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Magnetic Resonance Imaging in Acute Ischemic Stroke Treatment
Although intravenous administration of tissue plasminogen activator is the only proven treatment after acute ischemic stroke, there is always a concern of hemorrhagic risk after thrombolysis. Therefore, selection of patients with potential benefits in overcoming potential harms of thrombolysis is of...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Korean Stroke Society
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4200598/ https://www.ncbi.nlm.nih.gov/pubmed/25328872 http://dx.doi.org/10.5853/jos.2014.16.3.131 |
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author | Kim, Bum Joon Kang, Hyun Goo Kim, Hye-Jin Ahn, Sung-Ho Kim, Na Young Warach, Steven Kang, Dong-Wha |
author_facet | Kim, Bum Joon Kang, Hyun Goo Kim, Hye-Jin Ahn, Sung-Ho Kim, Na Young Warach, Steven Kang, Dong-Wha |
author_sort | Kim, Bum Joon |
collection | PubMed |
description | Although intravenous administration of tissue plasminogen activator is the only proven treatment after acute ischemic stroke, there is always a concern of hemorrhagic risk after thrombolysis. Therefore, selection of patients with potential benefits in overcoming potential harms of thrombolysis is of great importance. Despite the practical issues in using magnetic resonance imaging (MRI) for acute stroke treatment, multimodal MRI can provide useful information for accurate diagnosis of stroke, evaluation of the risks and benefits of thrombolysis, and prediction of outcomes. For example, the high sensitivity and specificity of diffusion-weighted image (DWI) can help distinguish acute ischemic stroke from stroke-mimics. Additionally, the lesion mismatch between perfusion-weighted image (PWI) and DWI is thought to represent potential salvageable tissue by reperfusion therapy. However, the optimal threshold to discriminate between benign oligemic areas and the penumbra is still debatable. Signal changes of fluid-attenuated inversion recovery image within DWI lesions may be a surrogate marker for ischemic lesion age and might indicate risks of hemorrhage after thrombolysis. Clot sign on gradient echo image may reflect the nature of clot, and their location, length and morphology may provide predictive information on recanalization by reperfusion therapy. However, previous clinical trials which solely or mainly relied on perfusion-diffusion mismatch for patient selection, failed to show benefits of MRI-based thrombolysis. Therefore, understanding the clinical implication of various useful MRI findings and comprehensively incorporating those variables into therapeutic decision-making may be a more reasonable approach for expanding the indication of acute stroke thrombolysis. |
format | Online Article Text |
id | pubmed-4200598 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Korean Stroke Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-42005982014-10-17 Magnetic Resonance Imaging in Acute Ischemic Stroke Treatment Kim, Bum Joon Kang, Hyun Goo Kim, Hye-Jin Ahn, Sung-Ho Kim, Na Young Warach, Steven Kang, Dong-Wha J Stroke Review Although intravenous administration of tissue plasminogen activator is the only proven treatment after acute ischemic stroke, there is always a concern of hemorrhagic risk after thrombolysis. Therefore, selection of patients with potential benefits in overcoming potential harms of thrombolysis is of great importance. Despite the practical issues in using magnetic resonance imaging (MRI) for acute stroke treatment, multimodal MRI can provide useful information for accurate diagnosis of stroke, evaluation of the risks and benefits of thrombolysis, and prediction of outcomes. For example, the high sensitivity and specificity of diffusion-weighted image (DWI) can help distinguish acute ischemic stroke from stroke-mimics. Additionally, the lesion mismatch between perfusion-weighted image (PWI) and DWI is thought to represent potential salvageable tissue by reperfusion therapy. However, the optimal threshold to discriminate between benign oligemic areas and the penumbra is still debatable. Signal changes of fluid-attenuated inversion recovery image within DWI lesions may be a surrogate marker for ischemic lesion age and might indicate risks of hemorrhage after thrombolysis. Clot sign on gradient echo image may reflect the nature of clot, and their location, length and morphology may provide predictive information on recanalization by reperfusion therapy. However, previous clinical trials which solely or mainly relied on perfusion-diffusion mismatch for patient selection, failed to show benefits of MRI-based thrombolysis. Therefore, understanding the clinical implication of various useful MRI findings and comprehensively incorporating those variables into therapeutic decision-making may be a more reasonable approach for expanding the indication of acute stroke thrombolysis. Korean Stroke Society 2014-09 2014-09-30 /pmc/articles/PMC4200598/ /pubmed/25328872 http://dx.doi.org/10.5853/jos.2014.16.3.131 Text en Copyright © 2014 Korean Stroke Society http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Review Kim, Bum Joon Kang, Hyun Goo Kim, Hye-Jin Ahn, Sung-Ho Kim, Na Young Warach, Steven Kang, Dong-Wha Magnetic Resonance Imaging in Acute Ischemic Stroke Treatment |
title | Magnetic Resonance Imaging in Acute Ischemic Stroke Treatment |
title_full | Magnetic Resonance Imaging in Acute Ischemic Stroke Treatment |
title_fullStr | Magnetic Resonance Imaging in Acute Ischemic Stroke Treatment |
title_full_unstemmed | Magnetic Resonance Imaging in Acute Ischemic Stroke Treatment |
title_short | Magnetic Resonance Imaging in Acute Ischemic Stroke Treatment |
title_sort | magnetic resonance imaging in acute ischemic stroke treatment |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4200598/ https://www.ncbi.nlm.nih.gov/pubmed/25328872 http://dx.doi.org/10.5853/jos.2014.16.3.131 |
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