title: Prediction of Early Reperfusion From Repeated Arterial Spin Labeling Perfusion Magnetic Resonance Imaging During Intravenous Thrombolysis.
abstract: OBJECTIVE
  There are few in vivo data on the pathophysiology of reperfusion during systemic thrombolysis. We monitored the time course of cerebral perfusion changes in patients during thrombolysis with repeated arterial spin labeling perfusion magnetic resonance imaging.
  
  
  METHODS
  Ten patients with proximal arterial occlusion within 4.5 hours after symptom onset were prospectively enrolled. All patients received intravenous thrombolysis during the magnetic resonance imaging examination. Repeated arterial spin labeling perfusion images were acquired during the 60-minute therapy and at follow-up after 24 to 72 hours. Clinical data, magnetic resonance imaging features, and cerebral perfusion changes were analyzed.
  
  
  RESULTS
  Before thrombolysis, arterial spin labeling hypoperfusion and fluid-attenuation inversion recovery vascular hyperintensity in the territory of the occluded arteries were observed in all patients. In 5 patients, extensive arterial transit artifacts (ATA) developed in the hypoperfused area. The ATA corresponded with fluid-attenuation inversion recovery vascular hyperintensities. All 5 patients who developed extensive ATA in the hypoperfused area had complete reperfusion after thrombolysis, whereas the 5 without extensive ATA showed no or only partial reperfusion (P<0.01). The development of ATA preceded the normalization of tissue perfusion.
  
