Skip to main content
SpringerLink
Log in

The Impact of Neuroimaging on Acute Stroke Treatment: Role of Magnetic Resonance Imaging

  • Chapter
  • First Online:
Book cover Thrombolytic Therapy for Acute Stroke

  • 1571 Accesses

Abstract

Intravenous thrombolysis with rt-PA has been the only proven acute stroke treatment for nearly two decades. There has been an ongoing debate about which imaging modality is the best and most adequate for acute stroke patients. In essence, the competitors are CT-based protocols (see previous chapter) and MRI-based approaches, which are the content of this chapter. We describe first protocol design for acute stroke MRI protocols and then what can be seen on the single sequences of a stroke MRI protocol. The advantages of MRI as an imaging modality are put forward and imaging based treatment paradigms are presented and discussed. Finally, we elaborate on the most recent trials utilizing this intriguing technology in perspective to clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

AICS:

Acute ischemic cerebrovascular syndrome

AIS:

Acute ischemic stroke

ADC:

Apparent diffusion coefficient

CBV:

Cerebral blood volume

CT:

Computed tomography

DWI:

Diffusion-weighted imaging

DSC:

Dynamic susceptibility contrast-enhanced

FLAIR:

Fluid attenuated inversion recovery

GRE:

Gradient echo

IA:

Intra-arterial

ICH:

Intracerebral hemorrhage

IV:

Intravenous

MRA:

Magnetic resonance angiography

MRI:

Magnetic resonance imaging

MIP:

Maximum intensity projection

NINDS:

National Institutes of Neurological Disorders and Stroke

SPECT:

Single-photon emission computed tomography

SAH:

Subarachnoid hemorrhage

SWI:

Susceptibility-weighted imaging

T2*-WI:

T2*-weighted imaging

tPA:

Tissue plasminogen activator

PI:

Perfusion imaging

PI/DWI-mismatch:

Perfusion-diffusion mismatch

PET:

Positron emission tomography

T2-WI:

T2-weighted imaging

TOF:

Time-of-flight

References

  1. Powers WJ, Zivin J. Magnetic resonance imaging in acute stroke: not ready for prime time. Neurology. 1998;50:842–3.

    Article  CAS  PubMed  Google Scholar 

  2. Schellinger PD. The evolving role of advanced MR imaging as a management tool for adult ischemic stroke: a western-European perspective. Neuroimaging Clin N Am. 2005;15:245–58, ix.

    Article  PubMed  Google Scholar 

  3. Sunshine JL, Tarr RW, Lanzieri CF, Landis DMD, Selman WR, Lewin JS. Hyperacute stroke: ultrafast MR imaging to triage patients prior to therapy. Radiology. 1999;212:325–32.

    Article  CAS  PubMed  Google Scholar 

  4. Schellinger PD, Jansen O, Fiebach JB, Pohlers O, Ryssel H, Heiland S, Steiner T, Hacke W, Sartor K. Feasibility and practicality of MR imaging of stroke in the management of hyperacute cerebral ischemia. AJNR Am J Neuroradiol. 2000;21:1184–9.

    CAS  PubMed  Google Scholar 

  5. Ruland S, Gorelick PB, Schneck M, Kim D, Moore CG, Leurgans S. Acute stroke care in illinois: a statewide assessment of diagnostic and treatment capabilities. Stroke. 2002;33:1334–9.

    Article  PubMed  Google Scholar 

  6. Mohr JP, Biller J, Hilal SK, Yuh WT, Tatemichi TK, Hedges S, Tali E, Nguyen H, Mun I, Adams Jr HP, et al. Magnetic resonance versus computed tomographic imaging in acute stroke. Stroke. 1995;26:807–12.

    Article  CAS  PubMed  Google Scholar 

  7. Schellinger PD, Chalela JA, Kang DW, Latour LL, Warach S. Diagnostic and prognostic value of early MR imaging vessel signs in hyperacute stroke patients imaged <3 hours and treated with recombinant tissue plasminogen activator. AJNR Am J Neuroradiol. 2005;26:618–24.

