Neuroimaging in acute ischaemic stroke: Insights into unanswered questions of pathophysiology

Journal of Internal Medicine

Volumn 267, Issue 2, 2010, Pages 172-190

  Wardlaw, J M ^a  

^a UNIVERSITY OF EDINBURGH   (United Kingdom)

Author keywords

CT; Imaging; Ischaemic penumbra; MR; Stroke

Indexed keywords

BRAIN BLOOD FLOW; BRAIN PERFUSION; CEREBROVASCULAR ACCIDENT; COMPUTED TOMOGRAPHIC ANGIOGRAPHY; COMPUTER ASSISTED TOMOGRAPHY; CONFERENCE PAPER; DIFFUSION WEIGHTED IMAGING; HUMAN; MAGNETIC RESONANCE ANGIOGRAPHY; NEUROIMAGING; NUCLEAR MAGNETIC RESONANCE IMAGING; PATHOPHYSIOLOGY; POSITRON EMISSION TOMOGRAPHY; PRIORITY JOURNAL;

ACUTE DISEASE; ANIMALS; BRAIN; BRAIN ISCHEMIA; HUMANS; MAGNETIC RESONANCE IMAGING; MODELS, BIOLOGICAL; STROKE; TOMOGRAPHY, X-RAY COMPUTED;

EID: 74849135897     PISSN: 09546820     EISSN: 13652796     Source Type: Journal    
DOI: 10.1111/j.1365-2796.2009.02200.x     Document Type: Conference Paper

References (114)

