快速液体衰减反转恢复序列图像上的动脉高信号：扩散加权磁共振成像未检测到的超急性卒中的细微表现。
Arterial hyperintensity on fast fluid-attenuated inversion recovery images: a subtle finding for hyperacute stroke undetected by diffusion-weighted MR imaging.
作者信息
Maeda M, Yamamoto T, Daimon S, Sakuma H, Takeda K
机构信息
Department of Medicine, Mie University School of Medicine, Maizuru Kyosai Hospital, Japan.
出版信息
AJNR Am J Neuroradiol. 2001 Apr;22(4):632-6.
BACKGROUND AND PURPOSE
Diffusion-weighted MR imaging is generally acknowledged to be more sensitive in detecting acute stroke than is conventional MR imaging. Our purpose in the present study was to evaluate the utility of fast fluid-attenuated inversion recovery (FLAIR) MR imaging compared with that of diffusion-weighted MR imaging for the diagnosis of hyperacute stroke.
METHODS
We reviewed patient records and cerebral MR images from all patients in a 13-month period from whom diffusion-weighted and fast-FLAIR imaging were obtained within 6 hours after symptom onset (n = 11). Special attention was paid to the presence or absence of arterial hyperintensity on FLAIR images and abnormally high-signal regions on diffusion-weighted images in the affected vascular territories.
RESULTS
Arterial hyperintensity was found in eight of 11 patients, all of whom had embolic or thrombotic infarctions with middle cerebral arterial (MCA) distribution. Arterial hyperintensity was negative in the remaining three patients; the vascular territories were the posterior circulation region in two of these patients and the MCA region in one, and the types of infarction in these same patients were lacunar in two and embolic in one. Regions with high-signal diffusion abnormalities relevant to the patients' symptoms were found in 10 of 11 patients. One patient showed no diffusion abnormalities but the presence of arterial hyperintensity in the affected MCA territory on the initial MR examination, and manifested embolic infarction along with arterial hyperintensity on the initial FLAIR image.
CONCLUSION
Although diffusion-weighted MR imaging is highly sensitive to stroke, diffusion-weighted MR imaging alone may not rule out a possible infarction. Arterial hyperintensity on FLAIR images can precede diffusion abnormalities and may provide a clue to the early detection of impending infarction.
背景与目的
一般认为，扩散加权磁共振成像在检测急性卒中方面比传统磁共振成像更敏感。本研究的目的是评估快速液体衰减反转恢复（FLAIR）磁共振成像与扩散加权磁共振成像在超急性卒中诊断中的效用。
方法
我们回顾了13个月期间所有患者的病历和脑磁共振图像，这些患者在症状发作后6小时内接受了扩散加权成像和快速FLAIR成像（n = 11）。特别关注FLAIR图像上动脉高信号的有无以及受累血管区域扩散加权图像上的异常高信号区域。
结果
11例患者中有8例发现动脉高信号，所有这些患者均有大脑中动脉（MCA）分布的栓塞性或血栓性梗死。其余3例患者动脉高信号为阴性；其中2例患者的血管区域为后循环区域，1例为MCA区域，这些患者的梗死类型2例为腔隙性，1例为栓塞性。11例患者中有10例发现与患者症状相关的扩散异常高信号区域。1例患者在最初的磁共振检查中未显示扩散异常，但在受累的MCA区域存在动脉高信号，并且在最初的FLAIR图像上显示为栓塞性梗死伴动脉高信号。
结论
虽然扩散加权磁共振成像对卒中高度敏感，但仅靠扩散加权磁共振成像可能无法排除可能的梗死。FLAIR图像上的动脉高信号可先于扩散异常出现，并可能为早期发现即将发生的梗死提供线索。
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