    PubMed  Google Scholar 

  8. Ebinger M, Kufner A, Galinovic I, Brunecker P, Malzahn U, Nolte CH, Endres M, Fiebach JB. Fluid-attenuated inversion recovery images and stroke outcome after thrombolysis. Stroke. 2012;43:539–42.

    Article  PubMed  Google Scholar 

  9. Ebinger M, Scheitz JF, Kufner A, Endres M, Fiebach JB, Nolte CH. MRI-based intravenous thrombolysis in stroke patients with unknown time of symptom onset. Eur J Neurol. 2012;19:348–50.

    Article  CAS  PubMed  Google Scholar 

  10. Thomalla G, Cheng B, Ebinger M, Hao Q, Tourdias T, Wu O, Kim JS, Breuer L, Singer OC, Warach S, Christensen S, Treszl A, Forkert ND, Galinovic I, Rosenkranz M, Engelhorn T, Kohrmann M, Endres M, Kang DW, Dousset V, Sorensen AG, Liebeskind DS, Fiebach JB, Fiehler J, Gerloff C. DWI-FLAIR mismatch for the identification of patients with acute ischaemic stroke within 4.5 h of symptom onset (pre-flair): a multicentre observational study. Lancet Neurol. 2011;10:978–86.

    Article  PubMed  Google Scholar 

  11. Moseley ME, Kucharczyk J, Mintorovitch J, Cohen Y, Kurhanewicz J, Derugin N, Asgari H, Norman D. Diffusion-weighted MR imaging of acute stroke: correlation with t2-weighted and magnetic susceptibility-enhanced MR imaging in cats. AJNR Am J Neuroradiol. 1990;11:423–9.

    CAS  PubMed  Google Scholar 

  12. Purushotham A, Campbell BC, Straka M, Mlynash M, Olivot JM, Bammer R, Kemp SM, Albers GW, Lansberg MG. Apparent diffusion coefficient threshold for delineation of ischemic core. Int J Stroke. 2013.

    Google Scholar 

  13. Fiehler J, Foth M, Kucinski T, Knab R, von Bezold M, Weiller C, Zeumer H, Röther J. Severe ADC decreases do not predict irreversible tissue damage in humans. Stroke. 2002;33:79–86.

    Article  PubMed  Google Scholar 

  14. Latour LL, Warach S. Cerebral spinal fluid contamination of the measurement of the apparent diffusion coefficient of water in acute stroke. Magn Reson Med. 2002;48:478–86.

    Article  PubMed  Google Scholar 

  15. Fiebach JB, Schellinger PD, Jansen O, Meyer M, Wilde P, Bender J, Schramm P, Jüttler E, Öhler J, Hartmann M, Hähnel S, Knauth M, Hacke W, Sartor K. CT and diffusion-weighted MR-imaging in randomized order: DWI results in higher accuracy and lower interrater variability in the diagnosis of hyperacute ischemic stroke. Stroke. 2002;33:2206–10.

    Article  CAS  PubMed  Google Scholar 

  16. Saur D, Kucinski T, Grzyska U, Eckert B, Eggers C, Niesen W, Schoder V, Zeumer H, Weiller C, Rother J. Sensitivity and interrater agreement of ct and diffusion-weighted MR imaging in hyperacute stroke. AJNR Am J Neuroradiol. 2003;24:878–85.

    PubMed  Google Scholar 

  17. Chalela JA, Kang DW, Luby M, Ezzeddine M, Latour LL, Todd JW, Dunn B, Warach S. Early magnetic resonance imaging findings in patients receiving tissue plasminogen activator predict outcome: insights into the pathophysiology of acute stroke in the thrombolysis era. Ann Neurol. 2004;55:105–12.

    Article  PubMed  Google Scholar 

  18. Lovblad KO, Jakob PM, Chen Q, Baird AE, Schlaug G, Warach S, Edelman RR. Turbo spin-echo diffusion-weighted MR of ischemic stroke. AJNR Am J Neuroradiol. 1998;19:201–8.

