CT Perfusion Imaging in Acute Stroke

Neuroimaging Clinics of North America

Volumn 21, Issue 2, 2011, Pages 215-238

  Konstas, Angelos A ^a   Wintermark, Max ^b   Lev, Michael H ^a  

^a MASSACHUSETTS GENERAL HOSPITAL   (United States)

^b UNIVERSITY OF VIRGINIA   (United States)

Author keywords

Acute stroke; CBV CBF mismatch; Cerebral blood flow; Cerebral blood volume; CT perfusion; Ischemic core; Ischemic penumbra

Indexed keywords

GADOLINIUM;

BLEEDING; BLOOD CLOT LYSIS; BLOOD VOLUME; BRAIN BLOOD FLOW; BRAIN DISEASE; BRAIN HEMORRHAGE; BRAIN ISCHEMIA; COMPUTED TOMOGRAPHIC ANGIOGRAPHY; COMPUTED TOMOGRAPHY PERFUSION IMAGING; DIFFUSION WEIGHTED IMAGING; HEMODYNAMICS; HUMAN; IMAGE ANALYSIS; IMAGE ENHANCEMENT; IMAGE PROCESSING; INTERMETHOD COMPARISON; ISCHEMIC PENUMBRA; NEUROIMAGING; NEURORADIOLOGY; NUCLEAR MAGNETIC RESONANCE IMAGING; OUTCOME ASSESSMENT; PERFUSION WEIGHTED IMAGING; POSITRON EMISSION TOMOGRAPHY; PRIORITY JOURNAL; RECANALIZATION; REVIEW; RISK ASSESSMENT; SAFETY; SCINTIGRAPHY;

CEREBRAL ANGIOGRAPHY; CEREBRAL HEMORRHAGE; HUMANS; PERFUSION IMAGING; RADIOGRAPHIC IMAGE ENHANCEMENT; STROKE; TOMOGRAPHY, X-RAY COMPUTED;

EID: 79957834472     PISSN: 10525149     EISSN: 15579867     Source Type: Journal    
DOI: 10.1016/j.nic.2011.01.008     Document Type: Review

References (178)

1. Hacke W., Kaste M., Bluhmki E., et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008, 359:1317-1329.
2. Saver J.L., Gornbein J., Grotta J., et al. Number needed to treat to benefit and to harm for intravenous tissue plasminogen activator therapy in the 3- to 4.5-hour window: joint outcome table analysis of the ECASS 3 trial. Stroke 2009, 40:2433-2437.
3. Ninds G. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995, 333:1581-1587.
4. Furlan A., Higashida R., Wechsler L., et al. Intra-arterial prourokinase for acute ischemic stroke. JAMA 1999, 282:2003-2011.
5. Marler J.R., Tilley B.C., Lu M., et al. Early stroke treatment associated with better outcome: the NINDS rt-PA stroke study. Neurology 2000, 55:1649-1655.
6. del Zoppo G.J., Poeck K., Pessin M.S., et al. Recombinant tissue plasminogen activator in acute thrombotic and embolic stroke. Ann Neurol 1992, 32:78-86.
7. Hacke W., Kaste M., Fieschi C., et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA 1995, 274:1017-1025.
8. Gobin Y.P., Starkman S., Duckwiler G.R., et al. MERCI 1: a phase 1 study of mechanical embolus removal in cerebral ischemia. Stroke 2004, 35:2848-2854.
9. Katz J.M., Gobin Y.P. Merci retriever in acute stroke treatment. Expert Rev Med Devices 2006, 3:273-280.
10. Smith W.S., Sung G., Starkman S., et al. Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial. Stroke 2005, 36:1432-1438.
11. Phan T.G., Donnan G.A., Koga M., et al. The ASPECTS template is weighted in favor of the striatocapsular region. Neuroimage 2006, 31:477-481.
12. Phan T.G., Donnan G.A., Koga M., et al. Assessment of suitability of thrombolysis in middle cerebral artery infarction: a proof of concept study of a stereologically-based technique. Cerebrovasc Dis 2007, 24:321-327.
13. Fang M.C., Cutler D.M., Rosen A.B. Trends in thrombolytic use for ischemic stroke in the United States. J Hosp Med 2010, 5:406-409.
14. Lev M.H., Farkas J., Rodriguez V.R., et al. CT angiography in the rapid triage of patients with hyperacute stroke to intraarterial thrombolysis: accuracy in the detection of large vessel thrombus. J Comput Assist Tomogr 2001, 25:520-528.
15. Lev M.H., Gonzalez R.G. CT angiography and CT perfusion imaging. Brain mapping: the methods 2002, 427-484. Academic Press, San Diego (CA). 2nd edition. A.W. Toga, J.C. Mazziotta (Eds.).
