Neurology
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Correspondence:
Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Correspondence are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Marks, M. P.
Right arrow Articles by Moseley, M. E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Marks, M. P.
Right arrow Articles by Moseley, M. E.
Neurology 1999;52:1792
© 1999 American Academy of Neurology
Articles

Evaluation of early reperfusion and IV tPA therapy using diffusion- and perfusion-weighted MRI

M. P. Marks, MD, D. C. Tong, MD, C. Beaulieu, PhD, G. W. Albers, MD, A. de Crespigny, PhD and M. E. Moseley, PhD

From the Stanford University Medical Center, CA.

Address correspondence and reprint requests to Dr. Michael P. Marks, Stanford Stroke Center, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305-5105; e-mail: m.marks{at}stanford.edu

OBJECTIVE: To characterize the effects of recombinant tissue plasminogen activator (rt-PA) therapy and early reperfusion on diffusion-weighted (DWI) and perfusion-weighted imaging (PWI) changes observed following acute ischemic injury.

METHODS: Twelve patients were evaluated prospectively using echo planar DWI and bolus tracking PWI. Six patients received IV rt-PA 0.9 mg/kg and were compared with six patients who did not. Patients receiving rt-PA were initially imaged (T1) 3 to 5 hours postictus (mean, 4 hours 20 minutes) whereas those not treated with tissue plasminogen activator (tPA) were imaged 4 to 7 hours postictus (mean, 5 hours, 25 minutes). Follow-up imaging was performed 3 to 6 hours (T2), 24 to 36 hours (T3), 5 to 7 days (T4), and 30 days (T5) after the first scan in all patients. Lesion volumes were measured on both DWI and time-to-peak maps constructed from PW images.

RESULTS: PWI was performed successfully at T1 and T3 in 11 of 12 patients. In the group that received IV tPA, initial PWI volumes were less than DWI volumes in five of six patients (83%), whereas only one of five patients (20%) not receiving tPA had PWI < DWI volume (p = 0.08). PWI normalized by 24 to 36 hours (T3) in 6 of 11 patients (early reperfusers), with 5 of 6 of these early reperfusers having received tPA. The aggregate apparent diffusion coefficient (ADC) values for the early reperfusers were consistently higher at T2 (p = 0.04), T3 (p = 0.002), and T4 (p = 0.0005). Five of six patients with early reperfusion demonstrated regions of elevated ADC within the ischemic zone (mean ipsilateral ADC/contralateral ADC, 1.46 ± 0.19) by 24 to 36 hours, whereas none of the nonearly reperfusers showed these regions of elevated ADC (p = 0.015).

CONCLUSION: Early reperfusion is seen more frequently with IV tPA therapy. In addition, the study showed that ADC may undergo early increases that are tied closely to reperfusion, and marked ADC heterogeneity may exist within the same lesion. Early reperfusion is seen more frequently with IV tPA therapy.




This article has been cited by other articles:


Home page
 Am. J. Neuroradiol.Home page
J.M. Provenzale, K. Shah, U. Patel, and D.C. McCrory
Systematic Review of CT and MR Perfusion Imaging for Assessment of Acute Cerebrovascular Disease
AJNR Am. J. Neuroradiol., September 1, 2008; 29(8): 1476 - 1482.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
A. E. Hillis, L. Gold, V. Kannan, L. Cloutman, J. T. Kleinman, M. Newhart, J. Heidler-Gary, C. Davis, E. Aldrich, R. Llinas, et al.
Site of the ischemic penumbra as a predictor of potential for recovery of functions
Neurology, July 15, 2008; 71(3): 184 - 189.
[Abstract] [Full Text] [PDF]

Home page
 ImagingHome page
G TAN and T GODDARD
Neuroimaging applications of multislice CT perfusion
Imaging, June 1, 2007; 19(2): 142 - 152.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
Y. Liu, H. E. D'Arceuil, S. Westmoreland, J. He, M. Duggan, R. G. Gonzalez, J. Pryor, and A. J. d. Crespigny
Serial Diffusion Tensor MRI After Transient and Permanent Cerebral Ischemia in Nonhuman Primates
Stroke, January 1, 2007; 38(1): 138 - 145.
[Abstract] [Full Text] [PDF]

