Answer
Answer
Patients who have received recent thrombolysis or are critically ill from stroke are probably not well suited for MRI, because they cannot be monitored by clinical examinations during the period of imaging. If MRI is essential, it should be performed with the bare minimum of sequences required to make the diagnosis, such as T1-, T2-, diffusion-, or perfusion-weighted imaging and MRA. Many institutions have established acute stroke protocols to minimize scanning time.
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Media Gallery
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Magnetic resonance imaging in acute stroke. Left: Diffusion-weighted MRI in acute ischemic stroke performed 35 minutes after symptom onset. Right: Apparent diffusion coefficient (ADC) map obtained from the same patient at the same time.
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Magnetic resonance imaging in acute stroke. Left: Perfusion-weighted MRI of a patient who presented 1 hour after onset of stroke symptoms. Right: Mean transfer time (MTT) map of the same patient.
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Magnetic resonance imaging in acute stroke. Diffusion-perfusion mismatch in acute ischemic stroke. The perfusion abnormality (right) is larger than the diffusion abnormality (left), indicating the ischemic penumbra, which is at risk of infarction.
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The diffusion-weighted MRI reveals a region of hypointensity in the distribution of the right middle cerebral artery. Flanking the anterior and posterior regions of this abnormality are regions of hyperintensities, which represent regions of new infarct. The contiguity of these regions suggests that they are extensions of the old infarct.
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