core–Penumbra Quantification in Neonatal Ischemic Brain Injury

Significance of the perfusion‐diffusion mismatch in chronic cerebral ischemia

Use of Magnetic Resonance Imaging to Predict Outcome after Stroke: A Review of Experimental and Clinical Evidence

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