Home page
 RadioGraphicsHome page
A. Srinivasan, M. Goyal, F. A. Azri, and C. Lum
State-of-the-Art Imaging of Acute Stroke
RadioGraphics, October 1, 2006; 26(suppl_1): S75 - S95.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Neuroradiol.Home page
A. Shaibani, S. Khawar, W. Shin, T.A. Cashen, B. Schirf, M. Rohany, S. Kakodkar, and T.J. Carroll
First Results in an MR Imaging-Compatible Canine Model of Acute Stroke.
AJNR Am. J. Neuroradiol., September 1, 2006; 27(8): 1788 - 1793.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Roentgenol.Home page
H. S. Kim, D. H. Lee, C. W. Ryu, J. H. Lee, C. G. Choi, S. J. Kim, and D. C. Suh
Multiple Cerebral Microbleeds in Hyperacute Ischemic Stroke: Impact on Prevalence and Severity of Early Hemorrhagic Transformation After Thrombolytic Treatment.
Am. J. Roentgenol., May 1, 2006; 186(5): 1443 - 1449.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
G. Thomalla, C. Schwark, J. Sobesky, E. Bluhmki, J. B. Fiebach, J. Fiehler, O. Zaro Weber, T. Kucinski, E. Juettler, P. A. Ringleb, et al.
Outcome and Symptomatic Bleeding Complications of Intravenous Thrombolysis Within 6 Hours in MRI-Selected Stroke Patients: Comparison of a German Multicenter Study With the Pooled Data of ATLANTIS, ECASS, and NINDS tPA Trials
Stroke, March 1, 2006; 37(3): 852 - 858.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
N. Hjort, K. Butcher, S.M. Davis, C.S. Kidwell, on behalf of the UCLA Thrombolysis Investigators, W.J. Koroshetz, J. Rother, P.D. Schellinger, S. Warach, and L. Ostergaard
Magnetic Resonance Imaging Criteria for Thrombolysis in Acute Cerebral Infarct
Stroke, February 1, 2005; 36(2): 388 - 397.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
A. Rovira, P. Orellana, J. Alvarez-Sabin, J. F. Arenillas, X. Aymerich, E. Grive, C. Molina, and A. Rovira-Gols
Hyperacute Ischemic Stroke: Middle Cerebral Artery Susceptibility Sign at Echo-planar Gradient-Echo MR Imaging
Radiology, August 1, 2004; 232(2): 466 - 473.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Neuroradiol.Home page
D. M. Somford, M. P. Marks, V. N. Thijs, and D. C. Tong
Association of Early CT Abnormalities, Infarct Size, and Apparent Diffusion Coefficient Reduction in Acute Ischemic Stroke
AJNR Am. J. Neuroradiol., June 1, 2004; 25(6): 933 - 938.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Neuroradiol.Home page
C. A. Jungreis, E. Nemoto, F. Boada, and M. B. Horowitz
Model of Reversible Cerebral Ischemia in a Monkey Model
AJNR Am. J. Neuroradiol., October 1, 2003; 24(9): 1834 - 1836.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
R. T. Higashida and A. J. Furlan
Trial Design and Reporting Standards for Intra-Arterial Cerebral Thrombolysis for Acute Ischemic Stroke
Stroke, August 1, 2003; 34 (8): e109 - e137.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
R. E. Latchaw, H. Yonas, G. J. Hunter, W. T.C. Yuh, T. Ueda, A. G. Sorensen, J. L. Sunshine, J. Biller, L. Wechsler, R. Higashida, et al.
Guidelines and Recommendations for Perfusion Imaging in Cerebral Ischemia: A Scientific Statement for Healthcare Professionals by the Writing Group on Perfusion Imaging, From the Council on Cardiovascular Radiology of the American Heart Association
Stroke, April 1, 2003; 34(4): 1084 - 1104.
[Full Text] [PDF]

Home page
 StrokeHome page
N. Nighoghossian, M. Hermier, P. Adeleine, L. Derex, J.F. Dugor, F. Philippeau, H. Ylmaz, J. Honnorat, P. Dardel, Y. Berthezene, et al.
Baseline Magnetic Resonance Imaging Parameters and Stroke Outcome in Patients Treated by Intravenous Tissue Plasminogen Activator
Stroke, February 1, 2003; 34(2): 458 - 463.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
P. D. Schellinger, J. B. Fiebach, W. Hacke, and J. Rother
Imaging-Based Decision Making in Thrombolytic Therapy for Ischemic Stroke: Present Status
Stroke, February 1, 2003; 34(2): 575 - 583.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
J. Rother, P.D. Schellinger, A. Gass, M. Siebler, A. Villringer, J.B. Fiebach, J. Fiehler, O. Jansen, T. Kucinski, V. Schoder, et al.
Effect of Intravenous Thrombolysis on MRI Parameters and Functional Outcome in Acute Stroke <6 Hours
Stroke, October 1, 2002; 33(10): 2438 - 2445.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
J. F. Arenillas, A. Rovira, C. A. Molina, E. Grive, J. Montaner, J. Alvarez-Sabin, and K.-O. Lovblad
Prediction of Early Neurological Deterioration Using Diffusion- and Perfusion-Weighted Imaging in Hyperacute Middle Cerebral Artery Ischemic Stroke * Editorial Comment
Stroke, September 1, 2002; 33(9): 2197 - 2205.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
I. Linfante, R. H. Llinas, M. Selim, C. Chaves, S. Kumar, R. A. Parker, L. R. Caplan, and G. Schlaug
Clinical and Vascular Outcome in Internal Carotid Artery Versus Middle Cerebral Artery Occlusions After Intravenous Tissue Plasminogen Activator
Stroke, August 1, 2002; 33(8): 2066 - 2071.
[Abstract] [Full Text] [PDF]