  
  CONCLUSIONS
  The development of ATA during thrombolysis is associated with early reperfusion after thrombolysis. arterial spin labeling assessment during intravenous thrombolysis has the potential to guide subsequent therapeutic strategies in patients with acute stroke.
authors.affiliation: From the Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (S.O., M.G., J.S.-S., M.E.W., A.G., M.G.H., K.S., R.K.); mediri GmbH, Heidelberg, Germany (J.G., M.G.); Institute for Medical Image Computing MEVIS, Fraunhofer MEVIS, Bremen, Germany (M.G.); MR-Imaging and Spectroscopy, Faculty 01 (Physics/Electrical Engineering), University of Bremen, Bremen, Germany (M.G.); and Department of Neurology, Klinikum Kempten, Kempten-Oberallgaeu, Germany (R.K.). s-okazaki@umin.ac.jp.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Okazaki
authors.affiliation: From the Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (S.O., M.G., J.S.-S., M.E.W., A.G., M.G.H., K.S., R.K.); mediri GmbH, Heidelberg, Germany (J.G., M.G.); Institute for Medical Image Computing MEVIS, Fraunhofer MEVIS, Bremen, Germany (M.G.); MR-Imaging and Spectroscopy, Faculty 01 (Physics/Electrical Engineering), University of Bremen, Bremen, Germany (M.G.); and Department of Neurology, Klinikum Kempten, Kempten-Oberallgaeu, Germany (R.K.).
authors.forename: Martin
authors.initials: M
authors.lastname: Griebe
authors.affiliation: From the Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (S.O., M.G., J.S.-S., M.E.W., A.G., M.G.H., K.S., R.K.); mediri GmbH, Heidelberg, Germany (J.G., M.G.); Institute for Medical Image Computing MEVIS, Fraunhofer MEVIS, Bremen, Germany (M.G.); MR-Imaging and Spectroscopy, Faculty 01 (Physics/Electrical Engineering), University of Bremen, Bremen, Germany (M.G.); and Department of Neurology, Klinikum Kempten, Kempten-Oberallgaeu, Germany (R.K.).
authors.forename: Johannes
authors.initials: J
authors.lastname: Gregori
authors.affiliation: From the Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (S.O., M.G., J.S.-S., M.E.W., A.G., M.G.H., K.S., R.K.); mediri GmbH, Heidelberg, Germany (J.G., M.G.); Institute for Medical Image Computing MEVIS, Fraunhofer MEVIS, Bremen, Germany (M.G.); MR-Imaging and Spectroscopy, Faculty 01 (Physics/Electrical Engineering), University of Bremen, Bremen, Germany (M.G.); and Department of Neurology, Klinikum Kempten, Kempten-Oberallgaeu, Germany (R.K.).
authors.forename: Matthias
authors.initials: M
authors.lastname: Günther
authors.affiliation: From the Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (S.O., M.G., J.S.-S., M.E.W., A.G., M.G.H., K.S., R.K.); mediri GmbH, Heidelberg, Germany (J.G., M.G.); Institute for Medical Image Computing MEVIS, Fraunhofer MEVIS, Bremen, Germany (M.G.); MR-Imaging and Spectroscopy, Faculty 01 (Physics/Electrical Engineering), University of Bremen, Bremen, Germany (M.G.); and Department of Neurology, Klinikum Kempten, Kempten-Oberallgaeu, Germany (R.K.).
authors.forename: Johannes
authors.initials: J
authors.lastname: Sauter-Servaes
authors.affiliation: From the Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (S.O., M.G., J.S.-S., M.E.W., A.G., M.G.H., K.S., R.K.); mediri GmbH, Heidelberg, Germany (J.G., M.G.); Institute for Medical Image Computing MEVIS, Fraunhofer MEVIS, Bremen, Germany (M.G.); MR-Imaging and Spectroscopy, Faculty 01 (Physics/Electrical Engineering), University of Bremen, Bremen, Germany (M.G.); and Department of Neurology, Klinikum Kempten, Kempten-Oberallgaeu, Germany (R.K.).
authors.forename: Marc E
authors.initials: ME
authors.lastname: Wolf
authors.affiliation: From the Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (S.O., M.G., J.S.-S., M.E.W., A.G., M.G.H., K.S., R.K.); mediri GmbH, Heidelberg, Germany (J.G., M.G.); Institute for Medical Image Computing MEVIS, Fraunhofer MEVIS, Bremen, Germany (M.G.); MR-Imaging and Spectroscopy, Faculty 01 (Physics/Electrical Engineering), University of Bremen, Bremen, Germany (M.G.); and Department of Neurology, Klinikum Kempten, Kempten-Oberallgaeu, Germany (R.K.).
authors.forename: Achim
authors.initials: A
authors.lastname: Gass
authors.affiliation: From the Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (S.O., M.G., J.S.-S., M.E.W., A.G., M.G.H., K.S., R.K.); mediri GmbH, Heidelberg, Germany (J.G., M.G.); Institute for Medical Image Computing MEVIS, Fraunhofer MEVIS, Bremen, Germany (M.G.); MR-Imaging and Spectroscopy, Faculty 01 (Physics/Electrical Engineering), University of Bremen, Bremen, Germany (M.G.); and Department of Neurology, Klinikum Kempten, Kempten-Oberallgaeu, Germany (R.K.).
authors.forename: Michael G
authors.initials: MG
authors.lastname: Hennerici
authors.affiliation: From the Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (S.O., M.G., J.S.-S., M.E.W., A.G., M.G.H., K.S., R.K.); mediri GmbH, Heidelberg, Germany (J.G., M.G.); Institute for Medical Image Computing MEVIS, Fraunhofer MEVIS, Bremen, Germany (M.G.); MR-Imaging and Spectroscopy, Faculty 01 (Physics/Electrical Engineering), University of Bremen, Bremen, Germany (M.G.); and Department of Neurology, Klinikum Kempten, Kempten-Oberallgaeu, Germany (R.K.).
authors.forename: Kristina
authors.initials: K
authors.lastname: Szabo
authors.affiliation: From the Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (S.O., M.G., J.S.-S., M.E.W., A.G., M.G.H., K.S., R.K.); mediri GmbH, Heidelberg, Germany (J.G., M.G.); Institute for Medical Image Computing MEVIS, Fraunhofer MEVIS, Bremen, Germany (M.G.); MR-Imaging and Spectroscopy, Faculty 01 (Physics/Electrical Engineering), University of Bremen, Bremen, Germany (M.G.); and Department of Neurology, Klinikum Kempten, Kempten-Oberallgaeu, Germany (R.K.).
authors.forename: Rolf
authors.initials: R
authors.lastname: Kern
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy*; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015424:Reperfusion / Q000379:methods*; D013113:Spin Labels; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*
chemical_list: D005343:Fibrinolytic Agents; D013113:Spin Labels
keywords: magnetic resonance imaging; perfusion imaging; reperfusion; spin labels; stroke