Beyond Mismatch: Evolving Paradigms in Imaging the Ischemic Penumbra With Multimodal Magnetic Resonance Imaging

Stella Kidwell, Jeffry R. Alger, Jeffrey L. Saver

Research output: Contribution to journalArticle

380 Citations (Scopus)

Abstract

Background - The ability to quickly and efficiently identify the ischemic penumbra in the acute stroke clinical setting is an important goal for stroke researchers and clinicians. Early and accurate identification of potentially salvageable versus irreversibly infarcted brain tissue may enable selection of the most appropriate candidates for early stroke therapies and identify patients who may still benefit from late recanalization or neuroprotective treatment. Recent advances in magnetic resonance imaging of the ischemic penumbra have been driven by serial MRI studies characterizing the natural evolution of cerebral infarction as well as the brain's response to reperfusion. Summary of Comment - Based on these studies, various models for imaging the penumbra with MRI have been proposed, including the pioneering diffusion-perfusion mismatch model and later multivariate approaches. Each model has its own unique advantages and disadvantages. Conclusions - There now are sufficient data to support paradigm shifts in a variety of central tenets regarding MRI and the ischemic penumbra. These include the insights that diffusion-perfusion mismatch does not optimally define the penumbra; that early diffusion lesions are in part reversible and often include both irreversibly infarcted tissue and penumbra; that the visible zone of perfusion abnormality overestimates the penumbra by including regions of benign oligemia; that MRI is a very practical method for acute stroke imaging; and that therapeutic salvage of the ischemic penumbra has been demonstrated in humans using diffusion-perfusion MRI.

Original languageEnglish (US)
Pages (from-to)2729-2735
Number of pages7
JournalStroke
Volume34
Issue number11
DOIs
StatePublished - Nov 2003
Externally publishedYes

Fingerprint

Perfusion
Stroke
Magnetic Resonance Imaging
Diffusion Magnetic Resonance Imaging
Cerebral Infarction
Brain
Secondary Prevention
Reperfusion
Research Personnel
Therapeutics

Keywords

  • Ischemia
  • Magnetic resonance imaging, diffusion-weighted
  • Magnetic resonance imaging, perfusion-weighted
  • Penumbra

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Beyond Mismatch : Evolving Paradigms in Imaging the Ischemic Penumbra With Multimodal Magnetic Resonance Imaging. / Kidwell, Stella; Alger, Jeffry R.; Saver, Jeffrey L.

In: Stroke, Vol. 34, No. 11, 11.2003, p. 2729-2735.

Research output: Contribution to journalArticle

@article{2f42c51c712f4c3a8b35f95ce72c908d,
title = "Beyond Mismatch: Evolving Paradigms in Imaging the Ischemic Penumbra With Multimodal Magnetic Resonance Imaging",
abstract = "Background - The ability to quickly and efficiently identify the ischemic penumbra in the acute stroke clinical setting is an important goal for stroke researchers and clinicians. Early and accurate identification of potentially salvageable versus irreversibly infarcted brain tissue may enable selection of the most appropriate candidates for early stroke therapies and identify patients who may still benefit from late recanalization or neuroprotective treatment. Recent advances in magnetic resonance imaging of the ischemic penumbra have been driven by serial MRI studies characterizing the natural evolution of cerebral infarction as well as the brain's response to reperfusion. Summary of Comment - Based on these studies, various models for imaging the penumbra with MRI have been proposed, including the pioneering diffusion-perfusion mismatch model and later multivariate approaches. Each model has its own unique advantages and disadvantages. Conclusions - There now are sufficient data to support paradigm shifts in a variety of central tenets regarding MRI and the ischemic penumbra. These include the insights that diffusion-perfusion mismatch does not optimally define the penumbra; that early diffusion lesions are in part reversible and often include both irreversibly infarcted tissue and penumbra; that the visible zone of perfusion abnormality overestimates the penumbra by including regions of benign oligemia; that MRI is a very practical method for acute stroke imaging; and that therapeutic salvage of the ischemic penumbra has been demonstrated in humans using diffusion-perfusion MRI.",
keywords = "Ischemia, Magnetic resonance imaging, diffusion-weighted, Magnetic resonance imaging, perfusion-weighted, Penumbra",
author = "Stella Kidwell and Alger, {Jeffry R.} and Saver, {Jeffrey L.}",
year = "2003",
month = "11",
doi = "10.1161/01.STR.0000097608.38779.CC",
language = "English (US)",
volume = "34",
pages = "2729--2735",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "11",