1. Astrup J, Siesjo BK, Symon L. Thresholds in cerebral ischemia - the ischemic penumbra. Stroke 1981 12 : 723 725.
2. Astrup J, Symon L, Branston NM, Lassen NA. Cortical evoked potential and extracellular K+ and H+ at critical levels of brain ischemia. Stroke 1977 8 : 51 7.
3. Bell BA, Symon L, Branston NM. CBF and time thresholds for the formation of ischemic cerebral edema, and effect of reperfusion in baboons. J Neurosurg 1985 62 : 31 41.
4. Mellergard P, Bengtsson F, Smith M-L, Riesenfeld V, Siesjo BK. Time course of early brain edema following reversible forebrain ischemia in rats. Stroke 1989 20 : 1565 1570.
5. Memezawa H, Smith ML, Siesjo BK. Penumbral tissues salvaged by reperfusion following middle cerebral artery occlusion in rats. Stroke 1992 23 : 552 559.
6. Siesjo BK. Pathophysiology and treatment of focal cerebral ischemia. Part I: pathophysiology. J Neurosurg 1992 77 : 169 184.
7. Siesjo BK. Pathophysiology and treatment of focal cerebral ischemia. Part II: mechanisms of damage and treatment. J Neurosurg 1992 77 : 337 354.
8. Marchal G, Serrati C, Rioux P et al. PET imaging of cerebral perfusion and oxygen consumption in acute ischaemic stroke: relation to outcome. Lancet 1993 341 : 925 927.
9. Baron JC. Mapping the ischaemic penumbra with PET: implications for acute stroke treatment. Cerebrovasc Dis 1999 9 : 193 201.
10. Heiss W-D. Ischemic penumbra: evidence from functional imaging in man. J Cereb Blood Flow Metab 2000 20 : 1276 1293.
11. Hacke W, Albers G, Al Rawi Y et al. The Desmoteplase in Acute Ischemic Stroke Trial (DIAS): a Phase II MRI-based 9-hour window acute stroke thrombolysis trial with intravenous desmoteplase. Stroke 2005 36 : 66 73.
12. Furlan AJ, Eyding D, Albers GW et al. Dose escalation of desmoteplase for acute ischemic stroke (DEDAS). Evidence of safety and efficacy 3 to 9 hours after stroke onset. Stroke 2006 37 : 1227 1231.
13. Hacke W, Furlan AJ, Al-Rawi Y et al. Intravenous desmoteplase in patients with acute ischaemic stroke selected by MRI perfusion-diffusion weighted imaging or perfusion CT (DIAS-2): a prospective, randomised, double-blind, placebo-controlled study. Lancet Neurol 2008 8 : 141 150.
14. Davis SM, Donnan G, Parsons MW et al. Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET): a placebo-controlled randomised trial. Lancet Neurol 2008 7 : 299 309.
15. Perel P, Roberts I, Sena E et al. Comparison of treatment effects between animal experiments and clinical trials: systematic review. BMJ 2007 334 : 197.
16. Davis SM, Donnan GA. Using mismatch on MRI to select thrombolytic responders: an attractive hypothesis awaiting confirmation. Stroke 2005 36 : 1106 1107.
17. Toth G, Albers GW. Use of MRI to estimate the therapeutic window in acute stroke. Is perfusion-weighted imaging/diffusion-weighted imaging mismatch an EPITHET for salvageable ischemic brain tissue? Stroke 2008 40 : 333 335.
18. Butcher K. Rapid advanced neuroimaging assessment in acute stroke. Int J Stroke 2009 4 : 97 100.
19. Wardlaw JM. Surrogate outcomes. A cautionary note. Stroke 2009 40 : 1029 1031.
20. Davis SM, Donnan GA. MR mismatch and thrombolysis: appealing but validation required. Stroke 2009 40 : 2910.
21. Rha J, Saver JL. The impact of recanalization on ischemic stroke outcome. A meta-analysis. Stroke 2007 38 : 967 973.
22. Wardlaw JM, Murray VE, Berge E, del Zoppo GJ. Thrombolysis in acute ischaemic stroke. Part 1. Thrombolysis versus control. Cochrane Database Syst Rev 2009 2009.
23. Kobayashi A, Wardlaw JM, Lindley RI, Lewis SC, Sandercock PAG, Czlonkowska A. Oxfordshire Community Stroke Project clinical stroke syndrome and appearances of tissue and vascular lesions on pre-treatment CT in hyperacute ischaemic stroke among the first 510 patients in the Third International Stroke Trial (IST-3). Stroke 2009 40 : 743 748.
24. Kharitonova T, Ahmed N, Thorén M et al. Hyperdense middle cerebral artery sign on admission CT scan - prognostic significance for ischaemic stroke patients treated with intravenous thrombolysis in the Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Register. Cerebrovasc Dis 2009 27 : 51 9.
