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Thrombolytic reversal of acute human cerebral ischemic injury shown by diffusion/perfusion magnetic resonance imaging
Author(s) -
Kidwell Chelsea S.,
Saver Jeffrey L.,
Mattiello James,
Starkman Sidney,
Vinuela Fernando,
Duckwiler Gary,
Gobin Y. Pierre,
Jahan Reza,
Vespa Paul,
Kalafut Mary,
Alger Jeffry R.
Publication year - 2000
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/1531-8249(200004)47:4<462::aid-ana9>3.0.co;2-y
Subject(s) - medicine , penumbra , thrombolysis , magnetic resonance imaging , effective diffusion coefficient , perfusion , ischemia , magnetic resonance angiography , radiology , diffusion mri , perfusion scanning , middle cerebral artery , cardiology , nuclear medicine , myocardial infarction
Diffusion magnetic resonance imaging provides an early marker of acute cerebral ischemic injury. Thrombolytic reversal of diffusion abnormalities has not previously been demonstrated in humans. Serial diffusion and perfusion imaging studies were acquired in patients experiencing acute hemispheric cerebral ischemia treated with intra‐arterial thrombolytic therapy within 6 hours of symptom onset. Seven patients met inclusion criteria of prethrombolysis and postthrombolysis magnetic resonance studies, presence of large artery anterior circulation occlusion at angiography, and achievement of vessel recanalization. Mean diffusion‐weighted imaging lesion volume at baseline was 23 cm 3 (95% confidence interval [95% CI], 8–38 cm 3 ) and decreased to 10 cm 3 (95% CI, 3–17 cm 3 ) 2.5 to 9.5 hours after thrombolysis. Mean apparent diffusion coefficient lesion volume decreased from 9 cm 3 (95% CI, 2–16 cm 3 ) at baseline to 1 cm 3 (95% CI, 0.4–2 cm 3 ) early after thrombolysis. A secondary increase in diffusion volumes was seen in 3 of 6 patients at day 7. In all 4 patients in whom perfusion imaging was obtained before and after treatment, complete resolution of the perfusion deficit was shown. Diffusion magnetic resonance signatures of early tissue ischemic injury can be reversed in humans by prompt thrombolytic vessel recanalization. The ischemic penumbra includes not only the region of diffusion/perfusion mismatch, but also portions of the region of initial diffusion abnormality. Ann Neurol 2000;47:462–469.