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Ischemic stroke trials have traditionally sought to limit the range of disease studied according to several dimensions based on clinical examination and CT scan results. It has been proposed that the optimal sample for stroke trials would inc lude a positive imaging diagnosis of a pathology rationally linked to the drug's mechanisms of action and that this would improve the likelihood of positive results. MRI with diffusion and perfusion has been an appealing imaging modality because it provi des pretreatment angiography, perfusion, and lesion volume information during a brief, non-invasive assessment. Current literature supports the validity of MRI as a marker for clinical severity and clinical improvement. The diffusion-perfusion mismatch, t he MRI marker for the ischemic penumbra, is a very strong predictor of lesion volume growth. Several acute trials in progress use a positive imaging diagnosis for the basis of selection. As the field of stroke clinical trials examines opportunities for im proving trial design, positive imaging diagnoses in patient selection are likely to assume an increasingly useful role. |
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CAT scan
cerebrovascular accident
cerebrovascular accident,acute management of
cerebrovascular accident,thrombolytic agents in treatment
cerebrovascular accident,volume
fibrinolytic agents
fibrinolytic agents,intra-arterial local infusion
ischemic penumbra
MRI
MRI,abnormal
MRI,CAT scan compared to
MRI,diffusion weighted
MRI,mismatch between perfusion/diffusion
MRI,perfusion
neuroprotective agents
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