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(Stroke. 2005;36:1098.)
© 2005 American Heart Association, Inc.

Controversies in Stroke

Perfusion-Weighted Imaging/Diffusion-Weighted Imaging Mismatch on MRI Can Now Be Used to Select Patients for Recombinant Tissue Plasminogen Activator Beyond 3 Hours

Pro

Peter D. Schellinger, MD Jochen B. Fiebach, MD

From the Departments of Neurology (P.D.S.), and Neuroradiology (J.B.F.), University of Heidelberg, Germany.

Correspondence to Peter D. Schellinger, MD, Neurologische Universitatsklinik, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany. E-mail Peter-Schellinger@med.uni-heidelberg.de

Section Editors: Geoffrey A. Donnan MD, FRACP Stephen M. Davis MD, FRACP

Key Words: diffusion magnetic resonance imaging • magnetic resonance imaging

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

"It’s now or never. I was caught in a dead end street. A look (into your eyes) can heal me. And after this moment, you gave me something (back). What I really need."

— Primal Fear, "Nuclear Fire," 2001

Of course, the "dead end street" refers to computed tomography (CT), "the healing look" to reading a stroke MRI, and being "given something that one really needs" to thrombolytic therapy.

What do we need to establish that a new methodology is ready to be put to use instead of an older one? We need to show that it is at least as good, if not better, than the old modality with regard to safety, feasibility, cost efficiency, and diagnostic and prognostic power. Over the last years, a growing number of reports on the use of multiparametric MRI protocols including diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) for guiding treatment in acute stroke patients have been published.¹

MRI is safe in acute stroke patients; side effects such as allergic reactions to contrast agent and x-ray load virtually do not exist. Feasibility of stroke MRI is estimated between 75% and 95%,^2–4 granted, somewhat lower than that of CT. The feasibility of stroke MRI depends in part on how patient instability, and therefore safety concerns, is defined in different centers. When compared with noncontrast CT alone, the cost of stroke MRI is higher; as soon as CT angiography and perfusion CT are added to the CT protocol, the difference in cost is marginal. Again, . . . [Full Text of this Article]

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