Automated three-dimensional signature model for assessing brain injury in emergent stroke

This presentation will focus on the value of established and newer MR metho ds that can be applied to the diagnosis and management of ischemic stroke w ith emphasis on future applications of MR to provide previously unmet needs of the treating clinician and clinical trials. Time alone is an inadequate indicator of the therapeutic window, especially when the time of stroke on set is uncertain. Thus, there is a need to predict the evolution of stroke in a way that more precisely and with greater resolution identifies the pro gression of cellular damage at the moment of investigation. This also would be of value for thrombolysis when knowledge of the degree and extent of ti ssue necrosis and the consequent potential for brain hemorrhage is of the u tmost importance. To provide this, we perform postprocessing of diffusion-, T-1- and T-2-weighted images to produce the apparent diffusion coefficient of water, and T-1 and T-2 maps that are then further processed to provide maps and quantitation of the tissue signatures of ischemic histopathology. By these means, we can accomplish objective volumetric analysis of infarct size and of the proportions of potentially viable and salvageable tissue. W e will show how this has the potential to predict long-term stroke outcome and facilitate decision-making in terms of safety of reperfusion strategies and the appropriateness of cytoprotective treatment. The value of our appr oach is to replace time as the therapeutic window and extend the opportunit y of treatment to those patients presenting beyond the stringent time limit s employed in current investigative clinical trials. Further, used as a sur rogate marker of clinical outcome, this form of stroke analysis may speed p roof of principle clinical trials in small numbers of stroke patients. Copy right (C) 2001 S. Karger AG, Basel.