Guadagno Joseph V, Warburton Elizabeth A, Aigbirhio Franklin I, Smielewski Piotr, Fryer Tim D, Harding Sally, Price Christopher J, Gillard Jonathan H, Carpenter T Adrian, Baron Jean-Claude
Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 2QQ, UK.
J Cereb Blood Flow Metab. 2004 Nov;24(11):1249-54. doi: 10.1097/01.WCB.0000141557.32867.6B.
In acute ischemic stroke, the diffusion-weighted imaging (DWI) lesion is widely held to represent the core of irreversible damage and is therefore crucial in selecting patients for thrombolysis. However, recent research suggests it may also represent penumbra. An illustrative patient was imaged 7 hours after stroke onset with back-to-back 3T diffusion tensor imaging and quantitative positron emission tomography, which showed a DWI lesion and misery perfusion, respectively. Using previously validated voxel-based probabilistic CBF, CMRO2, and Oxygen Extraction Fraction (OEF) thresholds, the authors show that the DWI lesion contained not only core but also substantial proportions of penumbra. Also, severe apparent diffusion coefficient reductions were present within the potentially salvageable penumbra as well as in the core. These findings have potential implications regarding treatment decisions.
在急性缺血性卒中中，扩散加权成像（DWI）病灶被广泛认为代表不可逆损伤的核心，因此在选择溶栓患者时至关重要。然而，最近的研究表明它也可能代表半暗带。一名具有代表性的患者在卒中发作7小时后接受了连续的3T扩散张量成像和定量正电子发射断层扫描，分别显示出DWI病灶和灌注不良。作者使用先前验证的基于体素的概率性脑血流量（CBF）、脑代谢率（CMRO2）和氧摄取分数（OEF）阈值，表明DWI病灶不仅包含核心区，还包含相当比例的半暗带。此外，在潜在可挽救的半暗带以及核心区内均存在明显的表观扩散系数降低。这些发现对治疗决策具有潜在影响。
