Neuroimaging, the ischaemic penumbra, and selection of patients for acute stroke therapy

Lancet Neurol. 2002 Nov;1(7):417-25. doi: 10.1016/s1474-4422(02)00189-8.


Advances in neuroimaging have been central to the expansion of knowledge in the neurosciences over the past 20 years. One of the most important roles of brain imaging is in the selection of patients for acute stroke therapy. Currently, computed tomography (CT) is commonly used to select patients who have had strokes for thrombolytic therapy on the basis of the absence of haemorrhage and, more controversially, the presence of early CT changes of ischaemia. Since patients with ischaemic penumbra are more likely than those without to respond to therapy, identification of patients with this feature will become increasingly important. Although several imaging modalities can identify the penumbra, the most practical is magnetic resonance imaging (MRI) showing perfusion-weighted and diffusion-weighted imaging mismatch. Although uncertainties in image interpretation remain, surrogate MRI outcome measures are becoming an important component of translational research. Future developments in imaging technologies may provide other opportunities for surrogate outcome studies.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acute Disease
  • Brain Ischemia / diagnostic imaging
  • Brain Ischemia / drug therapy*
  • Brain Ischemia / pathology
  • Humans
  • Intracranial Thrombosis / diagnostic imaging
  • Intracranial Thrombosis / drug therapy*
  • Intracranial Thrombosis / pathology
  • Magnetic Resonance Angiography / methods
  • Magnetic Resonance Angiography / standards
  • Magnetic Resonance Imaging / methods
  • Magnetic Resonance Imaging / standards
  • Patient Selection*
  • Stroke / diagnostic imaging
  • Stroke / drug therapy*
  • Stroke / pathology
  • Tomography, X-Ray Computed / methods
  • Tomography, X-Ray Computed / standards