Abstract
Thrombolytic therapy during the hyperacute stage is important for salvaging dying cerebral tissue. To date, however, accurate non-invasive assessment of an ischemic lesion during the hyperacute stage has not been possible. Perfusion MRI may be the key to the quick diagnosis of ischemic lesions. To assess the feasibility of dynamic contrast enhanced perfusion MRI, echo planar imaging was performed in 10 patients with ischemic stroke. The relative cerebral blood volume (rCBV), mean transit time (MTT), and relative cerebral blood flow(rCBF) were measured based on moment analysis and the gamma variate method. These measurements, however, are not suitable for the detection of cerebral ischemia during the hyperacute stage. Therefore, we additionally studied the changes in a concentration curve (time-ΔR* curve) of Gd-DTPA, injected into the median vein of the forearm. From the curve the SUM (ΔR*) time to peak and the ΔR* peak, which may be calculated quickly, were determined and were compared to rCBV, MTT, and rCBF, respectively. The rCBV and the rCBF in the ischemic regions were less than those in the contralateral healthy regions (p<0.05), and the MTT in the ischemic regions was longer than that in the contralateral healthy regions (p<0.05). Additionally, SUM (ΔR*) and the ΔR* peak in the ischemic regions were less, and the time to peak in the ischemic regions was longer than the value in the contralateral healthy regions (p<0.05), correlating well to the rCBV, rCBF, and MTT measurements. Also, images of these parameters, depicting the ischemic lesion earlier than conventional T2 weighted images, can be easily made by using an MRI console. These results suggest that the SUM (ΔR*), time to peak and the ΔR* peak images calculated with dynamic contrast enhanced perfusion MRI may be one of the best techniques for the detection of cerebral ischemic lesions during the hyperacute stage. (J Nippon Med Sch 1998; 65: 148-154)
