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Computed http://www.selleckchem.com/products/a-1331852.html tomography perfusion imaging is now also available [33�C35], in which the patient is scanned rapidly through the brain during the first pass of an intravenously injected bolus of contrast agent. Studies so far suggest that both CT/CT perfusion (CTP) and MR diffusion weighted imaging (DWI)/perfusion weighted imaging (PWI) may yield similar information in the acute phase in comparable patients [36, 37]. As individual centres have differing experience of their use, and different access, future trial recruitment will likely be optimal (and the results more generalizable) if both CT and MR perfusion are sufficiently well understood so that the results are interchangeable. The practical limitations of MR, particularly in patients with more severe acute stroke symptoms, should not be underestimated [38�C40]. MR is not easy to perform in hyper-acute stroke [38�C40], http://www.selleck.cn/products/PLX-4720.html particularly when combined with the need to administer thrombolysis. As an indication of the difficulties, the DIAS [11], DEDAS [12], DEFUSE [41] and EPITHET [14] studies of thrombolysis in patients who had MR DWI/PWI imaging each took several years to recruit 104, 37, 74 and 100 patients respectively in multiple, well-resourced centres. The rising popularity of CT/CTP simply reflects the much greater availability of CT, and its rapidity and ease of access. Future acute stroke treatment trials should consider both MR and CT in their design in order to be as efficient, cost-efficient and generalizable as possible: faster patient recruitment reaches sample targets faster, so limiting trial staff infrastructure costs; if more centres can participate, results would be more generalizable to future clinical use. Many of the principles behind MR perfusion http://www.selleckchem.com/products/avelestat-azd9668.html imaging apply to CT, with only a few important differences [42, 43]. One main difference is that the MR signal change following intravenous contrast is not linearly related to the contrast agent concentration, whereas on CT the change in attenuation is linear with contrast concentration. The other major difference is that many CT scanners so far only provide a few brain slices, sometimes as few as two, thereby giving limited brain coverage compared with MR which gives whole brain coverage. The use of intravenous MR contrast is contraindicated in patients with impaired renal function [contraindicated relatively below an estimated glomerular filtration rate (eGFR) of 60?mL?min?1 and absolutely below 30?mL?min?1]. Determining renal function may delay perfusion imaging. CT contrast is generally accepted for cautious use except in patients with renal failure (eGFR