16. Wildermuth S., Knauth M., Brandt T., et al. Role of CT angiography in patient selection for thrombolytic therapy in acute hemispheric stroke. Stroke 1998, 29:935-938.
17. Knauth M., vonKummer R., Jansen O., et al. Potential of CT angiography in acute ischemic stroke. AJNR Am J Neuroradiol 1997, 18:1001-1010. [see comments].
18. Lev M.H., Nichols S.J. Computed tomographic angiography and computed tomographic perfusion imaging of hyperacute stroke. Top Magn Reson Imaging 2000, 11:273-287.
19. Schellinger P.D., Fiebach J.B., Hacke W. Imaging-based decision making in thrombolytic therapy for ischemic stroke: present status. Stroke 2003, 34:575-583.
20. Warach S. Tissue viability thresholds in acute stroke: the 4-factor model. Stroke 2001, 32:2460-2461.
21. Fox S.H., Tanenbaum L.N., Ackelsberg S., et al. Future directions in CT technology. Neuroimaging Clin N Am 1998, 8:497-513.
22. Smith W.S., Roberts H.C., Chuang N.A., et al. Safety and feasibility of a CT protocol for acute stroke: combined CT, CT angiography, and CT perfusion imaging in 53 consecutive patients. AJNR Am J Neuroradiol 2003, 24:688-690.
23. Gleason S., Furie K.L., Lev M.H., et al. Potential influence of acute CT on inpatient costs in patients with ischemic stroke. Acad Radiol 2001, 8:955-964.
24. Lee K.H., Lee S.J., Cho S.J., et al. Usefulness of triphasic perfusion computed tomography for intravenous thrombolysis with tissue-type plasminogen activator in acute ischemic stroke. Arch Neurol 2000, 57:1000-1008.
25. Lee K.H., Cho S.J., Byun H.S., et al. Triphasic perfusion computed tomography in acute middle cerebral artery stroke: a correlation with angiographic findings. Arch Neurol 2000, 57:990-999.
26. Lev M.H., Segal A.Z., Farkas J., et al. Utility of perfusion-weighted CT imaging in acute middle cerebral artery stroke treated with intra-arterial thrombolysis: prediction of final infarct volume and clinical outcome. Stroke 2001, 32:2021-2028.
27. Albers G.W. Expanding the window for thrombolytic therapy in acute stroke. The potential role of acute MRI for patient selection. Stroke 1999, 30:2230-2237.
28. Barber P.A., Demchuk A.M., Zhang J., et al. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet 2000, 355:1670-1674.
29. Broderick J.P., Lu M., Kothari R., et al. Finding the most powerful measures of the effectiveness of tissue plasminogen activator in the NINDS tPA stroke trial. Stroke 2000, 31:2335-2341.
30. Schellinger P.D., Jansen O., Fiebach J.B., et al. Monitoring intravenous recombinant tissue plasminogen activator thrombolysis for acute ischemic stroke with diffusion and perfusion MRI. Stroke 2000, 31:1318-1328.
31. Tong D., Yenari M., Albers G., et al. Correlation of perfusion- and diffusion weighted MRI with NIHSS Score in acute (<6.5 hour) ischemic stroke. Stroke 1998, 29:2673.
32. Berzin T., Lev M., Goodman D., et al. CT perfusion imaging versus MR diffusion weighted imaging: prediction of final infarct size in hyperacute stroke. Stroke 2001, 32:317. [abstract].
33. Warach S. New imaging strategies for patient selection for thrombolytic and neuroprotective therapies. Neurology 2001, 57:S48-S52.
34. von Kummer R., Holle R., Grzyska U., et al. Interobserver agreement in assessing early CT signs of middle cerebral artery infarction. AJNR Am J Neuroradiol 1996, 17:1743-1748.
35. Grotta J.C., Chiu D., Lu M., et al. Agreement and variability in the interpretation of early CT changes in stroke patients qualifying for intravenous rtPA therapy. Stroke 1999, 30:1528-1533. [see comments].
36. Koroshetz W.J., Gonzales R.G. Imaging stroke in progress: magnetic resonance advances but computed tomography is poised for counterattack. Ann Neurol 1999, 46:556-558.
37. Koroshetz W.J., Lev M.H. Contrast computed tomography scan in acute stroke: " you can't always get what you want but you get what you need" Ann Neurol 2002, 51:415-416.
38. Lev M.H. CT versus MR for acute stroke imaging: is the " obvious" choice necessarily the correct one?. AJNR Am J Neuroradiol 2003, 24:1930-1931.
39. Lev M.H., Koroshetz W.J., Schwamm L.H., et al. CT or MRI for imaging patients with acute stroke: visualization of " Tissue at Risk" ?. Stroke 2002, 33:2736-2737.
