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A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
09:59

A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia

Published on: September 16, 2017

Clinical impact of MRI perfusion disturbances and normal diffusion in acute stroke patients

D Blondin1, R J Seitz, O Rusch

  • 1Institute of Diagnostic Radiology, University Hospital Duesseldorf, Moorenstr. 5, D-40225 Germany. blondin@med.uni-duesseldorf.de

European Journal of Radiology
|May 21, 2008
PubMed
Abstract

Insights

Perfusion imaging, not diffusion imaging, identified eligible acute stroke patients for thrombolysis. This approach enabled successful treatment and symptom reversal in patients with severe stroke symptoms but no diffusion abnormalities.

Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Acute ischemic stroke diagnosis often relies on MR imaging showing diffusion abnormalities and reduced perfusion, indicating the ischemic penumbra.
  • Mismatch between diffusion and perfusion imaging guides thrombolysis decisions.
  • The role of thrombolysis in acute stroke without diffusion abnormalities but with perfusion deficits is unclear.

Purpose of the Study:

  • To investigate the indication for thrombolytic treatment in acute stroke patients presenting with pathological perfusion and acute symptoms but no diffusion abnormalities on MR imaging.

Main Methods:

  • Retrospective analysis of MR imaging data from 1465 stroke patients treated between June 2004 and May 2007.
  • Inclusion criteria: severe neurological symptoms, large territorial perfusion disturbances, lack of diffusion abnormalities, and complete neurological recovery post-treatment.
  • Six patients met the inclusion criteria for detailed analysis.

Main Results:

  • Mean transit time (MTT) measurements revealed significantly depressed perfusion in the symptomatic hemisphere of all six analyzed patients (p<0.02).
  • Time-to-peak delay strongly correlated with mean transit time delay (0.949, p<0.01).
  • Thrombolysis was indicated based on perfusion abnormalities and clinical symptoms, leading to complete reversal of stroke symptoms without complications.

Conclusions:

  • Perfusion analysis, despite normal diffusion imaging, validated the use of systemic thrombolysis in selected acute stroke patients.
  • Multimodal MR imaging, including perfusion assessment, is crucial for guiding treatment decisions in acute stroke.
  • This study highlights the potential of perfusion imaging to identify candidates for thrombolysis when diffusion imaging is inconclusive.

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