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Application of contrast agents in the evaluation of stroke: Conventional MR and echo‐planar MR imaging
Author(s) -
Maeda Masayuki,
Maley Joan E.,
Crosby Daniel L.,
Quets Jerome P.,
Zhu MingWang,
Lee Ghi Jai,
Lawler Gregory J.,
Ueda Toshihiro,
Bendixen Birgitte H.,
Yuh William T. C.
Publication year - 1997
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/jmri.1880070105
Subject(s) - medicine , thrombolysis , stroke (engine) , perfusion , radiology , ischemia , angiography , perfusion scanning , magnetic resonance imaging , penumbra , cardiology , myocardial infarction , mechanical engineering , engineering
Abstract The availability of new therapeutic interventions, including neuroprotective agents and endovascular thrombolysis, has given new hope to patients suffering an acute stroke. Early intervention remains a key factor in the effectiveness of these new and traditional treatments. More importantly, the capability to assess the viability and reversibility of the ischemic tissue became essential for better delineation and differentiation of infarcted versus ischemic tissue and patient management. Abnormal MR imaging (MRI) findings during acute stroke usually reflect the underlying pathophysiologic changes, which can be classified into three sequential stages: ( a ) hypoperfusion, ( b ) cellular dysfunction and ( c ) breakdown of the blood‐brain barrier. The first stage is a kinetic phenomenon (not biologic) and, therefore, can be detected immediately. Contrast agents accentuate the abnormal flow kinetics and facilitate the early diagnosis of ischemia using either conventional MRI or newly developed echo‐planar perfusion imaging (EPPI). The demonstration of abnormal arterial or parenchymal enhancement on conventional MRI during acute stroke provides the earliest sign of vascular occlusion/stenosis. EPPI, in contrast, provides information related to microcirculation (< 100 microns) and tissue reserve (cerebral blood volume) that cannot be obtained by conventional angiography and is directly related to the target end‐organ. Further information obtained from both contrast MRI and EPPI may have a predictive value in the clinical outcome of acute stroke patients.