40. Wintermark M., Albers G.W., Alexandrov A.V., et al. Acute stroke imaging research roadmap. Stroke 2008, 39:1621-1628.
41. Wintermark M., Albers G.W., Alexandrov A.V., et al. Acute stroke imaging research roadmap. AJNR Am J Neuroradiol 2008, 29:e23-e30.
42. von Kummer R., Allen K.L., Holle R., et al. Acute stroke: usefulness of early CT findings before thrombolytic therapy. Radiology 1997, 205:327-333. [see comments].
43. von Kummer R. Early major ischemic changes on computed tomography should preclude use of tissue plasminogen activator. Stroke 2003, 34:820-821.
44. Madden K.P., Karanjia P.N., Adams H.P., et al. Accuracy of initial stroke subtype diagnosis in the TOAST study. Trial of ORG 10172 in acute stroke treatment. Neurology 1995, 45:1975-1979.
45. Ezzeddine M.A., Lev M.H., McDonald C.T., et al. CT angiography with whole brain perfused blood volume imaging: added clinical value in the assessment of acute stroke. Stroke 2002, 33:959-966.
46. Dubey N., Bakshi R., Wasay M., et al. Early computed tomography hypodensity predicts hemorrhage after intravenous tissue plasminogen activator in acute ischemic stroke. J Neuroimaging 2001, 11:184-188.
47. Wardlaw J., Dorman P., Lewis S., et al. Can stroke physicians and neuroradiologists identify signs of early cerebral infarction on CT?. J Neurol Neursosurg Psychiatry 1999, 67:651-653.
48. Fiorelli M., von Kummer R. Early ischemic changes on computed tomography in patients with acute stroke. JAMA 2002, 287:2361-2362. [author reply: 2362].
49. Mullins M.E., Lev M.H., Schellingerhout D., et al. Influence of availability of clinical history on detection of early stroke using unenhanced CT and diffusion-weighted MR imaging. AJR Am J Roentgenol 2002, 179:223-228.
50. Lev M., Farkas J., Gemmete J., et al. Acute stroke: improved nonenhanced CT detection-benefits of soft-copy interpretation by using variable window width and center level settings. Radiology 1999, 213:150-155.
51. Fiorelli M., Toni D., Bastianello S., et al. Computed tomography findings in the first few hours of ischemic stroke: implications for the clinician. J Neurol Sci 2000, 173:10-17.
52. Axel L. Cerebral blood flow determination by rapid-sequence computed tomography. Radiology 1980, 137:679-686.
53. Hunter G.J., Hamberg L.M., Ponzo J.A., et al. Assessment of cerebral perfusion and arterial anatomy in hyperacute stroke with three-dimensional functional CT: early clinical results. AJNR Am J Neuroradiol 1998, 19:29-37.
54. Hamberg L.M., Hunter G.J., Kierstead D., et al. Measurement of cerebral blood volume with subtraction three-dimensional functional CT. AJNR Am J Neuroradiol 1996, 17:1861-1869.
55. Sharma M., Fox A.J., Symons S., et al. CT angiographic source images: flow- or volume-weighted?. AJNR Am J Neuroradiol 2010, [Epub ahead of print].
56. Schaefer P.W., Roccatagliata L., Ledezma C., et al. First-pass quantitative CT perfusion identifies thresholds for salvageable penumbra in acute stroke patients treated with intra-arterial therapy. AJNR Am J Neuroradiol 2006, 27:20-25. [see comment].
57. Schaefer P.W., Mui K., Kamalian S., et al. Avoiding " pseudo-reversibility" of CT-CBV infarct core lesions in acute stroke patients after thrombolytic therapy. The need for algorithmically " delay-corrected" CT perfusion map postprocessing software. Stroke 2009, 40(8):2875-2878.
58. Cenic A., Nabavi D.G., Craen R.A., et al. Dynamic CT measurement of cerebral blood flow: a validation study. AJNR Am J Neuroradiol 1999, 20:63-73.
59. Nabavi D.G., Cenic A., Craen R.A., et al. CT assessment of cerebral perfusion: experimental validation and initial clinical experience. Radiology 1999, 213:141-149.
60. Wintermark M., Maeder P., Verdun F.R., et al. Using 80 kVp versus 120 kVp in perfusion CT measurement of regional cerebral blood flow. AJNR Am J Neuroradiol 2000, 21:1881-1884.
61. Roberts H.C., Roberts T.P., Smith W.S., et al. Multisection dynamic CT perfusion for acute cerebral ischemia: the " toggling-table" technique. AJNR Am J Neuroradiol 2001, 22:1077-1080.
62. Wintermark M., Reichhart M., Thiran J.P., et al. Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients. Ann Neurol 2002, 51:417-432.
63. Coutts S.B., Simon J.E., Tomanek A.I., et al. Reliability of assessing percentage of diffusion-perfusion mismatch. Stroke 2003, 34:1681-1683.
