Using Advanced MRI Techniques for Patient Selection Before Acute Stroke Therapy

  • Jean-Marc Olivot
  • Gregory W. Albers
Cerebrovascular Disease and Stroke

Opinion statement

Results of acute MRI studies may help guide the management of acute stroke. Patients with a malignant MRI pattern may be poor candidates for reperfusion therapies yet may benefit from hemicraniectomy. Preliminary data suggest that patients with a carefully identified diffusion weighted imaging (DWI)/perfusion weighted imaging (PWI) mismatch may benefit from intravenous recombinant tissue plasminogen activator in a 3- to 6-hour time window; however, confirmatory studies with larger sample sizes are required before clinical use of this strategy can be generally recommended. Post hoc analyses of recent studies suggest that PWI techniques that use a threshold to exclude benign oligemia from penumbra and DWI techniques that use apparent diffusion coefficient thresholds to exclude reversible DWI lesions to distinguish the ischemic core from penumbra appear to provide more accurate determinations of the volume of salvageable tissue. New automated software programs are now implementing these techniques to generate quantitative PWI and DWI maps within minutes. Prospective trials are in progress to investigate these new techniques. The results of these studies will further refine the application of MRI to select patients for acute recanalization therapies.


Apparent Diffusion Coefficient Acute Ischemic Stroke Diffusion Weighted Imaging Ischemic Penumbra Ischemic Core 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Dr. Albers has been a consultant to Lundbeck. No other potential conflicts of interest relevant to this article were reported.

References and Recommended Reading

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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of Neurology and Neurological Sciences and the Stanford Stroke CenterStanford University Medical CenterPalo AltoUSA

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