By K. Sartor, A. L. Baert
The imaging of stroke has passed through major alterations as a result of the quick development in imaging know-how. This quantity, comprising 3 components, is designed to supply a accomplished precis of the present position of MR imaging in sufferers with ischemic stroke. the 1st half outlines the scientific shows of stroke and discusses the diagnostic efficacy and healing influence of MR imaging. the second one and 3rd elements shape the center of the amount, and are according to a unique method in that the subject is gifted from very assorted viewpoints. half 2 presents an in depth presentation of the distinguishing beneficial properties of stroke from the radiologist's viewpoint. against this, half three addresses the wishes of the clinician, documenting particular stroke syndromes and their correlates on MR imaging. the general target has been to create a well-illustrated quantity with huge allure that hyperlinks pathology, radiology and stroke drugs in an informative manner.
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Example text
3 Vertebrobasilar Stroke The great majority of hyperacute stroke MRI studies have been limited to patients with supratentorial ischaemia. While much less frequent, vertebrobasilar infarction has a high mortality, up to 70%–80%. Both IA and IV thrombolysis in small, uncontrolled series have dramatically improved outcomes (Brandt et al. 1996; Grond et al. 1998; Hacke et al. 1988). Sensitivity of DWI, and especially PI, at the base of the skull is probably lower due to susceptibility artefacts. Recently of note, substantial regions of perfusion-diffusion mismatch have been demonstrated in the posterior fossa, with salvage of these regions after thrombolysis (Ostrem et al.
Most reports, however, show a strong correlation between acute PI lesions and baseline clinical scores (Barber et al. 1998a; Tong et al. 1998; Warach et al. 1996, 1999). This has led to the suggestion that the discrepancy between stroke severity, assessed with the NIHSS, and the volume of the DWI lesion (‘clinical-diffusion mismatch’) could be used as a surrogate for perfusion-diffusion mismatch. Our group has examined this hypothesis and have found that an NIHSS > 7 and DWI lesion volume < 25 cm 3 predicts the presence of perfusion-diffusion mismatch with > 90% specificity, but low sensitivity.
The fate of penumbral tissue is dependent upon reperfusion of the ischaemic region. If the artery remains occluded, most of the ischaemic penumbra progressively becomes incorporated into the infarct core. Early reperfusion (spontaneous or thrombolytic-assisted) can salvage the ischaemic penumbra from progression to infarction. Additionally, effective neuroprotective treatments, including drug therapy and manipulation of physiologic variables, may preserve the penumbra until reperfusion occurs (Davis and Donnan 2002; Fisher and Brott 2003).
Magnetic Resonance Imaging in Ischemic Stroke by K. Sartor, A. L. Baert
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