64. Roccatagliata L, Lev MH, Mehta N, et al. Estimating the size of ischemic regions on CT perfusion maps in acute stroke: is freehand visual segmentation sufficient? In: Proceedings of the 89th Scientific Assembly and Annual Meeting of the Radiological Society of North America. Chicago (IL); 2003. p. 1292.
65. Siebert E., Bohner G., Dewey M., et al. 320-slice CT neuroimaging: initial clinical experience and image quality evaluation. Br J Radiol 2009, 82:561-570.
66. Klingebiel R., Siebert E., Diekmann S., et al. 4-D Imaging in cerebrovascular disorders by using 320-slice CT: feasibility and preliminary clinical experience. Acad Radiol 2009, 16:123-129.
67. Fiehler J., Albers G.W., Boulanger J.M., et al. Bleeding Risk Analysis in Stroke Imaging before thromboLysis (BRASIL): pooled analysis of T2*-weighted magnetic resonance imaging data from 570 patients. Stroke 2007, 38:2738-2744.
68. Kendell B., Pullicono P. Intravascular contrast injection in ischemic lesions, II. Effect on prognosis. Neuroradiology 1980, 19:241-243.
69. Doerfler A., Engelhorn T., von Kommer R., et al. Are iodinated contrast agents detrimental in acute cerebral ischemia? An experimental study in rats. Radiology 1998, 206:211-217.
70. Palomaki H., Muuronen A., Raininko R., et al. Administration of nonionic iodinated contrast medium does not influence the outcome of patients with ischemic brain infarction. Cerebrovasc Dis 2003, 15:45-50.
71. Fiorella D., Heiserman J., Prenger E., et al. Assessment of the reproducibility of postprocessing dynamic CT perfusion data. AJNR Am J Neuroradiol 2004, 25:97-107.
72. Kealey S.M., Loving V.A., Delong D.M., et al. User-defined vascular input function curves: influence on mean perfusion parameter values and signal-to-noise ratio. Radiology 2004, 231:587-593.
73. Sanelli P.C., Lev M.H., Eastwood J.D., et al. The effect of varying user-selected input parameters on quantitative values in CT perfusion maps. Acad Radiol 2004, 11(10):1085-1092.
74. Soares B.P., Dankbaar J.W., Bredno J., et al. Automated versus manual post-processing of perfusion-CT data in patients with acute cerebral ischemia: influence on interobserver variability. Neuroradiology 2009, 51:445-451.
75. Wintermark M., Lev M.H. FDA investigates the safety of brain perfusion CT. AJNR Am J Neuroradiol 2010, 31:2-3.
76. Bogdanovich W. Radiation overdoses point up dangers of CT scans. New York Times October 15, 2009.
77. Smith-Bindman R. Is computed tomography safe?. N Engl J Med 2010, 363:1-4.
78. Konstas A.A., Goldmakher G.V., Lee T.Y., et al. Theoretic basis and technical implementations of CT perfusion in acute ischemic stroke, part 2: technical implementations. AJNR Am J Neuroradiol 2009, 30:885-892.
79. Konstas A.A., Goldmakher G.V., Lee T.Y., et al. Theoretic basis and technical implementations of CT perfusion in acute ischemic stroke, part 1: theoretic basis. AJNR Am J Neuroradiol 2009, 30:662-668.
80. Villringer A., Rosen B.R., Belliveau J.W., et al. Dynamic imaging with lanthanide chelates in normal brain: contrast due to magnetic susceptibility effects. Magn Reson Med 1988, 6:164-174.
81. Meier P., Zieler K. On the theory of the indicator-dilution method for measurement of blood flow and volume. J Appl Physiol 1954, 6:731-744.
82. Roberts G., Larson K. The interpretation of mean transit time measurements for multi-phase tissue systems. J Theor Biol 1973, 39:447-475.
83. Shetty S.K., Lev M.H. CT perfusion in acute stroke. Neuroimaging Clin N Am 2005, 15:481-501. ix.
84. Olivot J.M., Mlynash M., Thijs V.N., et al. Optimal Tmax threshold for predicting penumbral tissue in acute stroke. Stroke 2009, 40:469-475.
85. De Silva D.A., Fink J.N., Christensen S., et al. Assessing reperfusion and recanalization as markers of clinical outcomes after intravenous thrombolysis in the echoplanar imaging thrombolytic evaluation trial (EPITHET). Stroke 2009, 40:2872-2874.
86. Konstas A.A., Lev M.H. CT perfusion imaging of acute stroke: the need for arrival time, delay insensitive, and standardized postprocessing algorithms?. Radiology 2010, 254:22-25.