25. Heiss WD, Huber M, Fink GR et al. Progressive derangement of periinfarct viable tissue in ischemic stroke. J Cereb Blood Flow Metab 1992 12 : 193 203.
26. Markus R, Reutens DC, Kazui S et al. Spontaneous salvage of penumbral tissue improves clinical outcomes as late as 12-48 hr after stroke onset. Stroke 2004 35 : 295.
27. Moseley ME, Cohen Y, Mintorovich J, Chileuitt L, Shimizu H, Kucharczyk J. Early detection of regional cerebral ischemia in cats: comparison of diffusion- and T2-weighted MRI and spectroscopy. Magn Reson Med 1989 14 : 330 346.
28. Hjort N, Christensen S, Solling C et al. Ischemic injury detected by diffusion imaging 11 minutes after stroke. Ann Neurol 2005 58 : 462 465.
29. Wintermark M, Sesay M, Barbier E et al. Comparative overview of brain perfusion imaging techniques. Stroke 2005 36 : e83 99.
30. Ostergaard L, Weisskoff RM, Chesler D, Gyldensted C, Rosen BR. High resolution measurement of cerebral blood flow using intravascular tracer bolus passages. Part I: mathematical approach and statistical analysis. Magn Reson Med 1996 36 : 715 725. (Pubitemid 26376710)
31. Ostergaard L, Sorensen AG, Kwong KK, Weisskoff RM, Gyldensted C, Rosen BR. High resolution measurement of cerebral blood flow using intravascular tracer bolus passages. Part II: experimental comparison and preliminary results. Magn Reson Med 1996 36 : 726 736. (Pubitemid 26376711)
32. Alsop DC, Detre JA. Reduced transit-time sensitivity in noninvasive magnetic resonance imaging of human cerebral blood flow. J Cereb Blood Flow Metab 1996 16 : 1236 1249.
33. Mayer TE, Hamann GF, Baranczyk J et al. Dynamic CT perfusion imaging of acute stroke. AJNR Am J Neuroradiol 2000 21 : 1441 1449.
34. Murphy BD, Fox AJ, Lee DH et al. Identification of penumbra and infarct in acute ischemic stroke using computed tomography perfusion-derived blood flow and blood volume measurements. Stroke 2006 37 : 1771 1777.
35. Wintermark M, Flanders AE, Velthuis B et al. Perfusion-CT assessment of infarct core and penumbra. Receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke. Stroke 2006 37 : 979 985.
36. Schramm P, Schellinger PD, Klotz E et al. Comparison of perfusion computed tomography and computed tomography angiography source images with perfusion-weighted imaging and diffusion-weighted imaging in patients with acute stroke of less than 6 hours' duration. Stroke 2004 35 : 1652 1658.
37. Schaefer PW, Barak ER, Kamalian S et al. Quantitative assessment of core/penumbra mismatch in acute stroke: CT and MR perfusion imaging are strongly correlated when sufficient brain volume is imaged. Stroke 2008 39 : 2986 2992.
38. Hand PJ, Wardlaw JM, Rowat AM, Haisma JA, Lindley RI, Dennis MS. Magnetic resonance brain imaging in patients with acute stroke: feasibility and patient-related difficulties. J Neurol Neurosurg Psychiatry 2005 76 : 1525 1527.
39. Singer OC, Sitzer M, du Mesnil de Rochemont R, Neumann-Haefelin T. Practical limitations of acute stroke MRI due to patient-related problems. Neurology 2004 62 : 1848 1849.
40. Barber PA, Hill MD, Eliasziw M et al. Imaging of the brain in acute ischaemic stroke: comparison of computed tomography and magnetic resonance diffusion-weighted imaging. J Neurol Neurosurg Psychiatry 2005 76 : 1528 1533.
41. Albers GW, Thijs VN, Wechsler L et al. Magnetic resonance imaging profiles predict clinical response to early reperfusion: the Diffusion and perfusion imaging Evaluation for Understanding Stroke Evolution (DEFUSE) study. Ann Neurol 2006 60 : 508 517.
42. Klotz E, Konig M. Perfusion measurements of the brain: using dynamic CT for the quantitative assessment of cerebral ischemia in acute stroke. Eur J Radiol 1999 30 : 170 184.
43. Koenig M, Kraus M, Theek C, Klotz E, Gehlen W, Heuser L. Quantitative assessment of the ischemic brain by means of perfusion-related parameters derived from perfusion CT. Stroke 2001 32 : 431 437.
44. Dittrich R, Akdeniz S, Kloska SP et al. Low rate of contrast-induced nephropathy after CT perfusion and CT angiography in acute stroke patients. J Neurol 2007 254 : 1491 1497.
45. Oleinik A, Romero JM, Schwab K et al. CT angiography for intracerebral hemorrhage does not increase risk of acute nephropathy. Stroke 2009 40 : 2393 2397.