    CAS  PubMed  Google Scholar 

  19. Lovblad KO, Laubach HJ, Baird AE, Curtin F, Schlaug G, Edelman RR, Warach S. Clinical experience with diffusion-weighted MR in patients with acute stroke. AJNR Am J Neuroradiol. 1998;19:1061–6.

    CAS  PubMed  Google Scholar 

  20. Barber PA, Darby DG, Desmond PM, Yang Q, Gerraty RP, Jolley D, Donnan GA, Tress BM, Davis SM. Prediction of stroke outcome with echoplanar perfusion- and diffusion-weighted MRI. Neurology. 1998;51:418–26.

    Article  CAS  PubMed  Google Scholar 

  21. Warach S, Pettigrew LC, Dashe JF, Pullicino P, Lefkowitz DM, Sabounjian L, Harnett K, Schwiderski U, Gammans R. Effect of citicoline on ischemic lesions as measured by diffusion-weighted magnetic resonance imaging. Citicoline 010 investigators. Ann Neurol. 2000;48:713–22.

    Article  CAS  PubMed  Google Scholar 

  22. Kidwell CS, Alger JR, Di Salle F, Starkman S, Villablanca P, Bentson J, Saver JL. Diffusion MRI in patients with transient ischemic attacks. Stroke. 1999;30:1174–80.

    Article  CAS  PubMed  Google Scholar 

  23. Engelter ST, Provenzale JM, Petrella JR, Alberts MJ. Diffusion MR imaging and transient ischemic attacks. Stroke. 1999;30:2762–3.

    Article  CAS  PubMed  Google Scholar 

  24. Ay H, Oliveira-Filho J, Buonanno FS, Schaefer PW, Furie KL, Chang YC, Rordorf G, Schwamm LH, Gonzalez RG, Koroshetz WJ. ‘Footprints’ of transient ischemic attacks: a diffusion-weighted MRI study. Cerebrovasc Dis. 2002;14:177–86.

    Article  PubMed  Google Scholar 

  25. Takayama H, Mihara B, Kobayashi M, Hozumi A, Sadanaga H, Gomi S. [Usefulness of diffusion-weighted MRI in the diagnosis of transient ischemic attacks]. No To Shinkei. 2000;52:919–23.

    CAS  PubMed  Google Scholar 

  26. Bisschops RH, Kappelle LJ, Mali WP, van der Grond J. Hemodynamic and metabolic changes in transient ischemic attack patients: a magnetic resonance angiography and (1)h-magnetic resonance spectroscopy study performed within 3 days of onset of a transient ischemic attack. Stroke. 2002;33:110–5.

    Article  CAS  PubMed  Google Scholar 

  27. Rovira A, Rovira-Gols A, Pedraza S, Grive E, Molina C, Alvarez-Sabin J. Diffusion-weighted MR imaging in the acute phase of transient ischemic attacks. AJNR Am J Neuroradiol. 2002;23:77–83.

    PubMed  Google Scholar 

  28. Kamal AK, Segal AZ, Ulug AM. Quantitative diffusion-weighted MR imaging in transient ischemic attacks. AJNR Am J Neuroradiol. 2002;23:1533–8.

    PubMed  Google Scholar 

  29. Campbell BC, Purushotham A, Christensen S, Desmond PM, Nagakane Y, Parsons MW, Lansberg MG, Mlynash M, Straka M, De Silva DA, Olivot JM, Bammer R, Albers GW, Donnan GA, Davis SM. The infarct core is well represented by the acute diffusion lesion: sustained reversal is infrequent. J Cereb Blood Flow Metab. 2012;32:50–6.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Warach S, Kidwell CS. The redefinition of TIA: the uses and limitations of DWI in acute ischemic cerebrovascular syndromes. Neurology. 2004;62:359–60.

    Article  PubMed  Google Scholar 

  31. Kidwell CS, Alger JR, Saver JL. Beyond mismatch: evolving paradigms in imaging the ischemic penumbra with multimodal magnetic resonance imaging. Stroke. 2003;34:2729–35.