87. Kudo K., Sasaki M., Yamada K., et al. Differences in CT perfusion maps generated by different commercially available software: quantitative analysis using identical source data of acute stroke patients. Radiology 2010, 254(1):200-209. Acute Stroke Imaging Standardization Group Japan (ASIST-Japan) Investigators.
88. Kudo K., Sasaki M., Ogasawara K., et al. Difference in tracer delay-induced effect among deconvolution algorithms in CT perfusion analysis: quantitative evaluation with digital phantoms. Radiology 2009, 251:241-249.
89. Mullani N.A., Gould K.L. First-pass measurements of regional blood flow with external detectors. J Nucl Med 1983, 24:577-581.
90. Abels B., Klotz E., Tomandl B.F., et al. Perfusion CT in acute ischemic stroke: a qualitative and quantitative comparison of deconvolution and maximum slope approach. AJNR Am J Neuroradiol 2010, 31:1690-1698.
91. Ostergaard L., Weisskoff R.M., Chesler D.A., et al. High resolution of cerebral blood flow using intravascular tracer bolus passages. Part I: mathematical approach ad statistical analysis. Magn Reson Med 1996, 36(5):715-725.
92. Wirestam R., Andersson L., Ostergaard L., et al. Assessment of regional cerebral blood flow by dynamic susceptibility contrast MRI using different deconvolution techniques. Magn Reson Med 2000, 43:691-700.
93. Cenic A., Nabavi D.G., Craen R.A., et al. A CT method to measure hemodynamics in brain tumors: validation and application of cerebral blood flow maps. AJNR Am J Neuroradiol 2000, 21:462-470.
94. Nabavi D.G., Cenic A., Dool J., et al. Quantitative assessment of cerebral hemodynamics using CT: stability, accuracy, and precision studies in dogs. J Comput Assist Tomogr 1999, 23:506-515.
95. Nabavi D.G., Cenic A., Henderson S., et al. Perfusion mapping using computed tomography allows accurate prediction of cerebral infarction in experimental brain ischemia. Stroke 2001, 32:175-183.
96. Wintermark M., Thiran J.P., Maeder P., et al. Simultaneous measurement of regional cerebral blood flow by perfusion CT and stable xenon CT: a validation study. AJNR Am J Neuroradiol 2001, 22:905-914.
97. Stewart G.N. Researches on the circulation time in organs and on the influences which affect it. J Physiol 1894, 15:1.
98. Ostergaard L., Chesler D.A., Weisskoff R.M., et al. Modeling cerebral blood flow and flow heterogeneity from magnetic resonance residue data. J Cereb Blood Flow Metab 1999, 19:690-699.
99. Furukawa M., Kashiwagi S., Matsunaga N., et al. Evaluation of cerebral perfusion parameters measured by perfusion CT in chronic cerebral ischemia: comparison with xenon CT. J Comput Assist Tomogr 2002, 26:272-278.
100. Gillard J.H., Antoun N.M., Burnet N.G., et al. Reproducibility of quantitative CT perfusion imaging. Br J Radiol 2001, 74:552-555.
101. Eastwood J.D., Lev M.H., Wintermark M., et al. Correlation of early dynamic CT perfusion imaging with whole-brain MR diffusion and perfusion imaging in acute hemispheric stroke. AJNR Am J Neuroradiol 2003, 24:1869-1875.
102. Wintermark M., Reichhart M., Cuisenaire O., et al. Comparison of admission perfusion computed tomography and qualitative diffusion- and perfusion-weighted magnetic resonance imaging in acute stroke patients. Stroke 2002, 33:2025-2031.
103. Schramm P., Schellinger P.D., 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(7):1652-1658.
104. Wang X.C., Gao P.Y., Xue J., et al. Identification of infarct core and penumbra in acute stroke using CT perfusion source images. AJNR Am J Neuroradiol 2010, 31(1):34-39.
105. van der Schaaf I., Vonken E.J., Waaijer A., et al. Influence of partial volume on venous output and arterial input function. AJNR Am J Neuroradiol 2006, 27:46-50.
106. Calamante F., Gadian D.G., Connelly A. Delay and dispersion effects in dynamic susceptibility contrast MRI: simulations using singular value decomposition. Magn Reson Med 2000, 44:466-473.
107. Calamante F., Yim P.J., Cebral J.R. Estimation of bolus dispersion effects in perfusion MRI using image-based computational fluid dynamics. Neuroimage 2003, 19:341-353.
108. Wu O., Ostergaard L., Weisskoff R.M., et al. Tracer arrival timing-insensitive technique for estimating flow in MR perfusion-weighted imaging using singular value decomposition with a block-circulant deconvolution matrix. Magn Reson Med 2003, 50:164-174.
109. Knash M., Tsang A., Hameed B., et al. Low cerebral blood volume is predictive of diffusion restriction only in hyperacute stroke. Stroke 2010, 41:2795-2800.
