Clinical impact of MRI perfusion disturbances and normal diffusion in acute stroke patients.
OBJECTIVE
In acute ischemic stroke MR-imaging typically shows diffusion abnormalities surrounded by reduced perfusion signifying the so-called ischemic penumbra. Mismatch between diffusion and perfusion abnormalities gives indication for thrombolysis. But is there an indication for thrombolytic treatment, if there is no diffusion abnormality but pathologic perfusion combined with acute stroke symptoms?.


METHODS
MR-imaging of 1465 patients treated on our Stroke Unit between June 2004 and May 2007 retrospectively are analyzed. 6 patients met the inclusion criteria of severe neurological symptoms, large territorial perfusion disturbances, lack of diffusion abnormalities and complete neurological recovery after treatment.


RESULTS
In all six patients MTT measurements showed a significantly depressed perfusion in the symptomatic hemisphere (p<0.02). Time-to-peak delay correlated with the mean transit time delay (0.949, p<0.01). Indication for thrombolysis was based on perfusion abnormalities and clinical symptoms. Stroke symptoms could be reversed in all patients without any complication.


CONCLUSIONS
Whereas diffusion imaging could not reveal any abnormality, perfusion analysis legitimated therapy with systemic thrombolysis in heavily affected patients. This work underlines the importance of multimodal MR imaging for guiding treatment decisions in acute stroke patients.
Blondin
D
D
Institute of Diagnostic Radiology, University Hospital Duesseldorf, Moorenstr. 5, D-40225 Germany. blondin@med.uni-duesseldorf.de
Seitz
R J
RJ
Rusch
O
O
Janssen
H
H
Andersen
K
K
Wittsack
H-J
HJ
Turowski
B
B
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications* / Q000175:diagnosis*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D020521:Stroke / Q000150:complications* / Q000175:diagnosis*