    Article  PubMed  Google Scholar 

  32. Kidwell CS, Warach S. Acute ischemic cerebrovascular syndrome: diagnostic criteria. Stroke. 2003;34:2995–8.

    Article  PubMed  Google Scholar 

  33. Rosen BR, Belliveau JW, Chien D. Perfusion imaging by nuclear magnetic resonance. Magn Reson Q. 1989;5:263–81.

    CAS  PubMed  Google Scholar 

  34. Rosen BR, Belliveau JW, Vevea JM, Brady TJ. Perfusion imaging with NMR contrast agents. Magn Reson Med. 1990;14:249–65.

    Article  CAS  PubMed  Google Scholar 

  35. Baird AE, Lovblad KO, Dashe JF, Connor A, Burzynski C, Schlaug G, Straroselskaya I, Edelman RR, Warach S. Clinical correlations of diffusion and perfusion lesion volumes in acute ischemic stroke. Cerebrovasc Dis. 2000;10:441–8.

    Article  CAS  PubMed  Google Scholar 

  36. Schellinger PD, Fiebach JB, Jansen O, Ringleb PA, Mohr A, Steiner T, Heiland S, Schwab S, Pohlers O, Ryssel H, Orakcioglu B, Sartor K, Hacke W. Stroke magnetic resonance imaging within 6 hours after onset of hyperacute cerebral ischemia. Ann Neurol. 2001;49:460–9.

    Article  CAS  PubMed  Google Scholar 

  37. Griebe M, Kern R, Eisele P, Sick C, Wolf ME, Sauter-Servaes J, Gregori J, Gunther M, Hennerici MG, Szabo K. Continuous magnetic resonance perfusion imaging acquisition during systemic thrombolysis in acute stroke. Cerebrovasc Dis. 2013;35:554–9.

    Article  CAS  PubMed  Google Scholar 

  38. Paiva FF, Tannus A, Silva AC. Measurement of cerebral perfusion territories using arterial spin labelling. NMR Biomed. 2007;20:633–42.

    Article  PubMed  Google Scholar 

  39. Lansberg MG, Lee J, Christensen S, Straka M, De Silva DA, Mlynash M, Campbell BC, Bammer R, Olivot JM, Desmond P, Davis SM, Donnan GA, Albers GW. Rapid automated patient selection for reperfusion therapy: a pooled analysis of the echoplanar imaging thrombolytic evaluation trial (epithet) and the diffusion and perfusion imaging evaluation for understanding stroke evolution (defuse) study. Stroke. 2011;42:1608–14.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Straka M, Albers GW, Bammer R. Real-time diffusion-perfusion mismatch analysis in acute stroke. J Magn Reson Imaging. 2010;32:1024–37.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Fiebach JB, Schellinger PD, Gass A, Kucinski T, Siebler M, Villringer A, Olkers P, Hirsch JG, Heiland S, Wilde P, Jansen O, Rother J, Hacke W, Sartor K. Stroke magnetic resonance imaging is accurate in hyperacute intracerebral hemorrhage. A multicenter study on the validity of stroke imaging. Stroke. 2004;35:502–7.

    Article  PubMed  Google Scholar 

  42. Fiebach JB, Schellinger PD, Geletneky K, Wilde P, Meyer M, Hacke W, Sartor K. MRI in acute subarachnoid haemorrhage; findings with a standardised stroke protocol. Neuroradiology. 2004;46:44–8.

    Article  CAS  PubMed  Google Scholar 

  43. Kidwell CS, Chalela JA, Saver JL, Starkman S, Hill MD, Demchuk AM, Butman JA, Patronas N, Alger JR, Latour LL, Luby ML, Baird AE, Leary MC, Tremwel M, Ovbiagele B, Fredieu A, Suzuki S, Villablanca JP, Davis S, Dunn B, Todd JW, Ezzeddine MA, Haymore J, Lynch JK, Davis L, Warach S. Comparison of MRI and CT for detection of acute intracerebral hemorrhage. JAMA. 2004;292:1823–30.

