Original Article

Thrombolytic reversal of acute human cerebral ischemic injury shown by diffusion/perfusion magnetic resonance imaging

  1. Chelsea S. Kidwell MD1,2,*,
  2. Jeffrey L. Saver MD1,2,
  3. James Mattiello PhD3,
  4. Sidney Starkman MD1,2,4,
  5. Fernando Vinuela MD1,3,
  6. Gary Duckwiler MD1,3,
  7. Y. Pierre Gobin MD1,3,
  8. Reza Jahan MD1,3,
  9. Paul Vespa MD1,2,5,
  10. Mary Kalafut MD1,2,
  11. Jeffry R. Alger PhD1,3

Article first published online: 26 APR 2001

DOI: 10.1002/1531-8249(200004)47:4<462::AID-ANA9>3.0.CO;2-Y

Issue

Annals of Neurology

Annals of Neurology

Volume 47, Issue 4, pages 462–469, April 2000

Additional Information

How to Cite

Kidwell, C. S., Saver, J. L., Mattiello, J., Starkman, S., Vinuela, F., Duckwiler, G., Gobin, Y. P., Jahan, R., Vespa, P., Kalafut, M. and Alger, J. R. (2000), Thrombolytic reversal of acute human cerebral ischemic injury shown by diffusion/perfusion magnetic resonance imaging. Annals of Neurology, 47: 462–469. doi: 10.1002/1531-8249(200004)47:4<462::AID-ANA9>3.0.CO;2-Y

Author Information

  1. 1

    UCLA Stroke Center, Los Angeles, CA

  2. 2

    Department of Neurology, UCLA Medical Center, Los Angeles, CA

  3. 3

    Department of Radiological Sciences, UCLA Medical Center, Los Angeles, CA

  4. 4

    Department of Emergency Medicine, UCLA Medical Center, Los Angeles, CA

  5. 5

    Department of Neurosurgery, UCLA Medical Center, Los Angeles, CA

*UCLA Stroke Center, 710 Westwood Plaza, UCLA Medical Center, Los Angeles, CA 90095

Publication History

  1. Issue published online: 26 APR 2001
  2. Article first published online: 26 APR 2001
  3. Manuscript Accepted: 23 NOV 1999
  4. Manuscript Revised: 20 OCT 1999
  5. Manuscript Received: 14 SEP 1999

Funded by

  • American Heart Association. Grant Number: 9650621N
  • National Stroke Association

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Abstract

Diffusion magnetic resonance imaging provides an early marker of acute cerebral ischemic injury. Thrombolytic reversal of diffusion abnormalities has not previously been demonstrated in humans. Serial diffusion and perfusion imaging studies were acquired in patients experiencing acute hemispheric cerebral ischemia treated with intra-arterial thrombolytic therapy within 6 hours of symptom onset. Seven patients met inclusion criteria of prethrombolysis and postthrombolysis magnetic resonance studies, presence of large artery anterior circulation occlusion at angiography, and achievement of vessel recanalization. Mean diffusion-weighted imaging lesion volume at baseline was 23 cm3 (95% confidence interval [95% CI], 8–38 cm3) and decreased to 10 cm3 (95% CI, 3–17 cm3) 2.5 to 9.5 hours after thrombolysis. Mean apparent diffusion coefficient lesion volume decreased from 9 cm3 (95% CI, 2–16 cm3) at baseline to 1 cm3 (95% CI, 0.4–2 cm3) early after thrombolysis. A secondary increase in diffusion volumes was seen in 3 of 6 patients at day 7. In all 4 patients in whom perfusion imaging was obtained before and after treatment, complete resolution of the perfusion deficit was shown. Diffusion magnetic resonance signatures of early tissue ischemic injury can be reversed in humans by prompt thrombolytic vessel recanalization. The ischemic penumbra includes not only the region of diffusion/perfusion mismatch, but also portions of the region of initial diffusion abnormality. Ann Neurol 2000;47:462–469.

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