}

TY - JOUR

T1 - Beyond Mismatch

T2 - Evolving Paradigms in Imaging the Ischemic Penumbra With Multimodal Magnetic Resonance Imaging

AU - Kidwell, Stella

AU - Alger, Jeffry R.

AU - Saver, Jeffrey L.

PY - 2003/11

Y1 - 2003/11

N2 - Background - The ability to quickly and efficiently identify the ischemic penumbra in the acute stroke clinical setting is an important goal for stroke researchers and clinicians. Early and accurate identification of potentially salvageable versus irreversibly infarcted brain tissue may enable selection of the most appropriate candidates for early stroke therapies and identify patients who may still benefit from late recanalization or neuroprotective treatment. Recent advances in magnetic resonance imaging of the ischemic penumbra have been driven by serial MRI studies characterizing the natural evolution of cerebral infarction as well as the brain's response to reperfusion. Summary of Comment - Based on these studies, various models for imaging the penumbra with MRI have been proposed, including the pioneering diffusion-perfusion mismatch model and later multivariate approaches. Each model has its own unique advantages and disadvantages. Conclusions - There now are sufficient data to support paradigm shifts in a variety of central tenets regarding MRI and the ischemic penumbra. These include the insights that diffusion-perfusion mismatch does not optimally define the penumbra; that early diffusion lesions are in part reversible and often include both irreversibly infarcted tissue and penumbra; that the visible zone of perfusion abnormality overestimates the penumbra by including regions of benign oligemia; that MRI is a very practical method for acute stroke imaging; and that therapeutic salvage of the ischemic penumbra has been demonstrated in humans using diffusion-perfusion MRI.

AB - Background - The ability to quickly and efficiently identify the ischemic penumbra in the acute stroke clinical setting is an important goal for stroke researchers and clinicians. Early and accurate identification of potentially salvageable versus irreversibly infarcted brain tissue may enable selection of the most appropriate candidates for early stroke therapies and identify patients who may still benefit from late recanalization or neuroprotective treatment. Recent advances in magnetic resonance imaging of the ischemic penumbra have been driven by serial MRI studies characterizing the natural evolution of cerebral infarction as well as the brain's response to reperfusion. Summary of Comment - Based on these studies, various models for imaging the penumbra with MRI have been proposed, including the pioneering diffusion-perfusion mismatch model and later multivariate approaches. Each model has its own unique advantages and disadvantages. Conclusions - There now are sufficient data to support paradigm shifts in a variety of central tenets regarding MRI and the ischemic penumbra. These include the insights that diffusion-perfusion mismatch does not optimally define the penumbra; that early diffusion lesions are in part reversible and often include both irreversibly infarcted tissue and penumbra; that the visible zone of perfusion abnormality overestimates the penumbra by including regions of benign oligemia; that MRI is a very practical method for acute stroke imaging; and that therapeutic salvage of the ischemic penumbra has been demonstrated in humans using diffusion-perfusion MRI.

KW - Ischemia

KW - Magnetic resonance imaging, diffusion-weighted

KW - Magnetic resonance imaging, perfusion-weighted

KW - Penumbra

UR - http://www.scopus.com/inward/record.url?scp=0242694042&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0242694042&partnerID=8YFLogxK

U2 - 10.1161/01.STR.0000097608.38779.CC

DO - 10.1161/01.STR.0000097608.38779.CC

M3 - Article

C2 - 14576370

AN - SCOPUS:0242694042

VL - 34

SP - 2729

EP - 2735

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 11

ER -