Home page
 BrainHome page
A. E. Hillis, R. J. Wityk, P. B. Barker, N. J. Beauchamp, P. Gailloud, K. Murphy, O. Cooper, and E. J. Metter
Subcortical aphasia and neglect in acute stroke: the role of cortical hypoperfusion
Brain, May 1, 2002; 125(5): 1094 - 1104.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
J. Fiehler, M. Foth, T. Kucinski, R. Knab, M. von Bezold, C. Weiller, H. Zeumer, and J. Rother
Severe ADC Decreases Do Not Predict Irreversible Tissue Damage In Humans
Stroke, January 1, 2002; 33(1): 79 - 86.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
V. N. Thijs, A. Adami, T. Neumann-Haefelin, M. E. Moseley, M. P. Marks, and G. W. Albers
Relationship between severity of MR perfusion deficit and DWI lesion evolution
Neurology, October 9, 2001; 57(7): 1205 - 1211.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
T. A. Kent, V. M. Soukup, and R. H. Fabian
Heterogeneity Affecting Outcome From Acute Stroke Therapy: Making Reperfusion Worse
Stroke, October 1, 2001; 32(10): 2318 - 2327.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
T. M. Ringer, T. Neumann-Haefelin, R. A. Sobel, M. E. Moseley, and M. A. Yenari
Reversal of Early Diffusion-Weighted Magnetic Resonance Imaging Abnormalities Does Not Necessarily Reflect Tissue Salvage in Experimental Cerebral Ischemia
Stroke, October 1, 2001; 32(10): 2362 - 2369.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
S. Warach
New imaging strategies for patient selection for thrombolytic and neuroprotective therapies
Neurology, September 1, 2001; 57(90002): S48 - 52.
[Abstract] [Full Text]

Home page
 StrokeHome page
M. W. Parsons, Q. Yang, P. A. Barber, D. G. Darby, P. M. Desmond, R. P. Gerraty, B. M. Tress, and S. M. Davis
Perfusion Magnetic Resonance Imaging Maps in Hyperacute Stroke : Relative Cerebral Blood Flow Most Accurately Identifies Tissue Destined to Infarct
Stroke, July 1, 2001; 32(7): 1581 - 1587.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
P.J. Kelly, E.T. Hedley-Whyte, J. Primavera, J. He, and R.G. Gonzalez
Diffusion MRI in ischemic stroke compared to pathologically verified infarction
Neurology, April 10, 2001; 56(7): 914 - 920.
[Abstract] [Full Text] [PDF]

Home page
 Arch NeurolHome page
R. J. Wityk, M. A. Goldsborough, A. Hillis, N. Beauchamp, P. B. Barker, L. M. Borowicz Jr, and G. M. McKhann
Diffusion- and Perfusion-Weighted Brain Magnetic Resonance Imaging in Patients With Neurologic Complications After Cardiac Surgery
Arch Neurol, April 1, 2001; 58(4): 571 - 576.
[Abstract] [Full Text] [PDF]

Home page
 Arch NeurolHome page
D. C. Tong, A. Adami, M. E. Moseley, and M. P. Marks
Prediction of Hemorrhagic Transformation Following Acute Stroke: Role of Diffusion- and Perfusion-Weighted Magnetic Resonance Imaging
Arch Neurol, April 1, 2001; 58(4): 587 - 593.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
A.E. Hillis, P.B. Barker, N.J. Beauchamp, B.D. Winters, M. Mirski, and R.J. Wityk
Restoring blood pressure reperfused Wernicke's area and improved language
Neurology, March 13, 2001; 56(5): 670 - 672.
[Abstract] [Full Text] [PDF]

Home page
 BrainHome page
W.-D. Heiss, L. W. Kracht, A. Thiel, M. Grond, and G. Pawlik
Penumbral probability thresholds of cortical flumazenil binding and blood flow predicting tissue outcome in patients with cerebral ischaemia
Brain, January 1, 2001; 124(1): 20 - 29.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
J. O. Karonen, Y. Liu, R. L. Vanninen, L. Østergaard, P. L. Kaarina Partanen, P. A. Vainio, E. J. Vanninen, J. Nuutinen, R. Roivainen, S. Soimakallio, et al.
Combined Perfusion- and Diffusion-weighted MR Imaging in Acute Ischemic Stroke during the 1st Week: A Longitudinal Study
Radiology, December 1, 2000; 217(3): 886 - 894.
[Abstract] [Full Text]

