Use of diffusion and perfusion magnetic resonance imaging as a tool in acute stroke clinical trials

In light of the slow progress in developing effective therapies for ischemic stroke, magnetic resonance imaging techniques have emerged as new tools in stroke clinical trials. Rapid imaging with magnetic resonance imaging, diffusion weighted imaging, perfusion imaging and angiography are being incorporated into phase II and phase III stroke trials to optimize patient selection based on positive imaging diagnosis of the ischemic pathophysiology specifically related to a drug's mechanism of action and as a direct biomarker of the effect of a treatment's effect on the brain.

• Publication year

  2001

• Venue

  Current Controlled Trials in Cardiovascular Medicine

• Publication date

  2001-01-30

• Fields of study

  Medicine

• Identifiers
  DOI 10.1186/cvm-2-1-038PMID 11806771PMCID 59649
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• These imaging tools are used to optimize patient selection through positive imaging diagnosis of ischemic pathophysiology matched to a drug's mechanism of action and to serve as a direct biomarker of treatment effect on the brain.

  Confidence 0.96

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewAK (4715169a40) reviewjaeyoung (rb9u4m834j) review
• Magnetic resonance imaging, diffusion weighted imaging, perfusion imaging, and angiography are being incorporated into phase II and phase III acute stroke clinical trials.

  Confidence 0.98

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewAK (4715169a40) reviewjaeyoung (rb9u4m834j) review

• acute stroke clinical trials

  clinical trial setting

  Interventional studies in acute ischemic stroke that evaluate candidate treatments in the early treatment window.

  Aliases: phase II and phase III stroke trials

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewAK (4715169a40) reviewjaeyoung (rb9u4m834j) review
• angiography

  imaging modality

  An imaging technique used to visualize blood vessels and vascular anatomy.

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewAK (4715169a40) reviewjaeyoung (rb9u4m834j) review
• biomarker

  measurement

  A measurable indicator used to reflect a biological state or treatment response.

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewAK (4715169a40) reviewjaeyoung (rb9u4m834j) review
• diffusion weighted imaging

  imaging sequence

  An MRI sequence that measures the diffusion of water molecules in tissue.

  Aliases: DWI

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewAK (4715169a40) reviewjaeyoung (rb9u4m834j) review
• drug mechanism of action

  pharmacologic principle

  The biological process by which a treatment is expected to exert its effect.

  Aliases: mechanism of action

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewAK (4715169a40) reviewjaeyoung (rb9u4m834j) review
• ischemic pathophysiology

  pathophysiological process

  The disease mechanism of reduced blood supply and tissue injury in ischemic stroke.

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewAK (4715169a40) reviewjaeyoung (rb9u4m834j) review
• magnetic resonance imaging

  imaging modality

  An imaging modality that uses magnetic fields and radio waves to generate internal body images.

  Aliases: MRI

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewAK (4715169a40) reviewjaeyoung (rb9u4m834j) review
• patient selection

  trial design

  The process of choosing trial participants based on eligibility features and imaging findings.

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewAK (4715169a40) reviewjaeyoung (rb9u4m834j) review
• perfusion imaging

  imaging modality

  An imaging approach that measures blood flow through tissue.

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewAK (4715169a40) reviewjaeyoung (rb9u4m834j) review
• positive imaging diagnosis

  diagnostic criterion

  An imaging-based diagnosis that identifies evidence of the target ischemic process.

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewAK (4715169a40) reviewjaeyoung (rb9u4m834j) review

• Effect of citicoline on ischemic lesions as measured by diffusion‐weighted magnetic resonance imaging

  2000influential reference
• Effect of citicoline on ischemic lesions as measured by diffusion-weighted magnetic resonance imaging. Citicoline 010 Investigators.

  2000cited by this paper
• Glycine antagonist (gavestinel) in neuroprotection (GAIN International) in patients with acute stroke: a randomised controlled trial. GAIN International Investigators.

  2000cited by this paper
• Monitoring intravenous recombinant tissue plasminogen activator thrombolysis for acute ischemic stroke with diffusion and perfusion MRI.

  2000cited by this paper
• A randomized efficacy trial of citicoline in patients with acute ischemic stroke.

  2000cited by this paper
• Intra-arterial Prourokinase for Acute Ischemic Stroke

  2000cited by this paper
• Clinical Correlations of Diffusion and Perfusion Lesion Volumes in Acute Ischemic Stroke

  2000cited by this paper
• Pathophysiological topography of acute ischemia by combined diffusion-weighted and perfusion MRI.

  1999cited by this paper
• A randomized efficacy trial of citicoline in patients with acute ischemic stroke.

  1999cited by this paper
• MRI features of intracerebral hemorrhage within 2 hours from symptom onset.

  1999cited by this paper
• Intra-arterial Prourokinase for Acute Ischemic Stroke: The PROACT II Study: A Randomized Controlled Trial

  1999cited by this paper
• A standardized MRI stroke protocol: comparison with CT in hyperacute intracerebral hemorrhage.