46. Kidwell CS, Saver JL, Mattiello J et al. Thrombolytic reversal of acute human cerebral ischemic injury shown by diffusion/perfusion magnetic resonance imaging. Ann Neurol 2000 47 : 462 469.
47. Tong DC, Adami A, Moseley ME, Marks MP. Relationship between apparent diffusion coefficient and subsequent hemorrhagic transformation following acute ischemic stroke. Stroke 2000 31 : 2378 2384.
48. Fiehler J, Foth M, Kucinski T et al. Severe ADC decreases do not predict irreversible tissue damage in humans. Stroke 2002 33 : 79 86.
49. Loh PS, Butcher KS, Parsons MW et al. Apparent diffusion coefficient thresholds do not predict the response to acute stroke thrombolysis. Stroke 2005 36 : 2626 2631.
50. Na DG, Thijs VN, Albers GW, Moseley ME, Marks MP. Diffusion-weighted MR imaging in acute ischemia: value of apparent diffusion coefficient and signal intensity thresholds in predicting tissue at risk and final infarct size. AJNR Am J Neuroradiol 2004 25 : 1331 1336.
51. Guadagno JV, Warburton EA, Jones PS et al. The diffusion-weighted lesion in acute stroke: heterogeneous patterns of flow/metabolism uncoupling as assessed by quantitative positron emission tomography. Cerebrovasc Dis 2005 19 : 239 246.
52. Wardlaw JM, Keir SL, Bastin ME, Armitage PA, Rana AK. Is diffusion imaging appearance an independent predictor of outcome after ischaemic stroke? Neurology 2002 59 : 1381 1387.
53. Fiehler J, Kucinski T, Knudsen K et al. Are there time-dependent differences in diffusion and perfusion within the first 6 hours after stroke onset? Stroke 2004 35 : 2099 2104.
54. Fiehler J, Knab R, Reichenbach JR, Fitzek C, Weiller C, Rother J. Apparent diffusion coefficient decreases and magnetic resonance imaging perfusion parameters are associated in ischemic tissue of acute stroke patients. J Cereb Blood Flow Metab 2004 21 : 577 584.
55. Fiehler J, Remmele C, Kucinski T et al. Reperfusion after severe local perfusion deficit precedes hemorrhagic transformation: an MRI study in acute stroke patients. Cerebrovasc Dis 2005 19 : 117 124.
56. Rivers CS, Wardlaw JM, Armitage PA, Bastin ME, Hand PJ, Dennis MS. Acute ischemic stroke lesion measurement on diffusion-weighted imaging-important considerations in designing acute stroke trials with magnetic resonance imaging. J Stroke Cerebrovasc Dis 2007 16 : 64 70.
57. Labelle M, Khiat A, Durocher A, Boulanger Y. Comparison of metabolite levels and water diffusion between cortical and subcortical strokes as monitored by MRI and MRS. Invest Radiol 2001 36 : 155 163.
58. Nicoli F, Lefur Y, Denis B, Ranjeva JP, Confort-Gouny S, Cozzone PJ. Metabolic counterpart of decreased apparent diffusion coefficient during hyperacute ischemic stroke. A brain proton magnetic resonance spectroscopic imaging study. Stroke 2003 34 : e82 8.
59. Cvoro V, Wardlaw J, Marshall I et al. Associations between diffusion and perfusion parameters, N-acteyl aspartate, and lactate in acute ischemic stroke. Stroke 2009 40 : 767 772.
60. Cvoro V, Marshall I, Armitage PA et al. MR diffusion and perfusion parameters: relationship to metabolites in acute ischaemic stroke. J Neurol Neurosurg Psychiatry 2009 (in press) doi :.
61. Cvoro V, Wartolowska K, Farrall AJ et al. Voxel-based analysis of the relationship between metabolites diffusion and perfusion parameters in acute ischemic stroke. Cerebrovasc Dis 2004 17 : 96.
62. Fiehler J, Knudsen K, Kucinski T et al. Predictors of apparent diffusion coefficient normalization in stroke patients. Stroke 2004 35 : 514 519.
63. Kranz PG, Eastwood JD. Does diffusion-weighted imaging represent the ischemic core? An evidence-based systematic review AJNR Am J Neuroradiol 2009 30 : 1206 1212.
64. Keir SL, Wardlaw JM. Systematic review of diffusion and perfusion imaging in acute ischaemic stroke. Stroke 2000 31 : 2723 2731.
65. Rivers CS, Wardlaw JM. What has diffusion imaging in animals told us about diffusion imaging in patients with ischaemic stroke? Cerebrovasc Dis 2005 19 : 328 336.
66. Hjort N, Butcher K, Davis SM et al. Magnetic resonance imaging criteria for thrombolysis in acute cerebral infarct. Stroke 2005 36 : 388 397.
