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(Stroke. 2005;36:196.)
© 2005 American Heart Association, Inc.

Advances in Stroke 2004

Imaging

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

Correspondence to Dr Jean-Claude Baron, Department of Neurology, Addenbrooke’s Hospital Hills Road, Box 83, Cambridge, CB2 2QQ, United Kingdom. E-mail jcb54@cam.ac.uk

Key Words: Advances in Stroke • diffusion magnetic resonance imaging • magnetic resonance imaging • positron-emission tomography

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

	Acute Stroke

 
The Melbourne group reported further application of the positron-emission tomography (PET) hypoxia marker ¹⁸F-labeled fluoromisonidazole (F-MISO).^1–3 In one article, they further developed and validated their novel imaging methodology to map the penumbra using this tracer.¹ Applying this method, they elegantly showed that hypoxia affects white matter to a similar degree and extent as gray matter, suggesting the former has at least as high a resistance to ischemia than the latter and that its salvage should help to maximize benefit of treatment.² In a third article,³ they report that the impact of hypoxic tissue escaping infarction on subsequent clinical recovery is similar whether the tissue is identified within 12 hours of, or in the 12- and 48-hour interval after stroke onset, documenting that F-MISO identifies true penumbral tissue, and that, consistent with earlier evidence, appropriate interventions should improve outcome even beyond 24 hours.

The year 2004 has seen the first, long-awaited, articles reporting direct PET and diffusion-weighted imaging (DWI)/perfusion-weighted imaging (PWI) comparisons.^4–6 Using state-of-the-art diffusion tensor imaging (DTI) and fully quantitative PET as gold standard, Guadagno et al⁴ documented that the acute DWI lesion not only contains irreversibly damaged, but also penumbral tissue, in agreement with studies showing potential reversibility of the DWI lesion, while even severe apparent diffusion coefficient decreases can be found in either tissue category. One therapeutic implication is that a matched DWI/PWI lesion may still represent, at least in part, salvageable tissue. Comparing the predictive value of DWI and ¹¹C-Flumazenil (FMZ) for final infarction, Heiss et al⁵ . . . [Full Text of this Article]

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