  1999cited by this paper
• Longitudinal magnetic resonance imaging study of perfusion and diffusion in stroke: Evolution of lesion volume and correlation with clinical outcome

  1999cited by this paper
• The ischemic penumbra: operationally defined by diffusion and perfusion MRI.

  1999cited by this paper
• Absent middle cerebral artery flow predicts the presence and evolution of the ischemic penumbra

  1999cited by this paper
• Evaluation of early reperfusion and IV tPA therapy using diffusion- and perfusion-weighted MRI

  1999cited by this paper
• Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS Study: a randomized controlled trial. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke.

  1999cited by this paper
• Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism.

  1999cited by this paper
• Citicoline treatment for experimental intracerebral hemorrhage in mice.

  1998cited by this paper
• Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators.

  1998cited by this paper
• Magnetic resonance imaging in acute stroke

  1998cited by this paper
• Clinical experience with diffusion-weighted MR in patients with acute stroke.

  1998cited by this paper
• A Phantom for diffusion‐weighted imaging of acute stroke

  1998cited by this paper
• Magnetic Resonance Imaging of Acute Stroke

  1998cited by this paper
• Diffusion-weighted magnetic resonance imaging in acute stroke.

  1998cited by this paper
• Prediction of stroke outcome with echoplanar perfusion- and diffusion-weighted MRI

  1998cited by this paper
• Correlation of perfusion- and diffusion-weighted MRI with NIHSS score in acute (<6.5 hour) ischemic stroke

  1998cited by this paper
• Enlargement of human cerebral ischemic lesion volumes measured by diffusion‐weighted magnetic resonance imaging

  1997cited by this paper
• Ischemic lesion volumes in acute stroke by diffusion‐weighted magnetic resonance imaging correlate with clinical outcome

  1997cited by this paper
• Clinical Outcome in Ischemic Stroke Predicted by Early Diffusion-Weighted and Perfusion Magnetic Resonance Imaging: A Preliminary Analysis

  1996cited by this paper
• Detection of hyperacute primary intraparenchymal hemorrhage by magnetic resonance imaging.

  1996cited by this paper
• Tissue plasminogen activator for acute ischemic stroke.

  1996cited by this paper
• Acute human stroke studied by whole brain echo planar diffusion‐weighted magnetic resonance imaging

  1995cited by this paper
• Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group.

  1995cited by this paper
• Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS)

  1995cited by this paper
• Tissue plasminogen activator for acute ischemic stroke.

  1995cited by this paper
• The European Cooperative Acute Stroke Study (ECASS)

  1993cited by this paper
• Acute cerebral ischemia: evaluation with dynamic contrast-enhanced MR imaging and MR angiography.

  1992cited by this paper
• Fast magnetic resonance diffusion‐weighted imaging of acute human stroke

  1992cited by this paper
• Early detection of regional cerebral ischemia in cats: Comparison of diffusion‐ and T2‐weighted MRI and spectroscopy

  1990cited by this paper

• A Large-Kernel and Scale-Aware 2D CNN with Boundary Refinement for Multimodal Ischemic Stroke Lesion Segmentation

  2026cites this paper
• Stroke of Insight: Recognition, Work-Up, and Treatment of Acute Ischemic Stroke.

  2025cites this paper
• David G. Sherman Lecture: Improving Stroke Diagnosis and Treatment-A Journey Toward the End of Time.

  2024cites this paper
• Magnetic Resonance Imaging Diagnostics of Vascular Myelopathies: from Basic Sequences to Promising Imaging Protocols

  2024cites this paper
• A systematic review of the usefulness of magnetic resonance imaging in predicting the gait ability of stroke patients

  2021cites this paper
• Magnetic Resonance Imaging for Drug Development.

  2021cites this paper
• High On-Treatment Platelet Reactivity Affects the Extent of Ischemic Lesions in Stroke Patients Due to Large-Vessel Disease

  2020cites this paper
• Recurrent Ischemic Lesions After Acute Atherothrombotic Stroke: Clopidogrel Plus Aspirin Versus Aspirin Alone

  2016cites this paper
• The Impact of Neuroimaging on Acute Stroke Treatment: Role of Magnetic Resonance Imaging

  2015cites this paper
• A Comparison of Two Methods for MRI Classification of At-Risk Tissue and Core Infarction

  2014cites this paper
• Medical Image Search

  2012cites this paper
• A Randomized Placebo Controlled Trial of Early Treatment of Acute Ischemic Stroke with Atorvastatin and Irbesartan

  2012cites this paper
• Prediction of subacute infarct size in acute middle cerebral artery stroke: comparison of perfusion-weighted imaging and apparent diffusion coefficient maps.

  2012cites this paper
• Early ADC changes in motor structures predict outcome of acute stroke better than lesion volume.

  2011cites this paper
• Hyperglycemia and the Fate of Apparent Diffusion Coefficient–Defined Ischemic Penumbra

  2011cites this paper
• Diagnostyka obrazowa wczesnego udaru mózgu

  2010cites this paper
• Quantitative MR in multi‐center clinical trials

  2010cites this paper
• Thrombolytic therapy for acute stroke.

