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6 Hunter GJ, Hamberg LM, Ponzo JA, Hüang-Hellinger FR, Morris PP, Rabinov J, et al. Assessment of cerebral perfusion and arterial anatomy in hyperacute stroke with three-dimensional functional CT: early clinical results. Am J Neuroradiology 1998; 19:29-37. This is an early report of perfusion imaging using helical CT during the bolus infusion of contrast. The attraction of this method is that CT is routinely used in clinical practice. The authors propose that the quantitative map of perfused cerebral blood volume could be compared with the extent of early infarct signs to assess the proportions of infarcted tissue and tissue that is at risk, but much work is required to prove assertions about tissue viability. This procedure is currently limited to single slice acquisitions.
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7 Knauth M, von Kummer R, Jansen O, Hähnel S, Dörfler A, Sartor K. Potential of CT angiography in acute ischemic stroke. Am J Neuroradiology 1997; 18:1001-1010. High quality images were obtained in this well conducted study. CTA was most accurate for detecting intracranial internal carotid artery disease, MCA disease, and basilar artery disease, but less so for MCA branch occlusions. CTA compared favorably with digital subtraction angiography in 11 patients, and a reliable assessment of the extent of the collateral circulation could be made. However, image postprocessing time can take up to 30 min.
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11 Baird AE, Benfield A, Schlaug G, Siewert B, Lövblad KO, Edelman RR, Warach S. Enlargement of human cerebral ischemic lesion volumes measured by diffusion-weighted magnetic resonance imaging. Ann Neurol 1997; 41:581-589.
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14 Baird AE, Warach S. Magnetic resonance imaging of acute stroke. J Cereb Blood Flow Metab 1998; 18:583-609. This is a comprehensive and well-organized review of the methodology, pathophysiology, and potential clinical applications of magnetic resonance in acute stroke.
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15 Lövblad KO, Jakob PM, Chen Q, Baird AE, Schlaug G, Warach S, Edelman RR. Turbo spin-echo diffusion-weighted MR of ischemic stroke. Am J Neuroradiology 1998; 19:201-208. DWI half-Fourier single-shot turbo spin-echo is a fast diffusion-weighted imaging method that could be used on magnetic resonance systems that do not have EPt capability, and has fewer image distortions in the posterior fossa than EPI-DWI. However, as image acquisition is much slower (minutes) and requires cardiac gating, and because images are of lower resolution, it is not a threat to EPI-DWI which is available on the current generation of MRI scanners.
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16 Butts K, Pauly J, de Crespigny A, Moseley M. Isotropic diffusion-weighted and spiral-navigated interleaved EPI for routine imaging of acute stroke. Magn Res Med 1997; 38:741-749.
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18 van Zijl PCM, Eleff SM, Ulatowski JA, Qja JME, Ulug AM, Traystman RJ, Kauppinen RA. Quantitative assessment of blood flow, blood volume and blood oxygenation effects in functional magnetic resonance imaging. Nature Med 1998; 4:159-167. This paper provides quantitative physiologic relationships that relate changes in magnetic resonance BOLD signal to changes in cerebral blood flow, cerebral blood volume, and oxygen extraction. The physiologic parameters were validated in a model of cerebral hypoxia. Potentially, quantitative values for magnetic resonance BOLD perfusion imaging could be developed for cerebral ischemia, which would be very valuable for pathophysiologic studies. So far it has been implemented on higher field magnets than used in clinical practice.
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19 Pouwels PJW, Frahm J. Regional metabolite concentrations in human brain as determined by quantitative localized proton MRS. Magn Res Med 1998; 39:53-60.
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20 Loubinoux I, Volk A, Borredon J, Guirimand S, Tiffon B, Seylaz J, Méric P. Spreading of vasogenic edema and cytotoxic edema assessed by quantitative diffusion and T2 magnetic resonance imaging. Stroke 1997; 28:419-427.
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21 Kohno K, Hoehn-Berlage M, Mies G, Back T, Hossmann KA. Relationship between diffusion-weighted MR images, cerebral blood flow, and energy state in experimental brain infarction. Magn Reson Imaging 1995; 13:73-80.
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22 Hoehn-Berlage M, Norris DG, Kohno K, Mies G, Leibtritz D, Hossmann K-A. Evolution of regional changes in apparent diffusion coefficient during focal ischemia of rat brain: the relationship of quantitative diffusion NMR imaging to reduction of cerebral blood flow and metabolic disturbances. J Cereb Blood Flow Metab 1995; 15:1002-1011.
