Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Aug 2005
ReviewExtending the time window for thrombolysis: evidence from acute stroke trials.
Data from intravenous tissue plasminogen activator studies have shown rapidly diminishing clinical benefit beyond 3 hours when noncontrast CT is used for treatment triage. Newer trials, such as the Desmoteplase in Acute Ischemic Stroke trial, have now successfully pushed the time window out to 9 hours using the concept of penumbral imaging and treatment of the perfusion-diffusion mismatch. Advanced imaging with CT or MR imaging protocols is providing a means for rational physiologic selection and outcomes assessment in stroke treatment.
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Neuroimaging Clin. N. Am. · Aug 2005
ReviewDiffusion tensor imaging and fiber tractography in acute stroke.
Diffusion tensor imaging (DTI) permits the quantitative evaluation of white matter pathology using measures of diffusion anisotropy. Fiber tractography based on DTI can reveal the three-dimensional white matter connectivity of the human brain. ⋯ DTI also improves the evaluation of hypoxic-ischemic injury to the developing brain of newborns and infants. DTI and fiber tractography may prove useful in elucidating alterations in brain connectivity resulting from neuroplasticity after stroke.
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As new treatments are developed for stroke, the potential clinical applications of CT perfusion (CTP) imaging in the diagnosis, triage, and therapeutic monitoring of these diseases are certain to increase. Technical advances in scanner hardware and software should no doubt continue to increase the speed, coverage, and resolution of CTP imaging. CTP offers the promise of efficient use of imaging resources and, potentially, of decreased morbidity. Most importantly, current CT technology already permits the incorporation of CTP as part of an all-in-one acute stroke examination to answer the four fundamental questions of stroke triage quickly and accurately, further increasing the contribution of imaging to the diagnosis and treatment of acute stroke.