67. Bandera E, Botteri M, Minelli C, Sutton A, Abrams KR, Latronico N. Cerebral blood flow threshold of ischemic penumbra and infarct core in acute ischemic stroke. A systematic review. Stroke 2006 37 : 1334 1339.
68. Provenzale JM, Shah K, Patel U, McCrory DC. Systematic review of CT and MR perfusion imaging for assessment of acute cerebrovascular disease. AJNR Am J Neuroradiol 2008 29 : 1476 1482.
69. Wintermark M, Albers GW, Alexandrov AV et al. Acute stroke imaging research roadmap. Stroke 2008 39 : 1621 1628.
70. Sobesky J, Weber OZ, Lehnhardt FG et al. Which time-to-peak threshold best identifies penumbral flow? A comparison of perfusion-weighted magnetic resonance imaging and positron emission tomography in acute ischemic stroke. Stroke 2004 35 : 2843 2847.
71. Carpenter T, Lee M, Rivers CS, Wardlaw JM. Do MR perfusion thresholds reliably identify core and penumbra of ischaemic tissue in acute ischaemic stroke? Cerebrovasc Dis 2008 25 : 33.
72. Carpenter TK, Armitage PA, Bastin ME, Wardlaw JM. Artefacts in MR perfusion parametric images in ischaemic stroke - effects of variation in bolus arrival time. Cerebrovasc Dis 2003 16 : 92.
73. Armitage PA, Rivers CS, Carpenter TK, Bastin ME, Hand PJ, Wardlaw JM. MR perfusion imaging: problems resulting from a lack of contrast agent in infarcted regions. Cerebrovasc Dis 2003 16 : 92.
74. Calamante F, Gadian DG, Connelly A. Quantification of perfusion using bolus tracking magnetic resonance imaging in stroke: assumptions, limitations, and potential implications for clinical use. Stroke 2002 33 : 1146 1151.
75. Rivers CS, Wardlaw JM, Armitage P et al. Do acute diffusion- and perfusion-weighted MRI lesions identify final infarct volume in ischemic stroke? Stroke 2006 37 : 98 104.
76. Kane I, Carpenter T, Chappell F et al. Comparison of 10 different magnetic resonance perfusion imaging processing methods in acute ischemic stroke. Effect on lesion size, proportion of patients with diffusion/perfusion mismatch, clinical scores, and radiologic outcomes. Stroke 2007 38 : 3158 3164.
77. Carpenter T, Armitage PA, Bastin ME, Wardlaw JM. DSC perfusion MRI - quantification and reduction of systematic errors arising in areas of reduced cerebral blood flow. Magn Reson Med 2006 55 : 1342 1349.
78. Wu O, Christensen S, Hjort N et al. Characterizing physiological heterogeneity of infarction risk in acute human ischaemic stroke using MRI. Brain 2006 129 : 2384 2393.
79. Rana AK, Wardlaw JM, Armitage PA, Bastin ME. Apparent diffusion coefficient (ADC) measurements may be more reliable and reproducible than lesion volume on diffusion-weighted images from patients with acute ischaemic stroke - implications for study design. Magn Reson Imaging 2003 21 : 617 624.
80. Ay H, Arsava EM, Vangel M et al. Interexaminer difference in infarct volume measurements on MRI: a source of variance in stroke research. Stroke 2008 39 : 1171 1176.
81. Kane I, Hand PJ, Rivers C et al. A practical assessment of magnetic resonance diffusion-perfusion mismatch in acute stroke: observer variation and outcome. J Neurol 2009 256 : 1832 1838.
82. Coutts SB, Simon JE, Tomanek AI et al. Reliability of assessing percentage of diffusion-perfusion mismatch. Stroke 2003 34 : 1681 1685.
83. Singer OC, Kurre W, Humpich MC et al. Risk assessment of symptomatic intracerebral hemorrhage after thrombolysis using DWI-ASPECTS. Stroke 2009 40 : 2743 2748.
84. Parsons MW, Pepper EM, Chan V et al. Perfusion computed tomography: prediction of final infarct extent and stroke outcome. Ann Neurol 2005 58 : 672 679.
85. Schabitz WR. MR mismatch is useful for patient selection for thrombolysis: no. Stroke 2009 40 : 2908 2909.
86. Muñoz Maniega S, Bastin ME, Armitage PA et al. Temporal evolution of water diffusion parameters is different in grey and white matter in human ischaemic stroke. J Neurol Neurosurg Psychiatry 2004 75 : 1714 1718.
87. van der Zwan A, Hillen B, Tulleken CAF, Dujovny M, Dragovic L. Variability of the territories of the major cerebral arteries. J Neurosurg 1992 77 : 927 940.
88. Kansagra AP, Wong EC. Quantitative assessment of mixed cerebral vascular territory supply with vessel encoded arterial spin labeling MRI. Stroke 2008 39 : 2980 2985.