    Article  CAS  PubMed  Google Scholar 

  44. Fiehler J, Albers GW, Boulanger JM, Derex L, Gass A, Hjort N, Kim JS, Liebeskind DS, Neumann-Haefelin T, Pedraza S, Rother J, Rothwell P, Rovira A, Schellinger PD, Trenkler J. Bleeding risk analysis in stroke imaging before thrombolysis (brasil): pooled analysis of t2*-weighted magnetic resonance imaging data from 570 patients. Stroke. 2007;38:2738–44.

    Article  PubMed  Google Scholar 

  45. Schellinger PD, Richter G, Kohrmann M, Dorfler A. Noninvasive angiography (magnetic resonance and computed tomography) in the diagnosis of ischemic cerebrovascular disease. Techniques and clinical applications. Cerebrovasc Dis. 2007;24 Suppl 1:16–23.

    Article  PubMed  Google Scholar 

  46. Schellinger PD, Bryan RN, Caplan LR, Detre JA, Edelman RR, Jaigobin C, Kidwell CS, Mohr JP, Sloan M, Sorensen AG, Warach S. Evidence-based guideline: the role of diffusion and perfusion MRI for the diagnosis of acute ischemic stroke: report of the therapeutics and technology assessment subcommittee of the American academy of neurology. Neurology. 2010;75:177–85.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  47. Wintermark M, Albers GW, Alexandrov AV, Alger JR, Bammer R, Baron JC, Davis S, Demaerschalk BM, Derdeyn CP, Donnan GA, Eastwood JD, Fiebach JB, Fisher M, Furie KL, Goldmakher GV, Hacke W, Kidwell CS, Kloska SP, Kohrmann M, Koroshetz W, Lee TY, Lees KR, Lev MH, Liebeskind DS, Ostergaard L, Powers WJ, Provenzale J, Schellinger P, Silbergleit R, Sorensen AG, Wardlaw J, Wu O, Warach S. Acute stroke imaging research roadmap. Stroke. 2008;39:1621–8.

    Article  PubMed  Google Scholar 

  48. Wintermark M, Albers GW, Broderick JP, Demchuk AM, Fiebach JB, Fiehler J, Grotta JC, Houser G, Jovin TG, Lees KR, Lev MH, Liebeskind DS, Luby M, Muir KW, Parsons MW, von Kummer R, Wardlaw JM, Wu O, Yoo AJ, Alexandrov AV, Alger JR, Aviv RI, Bammer R, Baron JC, Calamante F, Campbell BC, Carpenter TC, Christensen S, Copen WA, Derdeyn CP, Haley Jr EC, Khatri P, Kudo K, Lansberg MG, Latour LL, Lee TY, Leigh R, Lin W, Lyden P, Mair G, Menon BK, Michel P, Mikulik R, Nogueira RG, Ostergaard L, Pedraza S, Riedel CH, Rowley HA, Sanelli PC, Sasaki M, Saver JL, Schaefer PW, Schellinger PD, Tsivgoulis G, Wechsler LR, White PM, Zaharchuk G, Zaidat OO, Davis SM, Donnan GA, Furlan AJ, Hacke W, Kang DW, Kidwell C, Thijs VN, Thomalla G, Warach SJ. Acute stroke imaging research roadmap II. Stroke. 2013;44:2628–39.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Astrup J, Siesjö B, Symon L. Thresholds in cerebral ischemia—the ischemic penumbra. Stroke. 1981;12:723–5.

    Article  CAS  PubMed  Google Scholar 

  50. Warach S. Tissue viability thresholds in acute stroke: the 4-factor model. Stroke. 2001;32:2460–1.

    CAS  PubMed  Google Scholar 

  51. Warach S. Use of diffusion and perfusion magnetic resonance imaging as a tool in acute stroke clinical trials. Curr Control Trials Cardiovasc Med. 2001;2:38–44.

    Article  PubMed Central  PubMed  Google Scholar 

  52. Fisher M, Prichard JW, Warach S. New magnetic resonance techniques for acute ischemic stroke. JAMA. 1995;274:908–11.

    Article  CAS  PubMed  Google Scholar 

  53. Schellinger PD, Fiebach JB, Hacke W. Imaging-based decision making in thrombolytic therapy for ischemic stroke: present status. Stroke. 2003;34:575–83.