  2009cites this paper
• Methodology of acute trials in stroke.

  2009cites this paper
• Interrater Agreement for Final Infarct MRI Lesion Delineation

  2009cites this paper
• Prediction of infarct growth based on apparent diffusion coefficients: penumbral assessment without intravenous contrast material.

  2009cites this paper
• Use of neuroimaging in acute stroke trials

  2009cites this paper
• Prediction of Infarct Growth Based on Apparent Diffusion Coefficients: Penumbral AssessmentwithoutIntravenous

  2009cites this paper
• Interexaminer Difference in Infarct Volume Measurements on MRI: A Source of Variance in Stroke Research

  2008cites this paper
• Incidental Acute Infarcts Identified on Diffusion-Weighted Images: A University Hospital-Based Study

  2008cites this paper
• Contrast-Enhanced MR Angiography Improves Detection of Carotid-T Occlusion by Acute Stroke MRI

  2008cites this paper
• Controversies in Stroke

  2008cites this paper
• Predictores de la evolución clínico-radiológica del ictus isquémico agudo tras el tratamiento trombolítico

  2008cites this paper
• Numerical simulation model of hyperacute/acute stage white matter infarction.

  2008cites this paper
• Acute Stroke Imaging for Thrombolytic Therapy – An Update

  2007cites this paper
• The Past and Future of Neuroprotection in Cerebral Ischaemic Stroke

  2007cites this paper
• Speed of tPA-Induced Clot Lysis Predicts DWI Lesion Evolution in Acute Stroke

  2007cites this paper
• Effect of the Glycine Antagonist Gavestinel on Cerebral Infarcts in Acute Stroke Patients, a Randomized Placebo-Controlled Trial: The GAIN MRI Substudy

  2006cites this paper
• The Ischemic Penumbra: A New Opportunity for Neuroprotection

  2006cites this paper
• Outcome Measure and Efficacy Analysis in Stroke Clinical Trials

  2006cites this paper
• The evolving role of advanced MR imaging as a management tool for adult ischemic stroke: a Western-European perspective.

  2005cites this paper
• Vascular occlusion sites determine differences in lesion growth from early apparent diffusion coefficient lesion to final infarct.

  2005cites this paper
• Imaging biomarkers predictive of disease/therapy outcome: ischemic stroke and drug development.

  2005cites this paper
• Imaging bio-markers predictive of disease/therapy outcome: ischemic stroke and drug development

  2005cites this paper
• Seeing the Brain So We Can Save It. The Evolution of Magnetic Resonance Imaging as a Clinical Tool

  2005cites this paper
• Using Magnetic Resonance Imaging to Select and Manage Patients for Treatment

  2005cites this paper
• Brain diffusion and perfusion magnetic resonance imaging in healthy subjects and in patients with ischemic stroke, carotid stenosis, and leukoaraiosis.

  2004cites this paper
• Das Schlaganfall-MRT: Pathophysiologie, Potenzial und Perspektiven

  2004cites this paper
• Improved cerebral protection through replacement of residual intracavital air by carbon dioxide: a porcine model using diffusion-weighted magnetic resonance imaging.

  2004cites this paper
• Diffusion weighted MR imaging on a low-field open magnet. Comparison with findings at 1.5T in 18 patients with cerebral ischemia.

  2003cites this paper
• Ischemic penumbra: MRI or PET.

  2003cites this paper
• Diffusion Weighted MR Imaging on a Low-Field Open Magnet in Stroke

  2003cites this paper
• Measurement of the ischemic penumbra with MRI: it's about time.

  2003cites this paper
• Editorial comment--Can we predict massive space-occupying edema in large hemispheric infarctions?

  2003cites this paper
• Measurement of the Ischemic Penumbra With MRI: It’s About Time Controversies in Stroke

  2003cites this paper
• Measurement of the Ischemic Penumbra With MRI: It’s About Time Controversies in Stroke

  2003cites this paper
• Best measure of ischemic penumbra: positron emission tomography.

  2003cites this paper
• Prediction of Malignant Middle Cerebral Artery Infarction by Early Perfusion- and Diffusion-Weighted Magnetic Resonance Imaging

  2003cites this paper
• The approximate planimetric method: a simple, rapid and reliable method for estimation of lesion size in acute ischemic stroke

  2003cites this paper
• Perfusion-based functional magnetic resonance imaging

  2003cites this paper
• Citicoline mechanisms and clinical efficacy in cerebral ischemia

  2002cites this paper
• Mini-Review Citicolin eMechanism san dClinica lEfficacy i nCerebra lIschemia

  2002cites this paper
• Toward Wisdom From Failure: Lessons From Neuroprotective Stroke Trials and New Therapeutic Directions

  2002cites this paper
• Early Detection of Irreversible Cerebral Ischemia in the Rat Using Dispersion of the Magnetic Resonance Imaging Relaxation Time, T1ρ

  2000cites this paper