Home page
 RadiologyHome page
P. W. Schaefer, P. E. Grant, and R. G. Gonzalez
Diffusion-weighted MR Imaging of the Brain
Radiology, November 1, 2000; 217(2): 331 - 345.
[Abstract] [Full Text]

Home page
 StrokeHome page
K. Krueger, H. Kugel, M. Grond, A. Thiel, D. Maintz, and K. Lackner
Late Resolution of Diffusion-Weighted MRI Changes in a Patient With Prolonged Reversible Ischemic Neurological Deficit After Thrombolytic Therapy
Stroke, November 1, 2000; 31(11): 2715 - 2718.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
D. C. Tong, A. Adami, M. E. Moseley, and M. P. Marks
Relationship Between Apparent Diffusion Coefficient and Subsequent Hemorrhagic Transformation Following Acute Ischemic Stroke
Stroke, October 1, 2000; 31(10): 2378 - 2384.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
A. E. Hillis, P. B. Barker, N. J. Beauchamp, B. Gordon, and R. J. Wityk
MR perfusion imaging reveals regions of hypoperfusion associated with aphasia and neglect
Neurology, September 26, 2000; 55(6): 782 - 788.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
T. Brott and J. Bogousslavsky
Treatment of Acute Ischemic Stroke
N. Engl. J. Med., September 7, 2000; 343(10): 710 - 722.
[Full Text] [PDF]

Home page
 StrokeHome page
T. Neumann-Haefelin, A. Kastrup, A. de Crespigny, M. A. Yenari, T. Ringer, G. H. Sun, M. E. Moseley, and M. Fisher
Serial MRI After Transient Focal Cerebral Ischemia in Rats : Dynamics of Tissue Injury, Blood-Brain Barrier Damage, and Edema Formation Editorial Comment: Dynamics of Tissue Injury, Blood-Brain Barrier Damage, and Edema Formation
Stroke, August 1, 2000; 31(8): 1965 - 1973.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Neuroradiol.Home page
P. D Schellinger, O. Jansen, J. B Fiebach, O. Pohlers, H. Ryssel, S. Heiland, T. Steiner, W. Hacke and, and K. Sartor
Feasibility and Practicality of MR Imaging of Stroke in the Management of Hyperacute Cerebral Ischemia
AJNR Am. J. Neuroradiol., July 1, 2000; 21(7): 1184 - 1189.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
P. D. Schellinger, O. Jansen, J. B. Fiebach, S. Heiland, T. Steiner, S. Schwab, O. Pohlers, H. Ryssel, K. Sartor, and W. Hacke
Monitoring Intravenous Recombinant Tissue Plasminogen Activator Thrombolysis for Acute Ischemic Stroke With Diffusion and Perfusion MRI
Stroke, June 1, 2000; 31(6): 1318 - 1328.
[Abstract] [Full Text] [PDF]

Home page
 BMJHome page
J. W Prichard and J. R Alger
The NMR revolution in brain imaging
BMJ, November 13, 1999; 319(7220): 1302 - 1302.
[Full Text]

Home page
 StrokeHome page
D. G. Darby, P. A. Barber, R. P. Gerraty, P. M. Desmond, Q. Yang, M. Parsons, T. Li, B. M. Tress, and S. M. Davis
Pathophysiological Topography of Acute Ischemia by Combined Diffusion-Weighted and Perfusion MRI
Stroke, October 1, 1999; 30(10): 2043 - 2052.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
G. W. Albers
Expanding the Window for Thrombolytic Therapy in Acute Stroke : The Potential Role of Acute MRI for Patient Selection
Stroke, October 1, 1999; 30(10): 2230 - 2237.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
D. C. Tong, G. W. Albers, M. A. Yenari, M. P. Marks, P. D. Schellinger, O. Jansen, J. B. Fiebach, and K. Sartor
A Standardized MRI Stroke Protocol: Comparison with CT in Hyperacute Intracerebral Hemorrhage • Response
Stroke, September 1, 1999; 30 (9): 1974a - 1981.
[Full Text] [PDF]

Home page
 NeurologyHome page
J. W. Prichard and R. I. Grossman
New reasons for early use of MRI in stroke
Neurology, June 1, 1999; 52(9): 1733 - 1733.
[Full Text]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 1999 by AAN Enterprises, Inc.