    Article  PubMed  Google Scholar 

  54. Jansen O, Schellinger PD, Fiebach JB, Hacke W, Sartor K. Early recanalization in acute ischemic stroke saves tissue at risk defined by MRI. Lancet. 1999;353:2036–7.

    Article  CAS  PubMed  Google Scholar 

  55. Schlaug G, Benfield A, Baird AE, Siewert B, Lovblad KO, Parker RA, Edelman RR, Warach S. The ischemic penumbra: operationally defined by diffusion and perfusion MRI. Neurology. 1999;53:1528–37.

    Article  CAS  PubMed  Google Scholar 

  56. Parsons MW, Barber PA, Chalk J, Darby DG, Rose S, Desmond PM, Gerraty RP, Tress BM, Wright PM, Donnan GA, Davis SM. Diffusion- and perfusion-weighted MRI response to thrombolysis in stroke. Ann Neurol. 2002;51:28–37.

    Article  PubMed  Google Scholar 

  57. Thomalla GJ, Kucinski T, Schoder V, Fiehler J, Knab R, Zeumer H, Weiller C, Rother J. Prediction of malignant middle cerebral artery infarction by early perfusion- and diffusion-weighted magnetic resonance imaging. Stroke. 2003;34:1892–9.

    Article  PubMed  Google Scholar 

  58. Kruetzelmann A, Hartmann F, Beck C, Juettler E, Singer OC, Kohrmann M, Kersten JF, Sobesky J, Gerloff C, Villringer A, Fiehler J, Neumann-Haefelin T, Schellinger PD, Rother J, Thomalla G. Combining magnetic resonance imaging within six-hours of symptom onset with clinical follow-up at 24 h improves prediction of ‘malignant’ middle cerebral artery infarction. Int J Stroke. 2013;9(2):210–4.

    Article  PubMed  Google Scholar 

  59. Albers GW, Thijs V, Wechsler L, Kemp S, Schlaug G, Skalabrin E, Bammer R, Marks MP, Kakuda W, Lansberg M, Shuaib A, Coplin W, Moseley M. Results of the diffusion-weighted imaging evaluation for understanding stroke evolution (defuse) study. Stroke. 2006;37:635–6.

    Article  Google Scholar 

  60. Mlynash M, Lansberg MG, De Silva DA, Lee J, Christensen S, Straka M, Campbell BC, Bammer R, Olivot JM, Desmond P, Donnan GA, Davis SM, Albers GW. Refining the definition of the malignant profile: insights from the defuse-epithet pooled data set. Stroke. 2011;42:1270–5.

    Article  PubMed Central  PubMed  Google Scholar 

  61. Kidwell CS, Saver JL, Mattiello J, Starkman S, Vinuela F, Duckwiler G, Gobin YP, Jahan R, Vespa P, Kalafut M, Alger JR. Thrombolytic reversal of acute human cerebral ischemic injury shown by diffusion/perfusion magnetic resonance imaging. Ann Neurol. 2000;47:462–9.

    Article  CAS  PubMed  Google Scholar 

  62. Neumann-Haefelin T, Wittsack HJ, Wenserski F, Siebler M, Seitz RJ, Moedder U, Freund HJ. Diffusion- and perfusion weighted MRI. The DWI/PWI mismatch region in acute stroke. Stroke. 1999;30:1591–7.

    Article  CAS  PubMed  Google Scholar 

  63. Olivot JM, Mlynash M, Thijs VN, Kemp S, Lansberg MG, Wechsler L, Bammer R, Marks MP, Albers GW. Optimal Tmax threshold for predicting penumbral tissue in acute stroke. Stroke. 2009;40:469–75.

    Article  PubMed Central  PubMed  Google Scholar 

  64. Sobesky J, Weber OZ, Lehnhardt FG, Hesselmann V, Thiel A, Dohmen C, Jacobs A, Neveling M, Heiss WD. Which time-to-peak threshold best identifies penumbral flow? A comparison of perfusion-weighted magnetic resonance imaging and positron emission tomography in acute ischemic stroke. Stroke. 2004;35:2843–7.

