Hjort N, Butcher K, Davis S M, Kidwell C S, Koroshetz W J, Röther J, Schellinger P D, Warach S, Østergaard L
Department of Neuroradiology, Center for Functionally Integrative Neuroscience, Arhus University Hospital, Nørrebrogade 44, 8000 Arhus C, Denmark.
Stroke. 2005 Feb;36(2):388-97. doi: 10.1161/01.STR.0000152268.47919.be. Epub 2004 Dec 23.
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.
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.
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.
磁共振成像（MRI）用于筛选适合溶栓治疗的中风患者是一项新兴应用。尽管对于通过计算机断层扫描（CT）筛选出的患者，已证实症状发作后3小时内静脉注射组织型纤溶酶原激活剂（tPA）的治疗效果，但尚无随机双盲MRI试验发表。
一些脑血管中心在进行溶栓治疗前对急性中风患者进行MRI筛查。与CT试验不同，MRI初步研究表明症状发作后长达6小时的治疗有益。本文回顾了促成当前基于MRI的溶栓对照试验的文献。我们研究了5个中风中心应用的MRI标准。结合这些中心临床医生的个人观点，调查揭示了各种必须进一步研究的临床和MRI技术方面：微出血的治疗后果、磁共振血管造影的应用、动态时间窗等。
MRI在中风患者的急性评估中是一项既定应用，在决定是否启动溶栓治疗时，它可能适合作为脑时钟，取代目前使用的流行病学时间时钟。一些脑血管中心应用了溶栓治疗的MRI标准，但在达成共识之前，必须等待正在进行的临床试验结果。