110. Wittsack H.J., Wohlschlager A.M., Ritzl E.K., et al. CT-perfusion imaging of the human brain: advanced deconvolution analysis using circulant singular value decomposition. Comput Med Imaging Graph 2008, 32:67-77.
111. Calamante F., Morup M., Hansen L.K. Defining a local arterial input function for perfusion MRI using independent component analysis. Magn Reson Med 2004, 52:789-797.
112. Ibaraki M., Shimosegawa E., Toyoshima H., et al. Tracer delay correction of cerebral blood flow with dynamic susceptibility contrast-enhanced MRI. J Cereb Blood Flow Metab 2005, 25:378-390.
113. Serena J., Davalos A., Segura T., et al. Stroke on awakening: looking for a more rational management. Cerebrovasc Dis 2003, 16:128-133.
114. Darby D.G., Barber P.A., Gerraty R.P., et al. Pathophysiological topography of acute ischemia by combined diffusion-weighted and perfusion MRI. Stroke 1999, 30:2043-2052.
115. Neumann-Haefelin T., Wittsack H.J., Wenserski F., et al. Diffusion- and perfusion-weighted MRI. The DWI/PWI mismatch region in acute stroke. Stroke 1999, 30:1591-1597.
116. Hacke W., Furlan A.J., 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 2009, 8:141-150.
117. Schramm P., Schellinger P.D., Fiebach J.B., et al. Comparison of CT and CT angiography source images with diffusion-weighted imaging in patients with acute stroke within 6 hours after onset. Stroke 2002, 33:2426-2432.
118. Aviv R.I., Shelef I., Malam S., et al. Early stroke detection and extent: impact of experience and the role of computed tomography angiography source images. Clin Radiol 2007, 62:447-452.
119. Coutts S.B., Lev M.H., Eliasziw M., et al. ASPECTS on CTA source images versus unenhanced CT: added value in predicting final infarct extent and clinical outcome. Stroke 2004, 35:2472-2476.
120. Lin K., Rapalino O., Law M., et al. Accuracy of the Alberta Stroke Program Early CT Score during the first 3 hours of middle cerebral artery stroke: comparison of noncontrast CT, CT angiography source images, and CT perfusion. AJNR Am J Neuroradiol 2008, 29:931-936.
121. Kidwell C.S., Saver J.L., 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.
122. Kidwell C.S., Saver J.L., Starkman S., et al. Late secondary ischemic injury in patients receiving intraarterial thrombolysis. Ann Neurol 2002, 52:698-703.
123. Warach S. Measurement of the ischemic penumbra with MRI: it's about time. Stroke 2003, 34:2533-2534.
124. Wu O., Koroshetz W.J., Ostergaard L., et al. Predicting tissue outcome in acute human cerebral ischemia using combined diffusion- and perfusion-weighted MR imaging. Stroke 2001, 32:933-942.
125. Barber P.A., Darby D.G., Desmond P.M., et al. Prediction of stroke outcome with echoplanar perfusion- and diffusion-weighted MRI. Neurology 1998, 51:418-426.
126. Astrup J., Siesjo B.K., Symon L. Thresholds in cerebral ischemia-the ischemic penumbra. Stroke 1981, 12:723-725.
127. Sorensen A.G., Buonanno F.S., Gonzalez R.G., et al. Hyperacute stroke: evaluation with combined multisection diffusion-weighted and hemodynamically weighted echo-planar MR imaging. Radiology 1996, 199:391-401.
128. Sunshine J.L., Tarr R.W., Lanzieri C.F., et al. Hyperacute stroke: ultrafast MR imaging to triage patients prior to therapy. Radiology 1999, 212:325-332.
129. Schlaug G., Benfield A., Baird A.E., et al. The ischemic penumbra: operationally defined by diffusion and perfusion MRI. Neurology 1999, 53:1528-1537.
130. Wintermark M., Flanders A.E., 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.
131. Mehta N, Lev MH, Mullins ME, et al. Prediction of final infarct size in acute stroke using cerebral blood flow/cerebral blood volume mismatch: added value of quantitative first pass CT perfusion imaging in successfully treated versus unsuccessfully treated/untreated patients. In: Proceedings of the 41st Annual Meeting of the American Society of Neuroradiology. Washington, DC, April 27 to May 2, 2003.
132. Aksoy FG, Lev MH, Eskey CJ, et al. CT perfusion imaging of acute stroke: how well do CBV, CBF, and MTT maps predict final infarct size? In: Proceedings of the 86th Scientific Assembly and Annual Meeting of the Radiological Society of North America. Chicago (IL), November 26 to December 1, 2000.
133. Donnan G.A., Baron J.C., Ma H., et al. Penumbral selection of patients for trials of acute stroke therapy. Lancet Neurol 2009, 8:261-269.
