Magnetic resonance imaging criteria for thrombolysis in acute cerebral infarct.
OBJECTIVE
Magnetic resonance imaging (MRI) selection of stroke patients eligible for thrombolytic therapy is an emerging application. Although the efficacy of therapy within 3 hours after onset of symptoms with intravenous (IV) tissue plasminogen activator (tPA) has been proven for patients selected with computed tomography (CT), no randomized, double-blinded MRI trial has been published yet.


RESULTS
MRI screening of acute stroke patients before thrombolytic therapy is performed in some cerebrovascular centers. In contrast to the CT trials, MRI pilot studies demonstrate benefit of therapy up to 6 hours after onset of symptoms. This article reviews the literature that has lead to current controlled MRI-based thrombolysis trials. We examined the MRI criteria applied in 5 stroke centers. Along with the personal views of clinicians at these centers, the survey reveals a variety of clinical and MRI technical aspects that must be further investigated: the therapeutic consequence of microbleeds, the use of magnetic resonance angiography, dynamic time windows, and others.


CONCLUSIONS
MRI is an established application in acute evaluation of stroke patients and may suit as a brain clock, replacing the currently used epidemiological time clock when deciding whether to initiate thrombolytic therapy. MRI criteria for thrombolytic therapy are applied in some cerebrovascular centers, but the results of ongoing clinical trials must be awaited before it is possible to reach consensus.
Hjort
N
N
Department of Neuroradiology, Center for Functionally Integrative Neuroscience, Arhus University Hospital, Nørrebrogade 44, 8000 Arhus C, Denmark. niels@pet.auh.dk
Butcher
K
K
Davis
S M
SM
Kidwell
C S
CS
Koroshetz
W J
WJ
Röther
J
J
Schellinger
P D
PD
Warach
S
S
Østergaard
L
L
D001921:Brain / Q000473:pathology; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000473:pathology; D002986:Clinical Trials as Topic; D006801:Humans; D007262:Infusions, Intravenous; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D018579:Patient Selection; D010865:Pilot Projects; D012107:Research Design / Q000592:standards; D020521:Stroke / Q000175:diagnosis* / Q000473:pathology; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed / Q000379:methods
D010959:Tissue Plasminogen Activator