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(Stroke. 2004;35:351.)
© 2004 American Heart Association, Inc.

Advances in Stroke 2003

Neuroimaging

Steven Warach, MD, PhD Jean-Claude Baron, MD, FRCP, FMedSci

From the National Institute of Neurological Disorders and Stroke (S.W.) National Institutes of Health, Bethesda, MD; and the Department of Neurology (J.-C.B.), University of Cambridge, UK.

Correspondence to Dr. Steven Warach, National Institutes of Health, NINDS, 10 Center Drive, MSC 1063, Building 10, Rm B1D733, Bethesda, MD 20892-4129. E-mail warachs@ninds.nih.gov

Key Words: Advances in Stroke • magnetic resonance imaging • stroke • tomography, emission computed

An extract of the first 250 words of the full text is provided, because this article has no abstract.

This past year saw a continuing array of reports of MRI and, increasingly, CT approaches to predicting clinical outcomes and tissue infarction from acute anatomical, hemodynamic, and diffusion variables alone or in combination.^1–10 Until definitive comparisons among predictive models are undertaken and one is validated on prospective, large, well-controlled samples as predictive of response to therapy, such predictive models—whether the simple perfusion>diffusion mismatch or sophisticated multiparametric models—will be of limited utility for routine clinical decision making. However, selection of patients with diffusion-perfusion patterns predictive of lesion growth has become a strategy in stroke trial design for enriching the sample of subjects most likely to demonstrate a treatment effect, analogous to the routine enrichment strategies of limiting range of age, severity, or stroke subtype. Toward that end, a novel diagnostic classification system was recently described for acute ischemic cerebrovascular syndrome (AICS) that defines the degree of diagnostic certainty by integrating neuroimaging and laboratory data with prior clinically based classification schemes to define 4 categories ranging from definite to not AICS.¹¹ Clinical trials testing new treatments for acute ischemic stroke or secondary stroke prevention may benefit by limiting enrollment to patients with definite AICS whenever feasible.

Adding to the physiological variables measurable by MRI to determine tissue viability is a technique to determine oxygen extraction ratio and cerebral oxygen metabolism based on the sensitivity of susceptibility-weighted MRI (T2* effects) to blood oxygen saturation.¹² This study of Lee and colleagues described results in 7 hyperacute stroke patients, demonstrated the feasibility of obtaining oxygen . . . [Full Text of this Article]

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