Magnetic resonance imaging profiles predict clinical response to early reperfusion: The diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study

Abstract

For stroke patients treated 3 to 6 hours after onset, baseline MRI findings can identify subgroups that are likely to benefit from reperfusion therapies and can potentially identify subgroups that are unlikely to benefit or may be harmed.

The Performance of MRI-Based Cerebral Blood Flow Measurements in Acute and Subacute Stroke Compared With 15O-Water Positron Emission Tomography

“…This is a relevant finding taking into account that a volumetric difference of 20% between DWI and PWI volume is commonly postulated for mismatch definition. 4,7,10,11,48 This methodical problem has already been addressed in previous ROI-based studies of a small patient sample 39,42 and in healthy volunteers. 38 These studies, like in our sample, found good agreement of ROI values on an individual basis.…”

“…Most studies used time-to-peak (TTP) or mean transit time maps for mismatch calculation because these parameters are robust and easy to obtain. [7][8][9][10][11][12][13] The MRI-based measurement of cerebral blood flow (CBF MRI ), although considered a close estimate of cerebral perfusion, 14 was applied in only few clinical studies. 13,[15][16][17][18][19][20][21] CBF MRI was mainly described with respect to infarct development on follow-up MRI that suffered from the uncertainty of perfusion changes between early MRI and follow-up imaging.…”

Stroke- on- Awakening: Safety of CT-CTA Based Selection for Reperfusion Therapy

“…patients with a small core of established infarction have the lowest risk of hemorrhage. 8 others have used multimodal Mr imaging or Ct perfusion imaging to define candidates for thrombolysis outside of proven treatment windows. 9 We believe that a simpler Ct-based paradigm may be used to treat selected patients.…”

Imaging techniques for acute ischemic stroke: nice gadgets or essential tools for effective treatment?

“…For the poor responders to intravenous thrombolysis, both MR and CT are able to provide information on the persistence or reappearance of vessel occlusion and the presence of salvageable tissue that is potentially aided by intra-arterial thrombolysis. MR and CT are potentially able to extend the time window by generating individualized imaging patterns that help stratify risk benefit [13,14]. This allows for more accurate prediction of intracerebral hemorrhage and poor or excellent treatment response to revascularization [15,16].…”

“…The first steps in this direction were taken with studies like Diffusion-Weighted Imaging Evaluation for Understanding Stroke Evolution or Echoplanar Imaging Thrombolysis Evaluation Trial [13,14]. However, they need to be replicated, expanded, and refined.…”