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Background and Purpose:Magnetic resonance imaging (MRI) selection of stroke p atients eligible for thrombolytic therapy is an emerging application. Although t he efficacy of therapy within 3 hours after onset of symptoms with intravenous ( IV) tissue plasminogen activator (tPA) has been proven for patients selected wit h computed tomography(CT), no randomized, double-blinded MRI trial has been pub lished yet. Summary of Review MRI screening of acute stroke patients before thro mbolytic 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 cente rs, the survey reveals a variety of clinical and MRI technical aspects that must be further investigated:the therapeutic consequence of microbleeds, the useof m agnetic resonance angiography, dynamic time windows,and others. Conclusion:MRI is an established application in acute evaluation of stroke patients and may sui t 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. u001a
Background and Purpose: Magnetic resonance imaging (MRI) selection of stroke pients eligible for thrombolytic therapy is an emerging application. Although t he efficacy of therapy within 3 hours after onset of symptoms with intravenous (IV) tissue plasminogen activator (tPA) has been proven for patients selected wit h computed tomography (CT), no randomized, double-blinded MRI trial has been pubished yet. Summary of Review MRI screening of acute stroke patients before thro mbolytic therapy is performed in some cerebrovascular centers. 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 cente rs, the survey reveals a variety of clinical and MRI technical aspects that must be further investigated: the therapeut ic consequence of microbleeds, the use of m agnetic resonance angiography, dynamic time windows, and others. Conclusion: MRI is an established application in acute evaluation of stroke patients and may sui t as a brain clock, replacing the currently used epidemiological time clock when deciding MRI of 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. u001a