134. Albers G.W., Thijs V.N., 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.
135. Sobesky J., Weber O.Z., Lehnhardt F.G., 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.
136. Davis S.M., Donnan G.A. MR mismatch and thrombolysis: appealing but validation required. Stroke 2009, 40:2910.
137. Sasaki O., Takeuchi S., Koizumi T., et al. Complete recanalization via fibrinolytic therapy can reduce the number of ischemic territories that progress to infarction. AJNR Am J Neuroradiol 1996, 17:1661-1668.
138. Ueda T., Sakaki S., Yuh W., et al. Outcome in acute stroke with successful intra-arterial thrombolysis procedure and predictive value of initial single-photon emission-computed tomography. J Cereb Blood Flow Metab 1999, 19:99-108.
139. Liu Y., Karonen J.O., Vanninen R.L., et al. Cerebral hemodynamics in human acute ischemic stroke: a study with diffusion- and perfusion-weighted magnetic resonance imaging and SPECT. J Cereb Blood Flow Metab 2000, 20:910-920.
140. Hatazawa J., Shimosegawa E., Toyoshima H., et al. Cerebral blood volume in acute brain infarction: a combined study with dynamic susceptibility contrast MRI and 99mTc-HMPAO-SPECT. Stroke 1999, 30:800-806.
141. Shimosegawa E., Hatazawa J., Inugami A., et al. Cerebral infarction within six hours of onset: prediction of completed infarction with technetium-99m-HMPAO SPECT. J Nucl Med 1994, 35:1097-1103.
142. Rohl L., Ostergaard L., Simonsen C.Z., et al. Viability thresholds of ischemic penumbra of hyperacute stroke defined by perfusion-weighted MRI and apparent diffusion coefficient. Stroke 2001, 32:1140-1146.
143. Suzuki Y., Nakajima M., Ikeda H., et al. Perfusion computed tomography for the indication of percutaneous transluminal reconstruction for acute stroke. J Stroke Cerebrovasc Dis 2006, 15:18-25.
144. Marchal G., Young A.R., Baron J.C. Early postischemic hyperperfusion: pathophysiologic insights from positron emission tomography. J Cereb Blood Flow Metab 1999, 19:467-482.
145. Kudo K., Sasaki M., Yamada K., et al. Differences in CT perfusion maps generated by different commercial software: quantitative analysis by using identical source data of acute stroke patients. Radiology 2010, 254:200-209.
146. Sorensen A.G., Copen W.A., Ostergaard L., et al. Hyperacute stroke: simultaneous measurement of relative cerebral blood volume, relative cerebral blood flow, and mean tissue transit time. Radiology 1999, 210:519-527.
147. Koennecke H.C. Editorial comment-Challenging the concept of a dynamic penumbra in acute ischemic stroke. Stroke 2003, 34:2434-2435.
148. Heiss W.D. Ischemic penumbra: evidence from functional imaging in man. J Cereb Blood Flow Metab 2000, 20:1276-1293.
149. Jovin T.G., Yonas H., Gebel J.M., et al. The cortical ischemic core and not the consistently present penumbra is a determinant of clinical outcome in acute middle cerebral artery occlusion. Stroke 2003, 34:2426-2433.
150. Lev MH, Roccatagliata L, Murphy EK, et al. A CTA based, multivariable, " benefit of recanalization" model for acute stroke triage: core infarct size on CTA source images independently predicts outcome. In: Proceedings of the 42nd Annual Meeting of the American Society of Neuroradiology. Seattle (WA), June 5-11, 2004.
151. Suarez J., Sunshine J., Tarr R., et al. Predictors of clinical improvement, angiographic recanalization, and intracranial hemorrhage after intra-arterial thrombolysis for acute ischemic stroke. Stroke 1999, 30:2094-2100.
152. Molina C.A., Alexandrov A.V., Demchuk A.M., et al. Improving the predictive accuracy of recanalization on stroke outcome in patients treated with tissue plasminogen activator. Stroke 2004, 35:151-156.
153. Baird A.E., Dambrosia J., Janket S., et al. A three-item scale for the early prediction of stroke recovery. Lancet 2001, 357:2095-2099.
154. Rosenthal E.S., Schwamm L.H., Roccatagliata L., et al. Role of recanalization in acute stroke outcome: rationale for a CT angiogram-based " benefit of recanalization" model. AJNR Am J Neuroradiol 2008, 29:1471-1475.
155. Nighoghossian N., Hermier M., Adeleine P., et al. Baseline magnetic resonance imaging parameters and stroke outcome in patients treated by intravenous tissue plasminogen activator. Stroke 2003, 34:458-463.