    Article  CAS  PubMed  Google Scholar 

  65. Lansberg MG, Straka M, Kemp S, Mlynash M, Wechsler LR, Jovin TG, Wilder MJ, Lutsep HL, Czartoski TJ, Bernstein RA, Chang CW, Warach S, Fazekas F, Inoue M, Tipirneni A, Hamilton SA, Zaharchuk G, Marks MP, Bammer R, Albers GW. MRI profile and response to endovascular reperfusion after stroke (defuse 2): a prospective cohort study. Lancet Neurol. 2012;11:860–7.

    Article  PubMed Central  PubMed  Google Scholar 

  66. Kidwell CS, Jahan R, Gornbein J, Alger JR, Nenov V, Ajani Z, Feng L, Meyer BC, Olson S, Schwamm LH, Yoo AJ, Marshall RS, Meyers PM, Yavagal DR, Wintermark M, Guzy J, Starkman S, Saver JL. A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med. 2013;368:914–23.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  67. Schellinger PD, Jansen O, Fiebach JB, Heiland S, Steiner T, Schwab S, Pohlers O, Ryssel H, Sartor K, Hacke W. Monitoring intravenous recombinant tissue plasminogen activator thrombolysis for acute ischemic stroke with diffusion and perfusion MRI. Stroke. 2000;31:1318–28.

    Article  CAS  PubMed  Google Scholar 

  68. Röther J, Schellinger PD, Gass A, Siebler M, Villringer A, Fiebach JB, Fiehler J, Jansen O, Kucinski T, Schoder V, Szabo K, Junge-Hülsing GJ, Hennerici M, Zeumer H, Sartor K, Weiller C, Hacke W. Effect of intravenous thrombolysis on MRI parameters and functional outcome in acute stroke <6h. Stroke. 2002;33:2438–45.

    Article  PubMed  Google Scholar 

  69. Chalela JA, Kidwell CS, Nentwich LM, Luby M, Butman JA, Demchuk AM, Hill MD, Patronas N, Latour L, Warach S. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet. 2007;369:293–8.

    Article  PubMed Central  PubMed  Google Scholar 

  70. Kohrmann M, Juttler E, Fiebach JB, Huttner HB, Siebert S, Schwark C, Ringleb PA, Schellinger PD, Hacke W. MRI versus CT-based thrombolysis treatment within and beyond the 3 h time window after stroke onset: a cohort study. Lancet Neurol. 2006;5:661–7.

    Article  PubMed  Google Scholar 

  71. Schellinger PD, Thomalla G, Fiehler J, Kohrmann M, Molina CA, Neumann-Haefelin T, Ribo M, Singer OC, Zaro-Weber O, Sobesky J. MRI-based and CT-based thrombolytic therapy in acute stroke within and beyond established time windows: an analysis of 1210 patients. Stroke. 2007;38:2640–5.

    Article  PubMed  Google Scholar 

  72. Furlan AJ, Eyding D, Albers GW, Al-Rawi Y, Lees KR, Rowley HA, Sachara C, Soehngen M, Warach S, Hacke W. Dose escalation of desmoteplase for acute ischemic stroke (DEDAS): evidence of safety and efficacy 3 to 9 hours after stroke onset. Stroke. 2006;37:1227–31.

    Article  CAS  PubMed  Google Scholar 

  73. Hacke W, Albers G, Al-Rawi Y, Bogousslavsky J, Davalos A, Eliasziw M, Fischer M, Furlan A, Kaste M, Lees KR, Soehngen M, Warach S. The desmoteplase in acute ischemic stroke trial (Dias): a phase II MRI-based 9-hour window acute stroke thrombolysis trial with intravenous desmoteplase. Stroke. 2005;36:66–73.

