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Diffusion magnetic resonance imaging provides and early marker of acute cerebral ischemic injury. Thrombolytic reversal of diffusion abnormalities has not previously been demonstrated in humans. Serial diffusion and perfusion imaging studies were acquired in patients experiencing acute hemispheric cerebral ischemia treated with intra-arterial thrombolytic therapy within 6 hours of symptom onset. Seven patients met inclusion criteria of prethrombolysis and postthrombolysis magnetic resonance studies, presence of large artery anterior circulation occlusion at angiography, and achievement of vessel recanalization. Mean diffusion-weighted imaging lesion volume at baseline was 23 cm^3 (95% confidence interval [95% CI], 8-38cm^3) and decreased to 10 cm^3 (95% CI, 3-17 cm^3) 2.5 to 9.5 hours after thrombolysis. Mean apparent diffusion coefficient lesion volume decreased from 9 cm^3 (95% CI, 2-16 cm^3) at baseline to 1 cm^3 (95% CI, 0.4-2 cm^3) early after thrombolysis. A secondary increase indiffusion volumes was seen in 3 of 6 patients at day 7. In all 4 patients in whom perfusion imaging was obtained before and after treatment, complete resolution of the perfusion deficit was shown. Diffusion magnetic resonance signatures of early tissue ischemic injury can be reversed in humans by prompt thromolytic vessel recanaliation. The ischemic penumbra includes not only the region of diffusion/perfusion mismatch, but also portions of the region of initial diffusion abnormality. |
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cerebrovascular accident,thrombolytic agents in treatment
fibrinolytic agents
fibrinolytic agents,intra-arterial local infusion
ischemic penumbra
MRI
MRI,abnormal
MRI,diffusion weighted
MRI,mismatch between perfusion/diffusion
MRI,perfusion
recanalization,arterial
treatment of neurologic disorder
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