Prediction of stroke outcome with echoplanar perfusion- and diffusion-weighted MRI

Barber, P. Alan; Darby, David; Desmond, Patricia; Yang, Qing; Gerraty, Richard; Jolley, Damien; Donnan, Geoffrey A; Tress, Brian M.; Davis, Stephen M.

doi:10.1212/wnl.51.2.418

Cited by 508 publications

(424 citation statements)

References 16 publications

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“…Mean volumes were 38 Ϯ 46 cm 3 at day 0, 69 Ϯ 72 cm 3 at day 1, and 57 Ϯ 66 cm 3 at day 60. Mean volumes for patients with arterial recanalization were 31 Ϯ 41 cm 3 , 51 Ϯ 61 cm 3 , and 41 Ϯ 58 cm 3 , respectively. Those for patients without arterial recanalization were 50 Ϯ 54 cm 3 , 100 Ϯ 82 cm 3 , and 86 Ϯ 72 cm 3 at day 60.…”

Section: Resultsmentioning

confidence: 99%

“…How- ever, the ischemic penumbra is a time-dependent dynamic concept, with lesion growth from the center to the periphery and recruitment of tissue at risk into the infarct (21,23). Thus, the mismatch (and thus, inversely, the DWI growth) became the target of stroke therapeutics to evaluate the salvageable tissue (3,24,25). The mismatch model assumes that the initial diffusion lesion represents irreversibly infarcted core tissue.…”

Section: Discussionmentioning

confidence: 99%

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Evolution of lesion volume in acute stroke treated by intravenous t‐PA

Pialat

Wiart

Nighoghossian

et al. 2005

Magnetic Resonance Imaging

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Purpose:To determine the evolution of the ischemic lesion volumes in a population treated with tissue plasminogen activator (t-PA), MRIs were performed before treatment and 24 hours later; final infarct size was evaluated 60 days later. Materials and Methods:A total of 42 patients with hemispheric stroke were recruited for a thrombolytic study. Intravenous t-PA was given after MRI within the first seven hours after stroke onset. Volumes were evaluated on day 0 and day 1 with diffusion-weighted imaging (DWI), on day 60 with T2-weighted imaging (T2WI), and recanalization was assessed based on day 1 MR angiography (MRA).Results: Lesion volume increased between day 0 and day 1, and decreased between day 1 and day 60. It was lower in the group of patients with recanalization on day 1 MRA. Conclusion:Volume analysis emphasizes the effectiveness of recanalization as a predictive factor for better outcome, based on final infarct size. The decrease in lesion volumes between day 1 and day 60 suggests that other factors leads to overestimation of day 1 abnormal diffusion volume. This could explain the delayed partial reversibility of the DWI abnormality.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evolution of lesion volume in acute stroke treated by intravenous t‐PA

Pialat

Wiart

Nighoghossian

et al. 2005

Magnetic Resonance Imaging

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show abstract

“…PWI shows the relative latency of arrival and clearance of blood flow to each voxel of the image. Areas of tissue with a time to peak arrival of contrast of > 4 seconds delay, relative to the homologous region in the contralesional hemisphere, are areas that may be getting enough blood to survive, but not enough to function correctly and can be considered "hypoperfused" (Barber, et al, 1998;Butcher et al, 2005;Hillis et al, 2001b). Therefore, tissue areas of dense ischemia and/or hypoperfusion can be considered dysfunctional.…”

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confidence: 99%

Right hemispatial neglect: Frequency and characterization following acute left hemisphere stroke

Kleinman

Newhart

Davis

et al. 2007

Brain and Cognition

137

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The frequency of various types of unilateral spatial neglect and associated areas of neural dysfunction after left hemisphere stroke are not well characterized. Unilateral spatial neglect (USN) in distinct spatial reference frames have been identified after acute right, but not left hemisphere stroke. We studied 47 consecutive right handed patients within 48 hours of left hemisphere stroke to determine the frequency and distribution of types of right USN using cognitive testing and MRI imaging. The distribution of USN types was different from the previously reported distribution following acute right hemisphere stroke. In this left hemisphere stroke population, allocentric neglect was more frequent than egocentric neglect.

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“…Salvageable tissue in the ischemic penumbra is present in many patients well beyond 3 hours, perhaps even up to 24 or 48 hours. 8,9 The clinical results are supported by Phase II imaging studies such as our Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET) trial, which showed the biological benefits of tPA at 3 to 6 hours in patients with perfusion-diffusion mismatch on MRI with significantly increased reperfusion, strong trends to infarct growth attenuation, and improved clinical outcomes. 10 There are many important questions for the reperfusion field that need to be addressed.…”

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confidence: 94%