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17 - MRI as a tool in stroke drug development
- By Steven Warach
Edited by Stephen Davis, Marc Fisher, National Institute of Mental Health, Bethesda, Maryland, Steven Warach, National Institutes of Health, Baltimore
Book:

Magnetic Resonance Imaging in Stroke

Published online:

26 August 2009

Print publication:

20 March 2003, pp 223-232
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Summary

The principle of optimal patient selection by imaging confirmation of the relevant pathology was first demonstrated by the results of the intra arterial pro-urokinase stroke study, PROACT II. Four major factors are hypothesized to predict tissue response and clinical efficacy in stroke trials: time to treatment, the salvageable tissue-at-risk, the relevance of the patient sample to the treatment and the intrinsic effectiveness of the therapeutic strategy. In using MRI as a selection criterion, the goal would be a sample selection based upon a positive imaging diagnosis of a pathology rationally linked to the drug's mechanisms of action. MRI measurements of lesion volume acutely and chronically have proven to be a marker of clinical severity. MRI is increasingly used as a selection tool and an outcome measure in stroke trials, reflecting recognition that direct pathophysiological imaging may provide a more rational approach to stroke therapeutics.