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Rüdiger von Kummer MD is
Professor of Diagnostic Radiology/
Neuroradiology and is Head of the
Department of Neuroradiology
at the University of Dresden,
Germany. Prior to taking up
these positions in 1996, Dr von
Kummer worked at the University
of Heidelberg School of Medicine
for 25 years. For 13 of these years,
he was Director of the Cerebral
Vascular Research Laboratory and
he also worked in the Departments
of Neurology and Neuroradiology.
Dr von Kummer’s research interests
include the pathophysiology of
cerebral circulation, together with
MRI and CT in acute ischemia.
He has published more than 170
original papers and has contributed
to over 50 books.
Imanuel Dzialowski MD is a
Stroke Fellow at the University
of Calgary, Department of
Neurosciences, Foothills Hospital.
Before taking up this appointment,
he participated in residencies in
Neurology and Neuroradiology
at the University of Dresden.
The subject of his MD thesis was
‘CT monitoring of experimental
ischaemic oedema during
ischaemia and reperfusion’. He
has published a number of papers
with Dr von Kummer on imaging
techniques in acute stroke. |
Role of diagnostic radiology in the management of acute stroke
Imanuel Dzialowski1,
Rüdiger von Kummer2
1 Department of Neurosciences, Stroke Program,
University of Calgary, Alberta, Canada;
2 Department of Neuroradiology, University of Dresden,
Germany
Address for correspondence:
Rüdiger von Kummer, MD
Professor of Neuroradiology
Head, Department of Neuroradiology
University Hospital, Fetscherstr. 74
D-01307 Dresden, Germany
Tel: +49-(351)-458-2660 Fax: +49-(351)-458-4370
Email: ruediger.vonkummer@uniklinikum-dresden.de
Abstract
This article discusses the clinical efficacy of diagnostic
imaging in acute stroke. It compares computed
tomography (CT) with magnetic resonance imaging
(MRI) according to six different levels of clinical efficacy.
The feasibility of MRI is limited. Both CT and MRI
have the technical capacity to exclude acute brain
haemorrhage. CT detects irreversibly injured brain
tissue with moderate reliability but high specificity. MRI
displays ischaemic tissue highly conspicuously and with
good sensitivity but cannot reliably distinguish between
reversible and irreversible brain damage within the first
hours following stroke onset. Both CT and MRI have
great therapeutic impact by differentiating haemorrhagic
from ischaemic stroke, thus allowing specific treatment
to take place. CT has been shown to improve patients’
outcome within the first 6 hours following stroke onset
and thereby reduce healthcare costs. The extent of early
ischaemic oedema that is apparent on CT may identify
patients who will not benefit from recanalisation
therapy. MRI assessment of acute stroke patients may
allow efficacious treatment beyond currently accepted
time-windows by applying the perfusion-diffusion
mismatch and assessment of arterial occlusion.
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