Magnetic
Resonance Spectroscopy.
MRS is a relatively new technique that, by enabling
measurement of ATP, lactate levels, and pH at discrete locations
within the brain [Dunbabin DW, Sandercock PAG, 1991], can
distinguish areas that have no viable neurons from areas
that may be salvageable (i.e., the ischemic penumbra) [Feiber
SR, et al. J Neurol. 1990;237:156].
Diffusion-Weighted
Imaging.
DWI involves measuring the diffusion of water molecules
over short distances. The apparent diffusion coefficient
of water is reduced in areas of ischemia within minutes
after onset. DWI studies obtained 2 to hours after
stroke onset have demonstrated the ischemic region, while
standard MRI studies did not. Subsequent MRI and CT
scans confirm the nature of the abnormal areas on the DWI
study. Thus, DWI can detect areas of ischemic brain
injury more quickly than standard MRI or CT. This
technique may substantially improve the initial diagnostic
accuracy and potentially provide a method for evaluating
the effects of the therapeutic interventions on the ischemic
region [Minematsu K, et al. Neurology. 1993;43:397-403.
Lo EH, et al. J Cereb Blood Flow Metab. 1994;14:597-603].
Perfusion
Imaging.
Perfusion imaging is usually performed by injecting
a contrast agent and then obtaining a rapid series of MRIs
using an ultrafast technique. The images track the
passage of the contrast agent through the brain. This
technique can be used to assess cerebral blood flow and
blood volume in various brain regions. Ultrafast MRI
techniques are currently used in research setting [Minematsu
K, et al. 1993].