89. Strong AJ, Anderson PJ, Watts HR et al. Peri-infarct depolarizations lead to loss of perfusion in ischaemic gyrencephalic cerebral cortex. Brain 2007 130 : 995 1008.
90. Strong AJ. Spreading depolarisations: tsunamis in the injured braAdv Clin Neurosci Rehabil 2009 9 : 32 4.
91. Kane I, Sandercock P, Wardlaw J. Magnetic resonance perfusion diffusion mismatch and thrombolysis in acute ischaemic stroke: a systematic review of the evidence to date. J Neurol Neurosurg Psychiatry 2007 78 : 485 491.
92. Mishra NK, Albers G, Davis GA et al. A systematic overview of thrombolysis 3-9H from stroke onset in patients selected according to mismatch criteria. Cerebrovasc Dis 2009 27 (Suppl. 6 31 (Abstract).
93. Butcher K, Parsons M, Allport L et al. Rapid assessment of perfusion-diffusion mismatch. Stroke 2008 75 81.
94. Ay H, Koroshetz WJ, Vangel M et al. Conversion of ischemic brain tissue into infarction increases with age. Stroke 2005 36 : 2632 2636.
95. Rivers CS, Wardlaw JM, Armitage PA et al. Persistent infarct hyperintensity on diffusion-weighted imaging late after stroke indicates heterogeneous, delayed, infarct evolution. Stroke 2006 37 : 1418 1423.
96. Ay H, Arsava EM, Rosand J et al. Severity of leukoaraiosis and susceptibility to infarct growth in acute stroke. Stroke 2008 39 : 1409 1413.
97. Mandell DM, Han JS, Poublanc J et al. Selective reduction of blood flow to white matter during hypercapnia corresponds with leukoaraiosis. Stroke 2008 39 : 1993 1998.
98. Rowat AM, Dennis MS, Wardlaw JM. Hypoxaemia in acute stroke is frequent and worsens outcome. Cerebrovasc Dis 2005 21 : 166 172.
99. Montaner J, Fernandez-Cadenas I, Molina CA et al. Post-stroke C-reactive protein is a powerful prognostic tool among candidates for thrombolysis. Stroke 2006 37 : 1205 1210.
100. Muir KW, Weir CJ, Alwan W, Squire IB, Lees KR. C-reactive protein and outcome after ischemic stroke. Stroke 1999 30 : 981 985.
101. Ribo M, Montaner J, Molina CA et al. Admission fibrinolytic profile is associated with symptomatic hemorrhagic transformation in stroke patients treated with tissue plasminogen activator. Stroke 2004 35 : 2123 2127. (Pubitemid 39129572)
102. Whiteley W, Jackson C, Lewis S et al. Inflammatory markers and poor outcome after stroke: a prospective cohort study and systematic review of interleukin-6. PLoS Med 2009 6 : e1000145. doi :.
103. Smith CJ, Emsley HC, Gavin CM et al. Peak plasma interleukin-6 and other peripheral markers of inflammation in the first week of ischaemic stroke correlate with brain infarct volume, stroke severity and long-term outcome. BMC Neurol 2004 4 : 2.
104. Scirica BM, Morrow DA, Verma S, Devaraj S, Jialal I. Is C-reactive protein an innocent bystander or proatherogenic culprit? The verdict is still out. Circulation 2006 113 : 2128 2134.
105. Majno G, Ames AI, Chiang J, Wright RL. No reflow after cerebral ischaemia. Lancet 1967 290 : 569 570.
106. Ames AI, Wright RL, Kowada M, Thurston JM, Majno G. Cerebral ischemia. II. The no-reflow phenomenon. Am J Pathol 1968 52 : 437 453.
107. Chiang J, Kowada M, Ames AI, Wright RL, Majno G. Cerebral ischemia. III. Vascular changes. Am J Pathol 1968 52 : 455 476.
108. Soares BP, Chien JD, Wintermark M. MT and CT monitoring of recanalization, reperfusion, and penumbra salvage. Everything that recanalizes does not necessarily reperfuse Stroke 2009 40 : S24 7.
109. Tomsick T. TIMI, TIBI, TICI: I came, I saw, I got confused. AJNR Am J Neuroradiol 2007 28 : 382 384.
110. Muñoz Maniega S, Cvoro V, Chappell FM et al. Changes in NAA and lactate following ischemic stroke: a serial MR spectroscopic imaging study. Neurology 2008 71 : 1993 1999.
111. Fiebach JB, Schellinger PD. MR mismatch is useful for patient selection for thrombolysis: yes. Stroke 2009 40 : 2906 2907.
112. von Kummer R. Changing directions in acute stroke diagnostics. Good-bye "mismatch"? Klin Neuroradiol 2009 19 : 105 107.
113. Hand PJ, Wardlaw JM, Rivers CS et al. MR diffusion-weighted imaging and outcome prediction after ischemic stroke. Neurology 2006 66 : 1159 1163.
114. van der Zwan A, Hillen B. Review of the variability of the territories of the major cerebral arteries. Stroke 1991 22 : 1078 1084.