156. Sanak D., Nosal V., Horak D., et al. Impact of diffusion-weighted MRI-measured initial cerebral infarction volume on clinical outcome in acute stroke patients with middle cerebral artery occlusion treated by thrombolysis. Neuroradiology 2006, 48:632-639.
157. Yoo A.J., Verduzco L.A., Schaefer P.W., et al. MRI-based selection for intra-arterial stroke therapy: value of pretreatment diffusion-weighted imaging lesion volume in selecting patients with acute stroke who will benefit from early recanalization. Stroke 2009, 40:2046-2054.
158. Gasparotti R., Grassi M., Mardighian D., et al. Perfusion CT in patients with acute ischemic stroke treated with intra-arterial thrombolysis: predictive value of infarct core size on clinical outcome. AJNR Am J Neuroradiol 2009, 30:722-727.
159. Pessin M.S., Del Zoppo G.J., Estol C.J. Thrombolytic agents in the treatment of stroke. Clin Neuropharmacol 1990, 13:271-289.
160. Hacke W., Kaste M., Fieschi C., et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet 1998, 352:1245-1251.
161. Swap C, Lev M, McDonald C, et al. Degree of oligemia by perfusion-weighted CT and risk of hemorrhage after IA thrombolysis. In: Stroke-Proceedings of the 27th International Conference on Stroke and Cerebral Circulation. San Antonio (TX), February 7-9, 2002.
162. Dzialowski I., Hill M.D., Coutts S.B., et al. Extent of early ischemic changes on computed tomography (CT) before thrombolysis: prognostic value of the Alberta Stroke Program Early CT Score in ECASS II. Stroke 2006, 37:973-978.
163. Larrue V., von Kummer R.R., Muller A., et al. Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator: a secondary analysis of the European-Australasian Acute Stroke Study (ECASS II). Stroke 2001, 32:438-441.
164. Hacke W., Donnan G., Fieschi C., et al. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 2004, 363:768-774.
165. Ogasawara K., Ogawa A., Ezura M., et al. Brain single-photon emission CT studies using 99mTc-HMPAO and 99mTc-ECD early after recanalization by local intraarterial thrombolysis in patients with acute embolic middle cerebral artery occlusion. AJNR Am J Neuroradiol 2001, 22:48-53.
166. Gupta R., Yonas H., Gebel J., et al. Reduced pretreatment ipsilateral middle cerebral artery cerebral blood flow is predictive of symptomatic hemorrhage post-intra-arterial thrombolysis in patients with middle cerebral artery occlusion. Stroke 2006, 37:2526-2530.
167. Kidwell C.S., Chalela J.A., Saver J.L., et al. Hemorrhage early MRI evaluation (HEME) study. Stroke 2003, 34:239. [abstract].
168. Kidwell C.S., Chalela J.A., Saver J.L., et al. Comparison of MRI and CT for detection of acute intracerebral hemorrhage. JAMA 2004, 292:1823-1830.
169. Campbell B.C., Christensen S., Butcher K.S., et al. Regional very low cerebral blood volume predicts hemorrhagic transformation better than diffusion-weighted imaging volume and thresholded apparent diffusion coefficient in acute ischemic stroke. Stroke 2010, 41(1):82-88.
170. Tomsick T. Timi, TIBI, TICI: I came, I saw, I got confused. AJNR Am J Neuroradiol 2007, 28:382-384.
171. Zaidat O.O., Suarez J.I., Sunshine J.L., et al. Thrombolytic therapy of acute ischemic stroke: correlation of angiographic recanalization with clinical outcome. AJNR Am J Neuroradiol 2005, 26:880-884.
172. Rha J.H., Saver J.L. The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke 2007, 38:967-973.
173. Tomsick T., Broderick J., Carrozella J., et al. Revascularization results in the interventional management of stroke II trial. AJNR Am J Neuroradiol 2008, 29:582-587.
174. Soares B.P., Chien J.D., Wintermark M. MR and CT monitoring of recanalization, reperfusion, and penumbra salvage: everything that recanalizes does not necessarily reperfuse!. Stroke 2009, 40:S24-S27.
175. Janjua N., Alkawi A., Suri M.F., et al. Impact of arterial reocclusion and distal fragmentation during thrombolysis among patients with acute ischemic stroke. AJNR Am J Neuroradiol 2008, 29:253-258.
176. Ames A., Wright R.L., Kowada M., et al. Cerebral ischemia. II. The no-reflow phenomenon. Am J Pathol 1968, 52:437-453.
177. del Zoppo G.J. Virchow's triad: the vascular basis of cerebral injury. Rev Neurol Dis 2008, 5(Suppl 1):S12-S21.
178. Soares B.P., Tong E., Hom J., et al. Reperfusion is a more accurate predictor of follow-up infarct volume than recanalization. a proof of concept using ct in acute ischemic stroke patients. Stroke 2010, 41(1):e34-e40.