By Rüdiger von Kummer, Tobias Back, K. Sartor

The imaging of stroke has passed through major alterations due to the fast development in imaging expertise. This quantity, comprising 3 elements, is designed to supply a accomplished precis of the present function of MR imaging in sufferers with ischemic stroke. the 1st half outlines the medical displays of stroke and discusses the diagnostic efficacy and healing influence of MR imaging. the second one and 3rd elements shape the center of the amount, and are in accordance with a unique procedure in that the subject is gifted from very assorted viewpoints. half 2 presents an in depth presentation of the distinguishing positive aspects of stroke from the radiologist's standpoint. in contrast, half three addresses the wishes of the clinician, documenting particular stroke syndromes and their correlates on MR imaging. the final target has been to create a well-illustrated quantity with vast attraction that hyperlinks pathology, radiology and stroke medication in an informative manner.

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In the comparison between tPA treated patients and untreated controls; baseline to outcome infarct expansion, reperfusion, and penumbral salvage all had strong correlations with clinically meaningful improvement. These correlations were independent of treatment group, although a higher proportion of tPA treated patients had better MRI and clinical outcomes. Other studies have also demonstrated the potential value of using PI/DWI in proof concept studies. Our group has shown, based on statistical modelling from a natural history stroke cohort with serial PI/DWI, that a therapy postulated to reduce infarct expansion by 50% would need 100 patients in each group to show a significant difference between treatment and placebo groups (Barber et al.

By 6 h, 75%–80% of patients still have penumbral tissue (Darby et al. 1999; Read et al. 2000). This is a substantial number, although a significant minority of patients in the 3- to 6-h window are unlikely to benefit from thrombolysis if the standard clinical and non-contrast CT criteria are applied (and may explain the less convincing 3to 6-h tPA trial results to date) (Hacke et al. 1995, 1998). Indeed, it was recently demonstrated that the size of the infarct core varied dramatically between patients in the first 6 h after middle cerebral artery (MCA) occlusion, and was the strongest predictor of outcome (Jovin et al.

W. Parsons and S. M. Davis 28 a b Fig. 5a,b. a Patient imaged at 3 h after stroke onset. There is a large perfusion lesion and extensive perfusion-diffusion mismatch. The PI map is a contrast mean transit time (MTT), green tissue is moderate contrast delay (4–6 s) and red is severe delay (> 6 s). The patient did not receive tPA, and at day 3 had persisting vessel occlusion on MRA (arrow) and large perfusion lesion. Consequently, there was major infarct expansion. b Patient treated with t-PA 5 h after symptom onset following MRI.

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