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26 Gröhn OHJ, Lukkarinen JA, Oja JME, van Zijl PCM, Ulatowski JA, Traystman RJ, Kauppinen RA. Noninvasive detection of cerebral hypoperfusion and reversible ischemia from reduction In the magnetic resonance imaging relaxation time, T2. J Cereb Blood Flow Metab 1998; 18:911-920. In focal rodent ischemia, T2-weighted magnetic resonance BOLD signal changes appeared before DWI lesions. This likely represented hypoperfused, hypoxic tissue before the development of injury, as the area of reduction in T2 signal on BOLD corresponded to hypoperfusion on bolus tracking studies. Three tissue signatures were identified that may represent hypoxia, ischemic injury, and irreversible injury. These signatures could ultimately be used to guide decision making about the administration of acute stroke therapy. At present this technique is restricted to experimental ischemia but has the potential for hyperacute stroke imaging in humans and for quantitation.
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27
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27 Els T, Röther J, Beaulieu C, de Crespigny A, Moseley M. Hyperglycemia delays terminal depolarization and enhances repolarization after peri-infarct spreading depression as measured by serial diffusion MR mapping. J Cereb Blood Flow Metab 1997; 17:591-595.
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28 Mancuso A, Nimura T, Weinstein PR. Prediction of delayed ischemic injury with diffusion-weighted MRI following temporary middle cerebral artery occlusion in rats. Brain Res 1997; 760:42-51.
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29 Takano K, Carano RAD, Tatlisumak T, Meiler M, Sotak CH, Kleinert HD, Fisher M. Efficacy of intra-arterial and intravenous prourokinase in an embolic stroke model evaluated by diffusion-perfusion magnetic resonance imaging. Neurology 1998; 50:870-875.
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30 Liu Y, Mituska S, Hashizume K, Hosaka T, Nukui H. The sequential change of local cerebral blood flow and local cerebral glucose metabolism after focal cerebral ischaemia and reperfusion in rat and the effect of MK-801 on local cerebral glucose metabolism. Acta Neurochurgica (Wein) 1997; 139:770-779.
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31 Tong DC, Yenari MA, Albers GW, O'Brien M, Marks MP, Moseley ME. Correlation of perfusion-and diffusion-weighted MRI with NIHSS score in acute (<6.5 hour) ischemic stroke. Neurology 1998; 50:864-870. This paper provides clinical correlations of perfusion and DWI lesion volumes in the first 6.5 h after stroke. In most patients the hypoperfusion volume (as measured by the mean transit time) was larger than the DWI lesion volume. The hypoperfusion and DWI lesion volumes showed a significant correlation with clinical severity at 24 h and with infarct volume at 7 days. The importance of these results is that they provide preliminary evidence to support the hypothesis that the evolving DWI lesion represents the recruitment of viable tissue into the infarct. The combination of MR diffusion weighted and perfusion imaging could ultimately provide MR imaging markers for prethrombolysis patient selection.
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32 Kamada K, Saguer M, Möller M, Wicklow K, Katenhäuser M, Kober H, Vieth J. Functional and metabolic analysis of cerebral ischemia using magnetoencephalography and proton magnetic resonance spectroscopy. Ann Neurol 1997; 42:554-563. This is an interesting study of the relation between brain function and metabolism in subacute and chronic cerebral infarcts. In some cases tissue adjacent to the infarct had abnormal magnetoencephalography and abnormal magnetic resonance spectroscopy (reduced N-acetyl aspartate) but was morphologically normal on T2-weighted images. In other cases, abnormal magnetoencephalography was associated with mild lactic acidosis but no loss of N-acetyl compounds. Results could be due to neuronal dropout or selective neuronal loss during acute ischemia, but the abnormal magnetoencephalography indicated that the remaining neurons may be functioning abnormally. It was proposed that this tissue could represent a chronic ischemic penumbra. Demonstration of persistent hypoperfusion is required to back up this assertion.
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36 Haufman MJ, Levin JM, Ross MH, Lange N, Rose SL, Kukes TJ, et al. Cocaine-induced cerebral vasoconstriction detected in humans with magnetic resonance angiography. JAMA 1998; 279:376-380. This paper provides first proof that cocaine's effect on the cerebral vasculature is through vasoconstriction of large and medium sized arteries. The effect occurred in a dose-dependent manner. Low-dose cocaine was intravenously administered to individuals with a history of cocaine usage. How imaging modalities can be used to study mechanisms of cerebral ischemia was demonstrated.
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