on December 23, 2004
Published online before print December 23, 2004, doi: 10.1161/01.STR.0000152268.47919.be
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Submitted on May 19, 2004
From the Department of Neuroradiology (N.H., L.O.), Center for Functionally Integrative Neuroscience, Århus University Hospital, Århus, Denmark; the Department of Neurology (K.B., S.M.D.), Royal Melbourne Hospital, Parkville, Victoria, Australia; the Department of Neurology and UCLA Stroke Center (C.S.K.), Los Angeles, Calif; the Department of Neurology (W.J.K.), Massachusetts General Hospital, Boston, Mass; the Department of Neurology (J.R.), University Hospital Hamburg-Eppendorf, Germany; the Department of Neurology (P.D.S.), Heidelberg, Germany; and the National Institutes of Health (P.D.S., S.W.), National Institute of Neurological Disorders and Stroke, Bethesda, Md. * To whom correspondence should be addressed. E-mail: niels{at}pet.auh.dk.
Background and Purpose--Magnetic resonance imaging (MRI) selection of stroke patients eligible for thrombolytic therapy is an emerging application. Although the efficacy of therapy within 3 hours after onset of symptoms with intravenous (IV) tissue plasminogen activator (tPA) has been proven for patients selected with computed tomography (CT), no randomized, double-blinded MRI trial has been published yet. Summary of Review--MRI screening of acute stroke patients before thrombolytic therapy is performed in some cerebrovascular centers. In contrast to the CT trials, MRI pilot studies demonstrate benefit of therapy up to 6 hours after onset of symptoms. This article reviews the literature that has lead to current controlled MRI-based thrombolysis trials. We examined the MRI criteria applied in 5 stroke centers. Along with the personal views of clinicians at these centers, the survey reveals a variety of clinical and MRI technical aspects that must be further investigated: the therapeutic consequence of microbleeds, the use of magnetic resonance angiography, dynamic time windows, and others. Conclusion--MRI is an established application in acute evaluation of stroke patients and may suit as a brain clock, replacing the currently used epidemiological time clock when deciding whether to initiate thrombolytic therapy. MRI criteria for thrombolytic therapy are applied in some cerebrovascular centers, but the results of ongoing clinical trials must be awaited before it is possible to reach consensus.
Revised on September 24, 2004
Accepted on October 19, 2004
Magnetic Resonance Imaging Criteria for Thrombolysis in Acute Cerebral Infarct
N. Hjort MD*; 
stergaard MD, MSc, PhD
Key words: diffusion magnetic resonance imaging • magnetic resonance imaging • perfusion magnetic resonance imaging • stroke management • thrombolysis
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