The imaging of ischaemic stroke.

Stroke is a clinical syndrome of a rapidly developing focal neurological deficit that may be classified for practical purposes into ischaemic and haemorrhagic. The role of imaging is to exclude mimics of ischaemic stroke or intracranial haemorrhage and confirm the presence of an ischaemic stroke. Computed tomography (CT) remains the investigation of choice to exclude acute intracranial haemorrhage but diffusion weighted magnetic resonance (MR) has proved to be a sensitive method of detecting early ischaemic infarction. Perfusion weighted MR allows further assessment at the same examination that could help guide the clinician in the risk/benefit analysis of treatment with thrombolytics or neuroprotective agents under evaluation. This can also be achieved with CT. This review article discusses the imaging of ischaemic stroke, relating the pathophysiology of stroke to it. It deals separately in more detail with these newer MR techniques.

[1]  H. Lutsep,et al.  Clinical utility of diffusion‐weighted magnetic resonance imaging in the assessment of ischemic stroke , 1997, Annals of neurology.

[2]  E. Levy,et al.  Reversible ischemia determined by xenon-enhanced CT after 90 minutes of complete basilar artery occlusion. , 1998, AJNR. American journal of neuroradiology.

[3]  G L Wolf,et al.  Assessment of cerebral perfusion and arterial anatomy in hyperacute stroke with three-dimensional functional CT: early clinical results. , 1998, AJNR. American journal of neuroradiology.

[4]  Ischemic core and penumbra in human stroke , 1999 .

[5]  L. Hedlund,et al.  Mechanism of Detection of Acute Cerebral Ischemia in Rats by Diffusion‐Weighted Magnetic Resonance Microscopy , 1992, Stroke.

[6]  T. L. Davis,et al.  Hyperacute stroke: evaluation with combined multisection diffusion-weighted and hemodynamically weighted echo-planar MR imaging. , 1996, Radiology.

[7]  F. Buonanno,et al.  Normal diffusion-weighted MRI during stroke-like deficits , 1999, Neurology.

[8]  Robert Turner,et al.  Diffusion and perfusion magnetic resonance imaging , 1992 .

[9]  B. Rosen,et al.  High resolution measurement of cerebral blood flow using intravascular tracer bolus passages. Part I: Mathematical approach and statistical analysis , 1996, Magnetic resonance in medicine.

[10]  J. Petrella,et al.  Use of MR exponential diffusion-weighted images to eradicate T2 "shine-through" effect. , 1999, AJR. American journal of roentgenology.

[11]  S. Warach,et al.  Pitfalls and potential of clinical diffusion-weighted MR imaging in acute stroke. , 1997, Stroke.

[12]  D. Gur,et al.  Stable xenon-enhanced CT measurement of cerebral blood flow in reversible focal ischemia in baboons. , 1990, Journal of neurosurgery.

[13]  J. Kucharczyk,et al.  Early detection of regional cerebral ischemia in cats: Comparison of diffusion‐ and T2‐weighted MRI and spectroscopy , 1990, Magnetic resonance in medicine.

[14]  H. Yonas,et al.  Xenon/computed tomography cerebral blood flow and its use in clinical management. , 1996, Neurosurgery clinics of North America.

[15]  J. Broderick,et al.  Frequency and accuracy of prehospital diagnosis of acute stroke. , 1995, Stroke.

[16]  S. Atlas,et al.  Diffusion-weighted MRI in acute subcortical infarction. , 1998, Stroke.

[17]  A. Alexandrov,et al.  Brain single-photon emission CT with HMPAO and safety of thrombolytic therapy in acute ischemic stroke. Proceedings of the meeting of the SPECT Safe Thrombolysis Study Collaborators and the members of the Brain Imaging Council of the Society of Nuclear Medicine. , 1997, Stroke.

[18]  J W Belliveau,et al.  Functional cerebral imaging by susceptibility‐contrast NMR , 1990, Magnetic resonance in medicine.

[19]  K. Noguchi,et al.  Diffusion-weighted echo-planar MRI of lacunar infarcts , 1998, Neuroradiology.

[20]  S M Davis,et al.  Identification of major ischemic change. Diffusion-weighted imaging versus computed tomography. , 1999, Stroke.

[21]  L H Schwamm,et al.  Regional ischemia and ischemic injury in patients with acute middle cerebral artery stroke as defined by early diffusion-weighted and perfusion-weighted MRI. , 1998, Stroke.

[22]  D. Le Bihan,et al.  Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging. , 1988, Radiology.

[23]  W. Yuh,et al.  Magnetic resonance versus computed tomographic imaging in acute stroke. , 1995, Stroke.

[24]  R. Latchaw,et al.  "Brain attack": the rationale for treating stroke as a medical emergency. , 1994, Neurosurgery.

[25]  T. Beardsley Cross reaction. Could AIDS really be an autoimmune disease? , 1991, Scientific American.