    Article  CAS  PubMed  Google Scholar 

  74. Hacke W, Furlan AJ, Al-Rawi Y, Davalos A, Fiebach JB, Gruber F, Kaste M, Lipka LJ, Pedraza S, Ringleb PA, Rowley HA, Schneider D, Schwamm LH, Leal JS, Sohngen M, Teal PA, Wilhelm-Ogunbiyi K, Wintermark M, Warach S. Intravenous desmoteplase in patients with acute ischaemic stroke selected by MRI perfusion-diffusion weighted imaging or perfusion ct (dias-2): a prospective, randomised, double-blind, placebo-controlled study. Lancet Neurol. 2009;8:141–50.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  75. Davis SM, Donnan GA. Echoplanar imaging thrombolysis evaluation trial: EPITHET. International Stroke Conference; 2006.

    Google Scholar 

  76. Fisher M, Albers GW. Advanced imaging to extend the therapeutic time window of acute ischemic stroke. Ann Neurol. 2013;73:4–9.

    Article  PubMed  Google Scholar 

  77. Fiebach JB, Al-Rawi Y, Wintermark M, Furlan AJ, Rowley HA, Lindsten A, Smyej J, Eng P, Warach S, Pedraza S. Vascular occlusion enables selecting acute ischemic stroke patients for treatment with desmoteplase. Stroke. 2012;43:1561–6.

    Article  PubMed  Google Scholar 

  78. von Kummer R, Albers GW, Mori E. The desmoteplase in acute ischemic stroke (DIAS) clinical trial program. Int J Stroke. 2012;7:589–96.

    Article  Google Scholar 

  79. Ma H, Parsons MW, Christensen S, Campbell BC, Churilov L, Connelly A, Yan B, Bladin C, Phan T, Barber AP, Read S, Hankey GJ, Markus R, Wijeratne T, Grimley R, Mahant N, Kleinig T, Sturm J, Lee A, Blacker D, Gerraty R, Krause M, Desmond PM, McBride SJ, Carey L, Howells DW, Hsu CY, Davis SM, Donnan GA. A multicentre, randomized, double-blinded, placebo-controlled phase III study to investigate extending the time for thrombolysis in emergency neurological deficits (extend). Int J Stroke. 2012;7:74–80.

    Article  PubMed  Google Scholar 

  80. Thomalla G, Fiebach JB, Ostergaard L, Pedraza S, Thijs V, Nighoghossian N, Roy P, Muir KW, Ebinger M, Cheng B, Galinovic I, Cho TH, Puig J, Boutitie F, Simonsen CZ, Endres M, Fiehler J, Gerloff C. A multicenter, randomized, double-blind, placebo-controlled trial to test efficacy and safety of magnetic resonance imaging-based thrombolysis in wake-up stroke (wake-up). Int J Stroke. 2013.

    Google Scholar 

  81. Meretoja A, Strbian D, Mustanoja S, Tatlisumak T, Lindsberg PJ, Kaste M. Reducing in-hospital delay to 20 minutes in stroke thrombolysis. Neurology. 2012;79:306–13.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Johannes Wesling Clinic Minden, Hans-Nolte-Str.1, 32429, Minden, Germany

    Peter D. Schellinger M.D., Ph.D., F.A.H.A., F.E.S.O.

  2. Department of NeuroGeriatry, Johannes Wesling Clinic Minden, Hans-Nolte-Str.1, 32429, Minden, Germany

    Peter D. Schellinger M.D., Ph.D., F.A.H.A., F.E.S.O.

  3. Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany

    Martin Köhrmann M.D., Ph.D.

Authors
  1. Peter D. Schellinger M.D., Ph.D., F.A.H.A., F.E.S.O.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martin Köhrmann M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter D. Schellinger M.D., Ph.D., F.A.H.A., F.E.S.O. .

Editor information

Editors and Affiliations

  1. Stroke Program, Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA

    Patrick D Lyden

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Schellinger, P.D., Köhrmann, M. (2015). The Impact of Neuroimaging on Acute Stroke Treatment: Role of Magnetic Resonance Imaging. In: Lyden, P. (eds) Thrombolytic Therapy for Acute Stroke. Springer, Cham. https://doi.org/10.1007/978-3-319-07575-4_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-07575-4_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-07574-7

  • Online ISBN: 978-3-319-07575-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation