Schramm Peter, Schellinger Peter D, Fiebach Jochen B, Heiland Sabine, Jansen Olav, Knauth Michael, Hacke Werner, Sartor Klaus
Department of Neuroradiology, University of Heidelberg Medical School, Heidelberg, Germany.
Stroke. 2002 Oct;33(10):2426-32. doi: 10.1161/01.str.0000032244.03134.37.
Although stroke MRI has advantages over other diagnostic imaging modalities in acute stroke patients, most of these individuals are admitted to emergency units without MRI facilities. There is a need for an accurate diagnostic tool that rapidly and reliably detects hemorrhage, extent of ischemia, and vessel status and potentially estimates tissue at risk. We sought to determine the diagnostic accuracy of the combination of non-contrast-enhanced CT, CT angiography (CTA), and CTA source images (CTA-SI, showing early parenchymal contrast enhancement) in comparison with a multiparametric stroke MRI protocol in patients with acute stroke within 6 hours after onset.
Non-contrast-enhanced CT, CTA, stroke MRI including diffusion-weighted imaging (DWI), and MR angiography (MRA) were performed in patients with symptoms of acute stroke within 6 hours after onset. We analyzed infarct volumes on days 1 and 5 as shown on CTA-SI, DWI, and T2-weighted images (Wilcoxon, Mann-Whitney, Spearman tests), estimated the collateral status, and assessed clinical outcome (modified Rankin Scale, Barthel Index, National Institutes of Health Stroke Scale, Scandinavian Stroke Scale).
We analyzed the data of 20 stroke patients who underwent CT and MRI scanning within 6 hours (mean, 2.83 and 3.38 hours, respectively). Vessel occlusion was present in 16 of 20 patients. CTA-SI volumes did not differ from DWI volumes (P=0.601). Furthermore, the CTA-SI lesion volumes significantly correlated with the initial DWI lesion volumes (P<0.0001, r=0.922) and with outcome lesion volumes (P=0.013 r=0.736). Patients with poor collaterals experienced infarct growth (P=0.0058) and had a significantly worse clinical outcome (all P<0.012); patients with good collaterals did not (P=0.176).
The combination of non-contrast-enhanced CT (exclusion of intracranial hemorrhage), CTA (vessel status), and early contrast-enhanced CTA-SI (demarcation of irreversible infarct) allows diagnostic assessment of acute stroke with a quality comparable to that of stroke MRI. Furthermore, it is possible to distinguish patients at risk of infarct growth from those who are not according to the collateral status, in analogy with the stroke MRI mismatch concept.
尽管在急性卒中患者中，卒中磁共振成像（MRI）相较于其他诊断成像方式具有优势，但大多数此类患者被收治到没有MRI设备的急诊科。因此需要一种准确的诊断工具，能够快速、可靠地检测出血、缺血范围、血管状况，并有可能评估有风险的组织。我们试图确定在发病6小时内的急性卒中患者中，非增强CT、CT血管造影（CTA）和CTA源图像（CTA-SI，显示早期实质对比增强）联合使用与多参数卒中MRI方案相比的诊断准确性。
对发病6小时内出现急性卒中症状的患者进行非增强CT、CTA、包括扩散加权成像（DWI）的卒中MRI以及磁共振血管造影（MRA）检查。我们分析了CTA-SI、DWI和T2加权图像上第1天和第5天的梗死体积（Wilcoxon检验、Mann-Whitney检验、Spearman检验），评估了侧支循环状况，并评估了临床结局（改良Rankin量表、Barthel指数、美国国立卫生研究院卒中量表、斯堪的纳维亚卒中量表）。
我们分析了20例在6小时内（平均分别为2.83小时和3.38小时）接受CT和MRI扫描的卒中患者的数据。20例患者中有16例存在血管闭塞。CTA-SI体积与DWI体积无差异（P = 0.601）。此外，CTA-SI病变体积与初始DWI病变体积显著相关（P < 0.0001，r = 0.922），与结局病变体积也显著相关（P = 0.013，r = 0.736）。侧支循环差的患者梗死灶增大（P = 0.0058），临床结局明显更差（所有P < 0.012）；侧支循环好的患者则不然（P = 0.176）。
非增强CT（排除颅内出血）、CTA（血管状况）和早期对比增强CTA-SI（不可逆梗死的界定）联合使用能够对急性卒中进行诊断评估，其质量与卒中MRI相当。此外，类似于卒中MRI不匹配概念，根据侧支循环状况可以区分有梗死灶增大风险的患者和无此风险的患者。