[26]  Outcome of acute ischemic lesions evaluated by diffusion and perfusion MR imaging. , 1999, AJNR. American journal of neuroradiology.

[27]  W T Yuh,et al.  Application of contrast agents in the evaluation of stroke: Conventional MR and echo‐planar MR imaging , 1997, Journal of magnetic resonance imaging : JMRI.

[28]  J. Kurhanewicz,et al.  Diffusion-weighted MR imaging of acute stroke: correlation with T2-weighted and magnetic susceptibility-enhanced MR imaging in cats. , 1990, AJNR. American journal of neuroradiology.

[29]  M. Paley,et al.  Acute neuromedical and neurosurgical admissions: Standard and ultrafast MR imaging of the brain compared with cranial CT , 2000, Acta radiologica.

[30]  C F Starmer,et al.  Computer computations of cardiac output using the gamma function. , 1970, Journal of applied physiology.

[31]  L. Axel Cerebral blood flow determination by rapid-sequence computed tomography: theoretical analysis. , 1980, Radiology.

[32]  R N Bryan,et al.  Absolute quantitation of diffusion constants in human stroke. , 1997, Stroke.

[33]  M Fisher,et al.  Characterizing the target of acute stroke therapy. , 1997, Stroke.

[34]  G. Albers,et al.  Applications of diffusion–perfusion magnetic resonance imaging in acute ischemic stroke , 1999, Neurology.

[35]  B. Rosen,et al.  High resolution measurement of cerebral blood flow using intravascular tracer bolus passages. Part II: Experimental comparison and preliminary results , 1996, Magnetic resonance in medicine.

[36]  B. Rosen,et al.  Pitfalls in MR measurement of tissue blood flow with intravascular tracers: Which mean transit time? , 1993, Magnetic resonance in medicine.

[37]  I D Wilkinson,et al.  Detection of subarachnoid haemorrhage with magnetic resonance imaging , 2001, Journal of neurology, neurosurgery, and psychiatry.

[38]  M E Moseley,et al.  Comparison of diffusion‐ and T2‐weighted MRI for the early detection of cerebral ischemia and reperfusion in rats , 1991, Magnetic resonance in medicine.

[39]  J. Alvir,et al.  Conditions that mimic stroke in the emergency department. Implications for acute stroke trials. , 1995, Archives of neurology.

[40]  W. Mali,et al.  Diffusion-weighted magnetic resonance imaging in acute stroke. , 1998, Stroke.

[41]  M Buxton-Thomas,et al.  Quantitative perfusion imaging in carotid artery stenosis using dynamic susceptibility contrast-enhanced magnetic resonance imaging. , 2000, Magnetic resonance imaging.

[42]  H Soltanian-Zadeh,et al.  Time course of ADCw changes in ischemic stroke: beyond the human eye! , 1998, Stroke.

[43]  H. Yonas,et al.  Relation between cerebral blood flow and neurologic deficit resolution in acute ischemic stroke , 1998, Neurology.

[44]  D Chien,et al.  MR diffusion imaging of cerebral infarction in humans. , 1992, AJNR. American journal of neuroradiology.

[45]  J. Lodder,et al.  Lacunar Infarcts: Pathogenesis and Validity of the Clinical Syndromes , 1991, Stroke.

[46]  E Klotz,et al.  Perfusion CT of the brain: diagnostic approach for early detection of ischemic stroke. , 1998, Radiology.

[47]  D. Gur,et al.  Adverse reactions to xenon-enhanced CT cerebral blood flow determination. , 1987, Radiology.

[48]  M. Kaste,et al.  Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS) , 1995, JAMA.

[49]  C. Manelfe,et al.  Early CT Diagnosis of Hemispheric Brain Infarction , 1995, Springer Berlin Heidelberg.

[50]  L H Schwamm,et al.  Diffusion-weighted MR imaging: diagnostic accuracy in patients imaged within 6 hours of stroke symptom onset. , 1999, Radiology.

[51]  Wei Li,et al.  Acute cerebral ischemia: evaluation with dynamic contrast-enhanced MR imaging and MR angiography. , 1992, Radiology.

[52]  J M Wardlaw,et al.  Can stroke physicians and neuroradiologists identify signs of early cerebral infarction on CT? , 1999, Journal of neurology, neurosurgery, and psychiatry.

[53]  B. Rosen,et al.  Dynamic imaging with lanthanide chelates in normal brain: Contrast due to magnetic susceptibility effects , 1988, Magnetic resonance in medicine.

[54]  David J. Weatherall,et al.  Oxford textbook of medicine , 1996 .

[55]  A. Bozzao,et al.  Early collateral blood supply and late parenchymal brain damage in patients with middle cerebral artery occlusion. , 1989, Stroke.

[56]  J. Tsuruda,et al.  Diffusion-weighted MR imaging of anisotropic water diffusion in cat central nervous system. , 1990, Radiology.