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Indication of thrombolysis for middle cerebral artery occlusion using MR diffusion - weighted image
Abstract:
We have evaluated the usefulness of diffusionweighted MRI (DWI) for determining an indication of emergent thrombolytic revascularization therapy in patients with acute occlusive cerebrovascular disease. Out of twenty-nine patients with acute occlusion of the middle cerebral artery within six hours after the onset, nine patients performed thrombolytic therapy. In results, seven patients of them obtained revascularization and good outcome. DWI findings on admission were correlated to the cerebral blood flow measured by SPECT and classified into four types; Type 1: no high intensity, Type 2: high intensity only in the perforator's territory, Type 3: limited high intensity in the cortical branches' territory, Type 4: extended high intensity. As presented cases, the high intensity area seen on DWI became obvious infarction regardless of implementation of revascularization therapy. However, thrombolytic therapy could rescue the area of low CBF on SPECT and could improve clinical symptoms. We considered that the area of low CBF without high intensity on DWI was "ischemic penumbra" and classification of DWI findings could be a valuable indicator in determining an indication of thrombolytic therapy.
Insights
Diffusion-weighted MRI (DWI) helps identify stroke patients who can benefit from thrombolytic therapy. DWI findings, combined with cerebral blood flow (CBF) SPECT scans, aid in selecting patients for reperfusion and improving outcomes.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Medicine
Background:
- Acute occlusive cerebrovascular disease requires timely intervention.
- Thrombolytic therapy offers a potential treatment for acute stroke.
- Accurate patient selection is crucial for successful thrombolytic therapy.
Purpose of the Study:
- To evaluate the utility of diffusion-weighted MRI (DWI) in guiding emergent thrombolytic revascularization therapy.
- To correlate DWI findings with cerebral blood flow (CBF) measurements.
- To identify indicators for selecting patients eligible for thrombolytic treatment.
Main Methods:
- Diffusion-weighted MRI (DWI) was performed on 29 patients with acute middle cerebral artery occlusion.
- Patients were assessed within six hours of symptom onset.
- DWI findings were correlated with SPECT-measured CBF and classified into four types based on lesion extent.
Main Results:
- Nine patients received thrombolytic therapy, with seven achieving revascularization and good outcomes.
- DWI high-intensity areas indicated established infarction, irrespective of treatment.
- Thrombolytic therapy successfully salvaged low CBF areas on SPECT, improving clinical symptoms.
Conclusions:
- The "ischemic penumbra" was defined as areas of low CBF without DWI high intensity.
- DWI classification is a valuable tool for determining thrombolytic therapy indications.
- This approach can optimize treatment selection for acute stroke patients.
