SINAPSE Collaboration, SFC Brain Imaging Research Centre, Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh EH4 2EX, UK.
J Intern Med. 2010 Feb;267(2):172-90. doi: 10.1111/j.1365-2796.2009.02200.x.
The treatment of acute ischaemic stroke is based on the principle that there is ischaemic but still potentially salvageable tissue that could be rescued if blood flow could be restored quickly. It is assumed that salvage might only be possible in the first few hours, and that infarct expansion is a direct result of failed recanalization of the main artery. This concept arose from experimental work in the 1970s, supported more recently by studies using imaging to identify penumbral tissue. However, although magnetic resonance diffusion and perfusion imaging is a way of imaging penumbral tissue and has been around for over a decade, it is not an easy technique to apply in practice and its use has produced conflicting results. Computed tomography perfusion, and any other tissue perfusion imaging technique, is likely to encounter the same difficulties. Indeed many factors, other than the presence of a diffusion-perfusion mismatch acutely, may determine or influence ultimate tissue fate even days after the stroke, and in turn, clinical outcome. Many of these potential influences are beginning to emerge from studies using different forms of imaging at later times after stroke. This review will explore the information now emerging from imaging studies in large artery ischaemic stroke to summarize knowledge to date and indicate unresolved issues for the future.
急性缺血性脑卒中的治疗基于这样一个原则，即存在缺血但仍具有潜在可挽救性的组织，如果能够迅速恢复血流，这些组织可能被挽救。据推测，这种挽救可能只在最初的几个小时内才有可能，梗死的扩大是主要动脉再通失败的直接结果。这一概念源于 20 世纪 70 年代的实验工作，最近的研究使用影像学来识别半暗带组织进一步支持了这一概念。然而，尽管磁共振弥散和灌注成像可以用来对半暗带组织成像，并且已经存在了十多年，但在实践中应用它并不是一件容易的事，其应用产生了相互矛盾的结果。计算机断层灌注成像，以及任何其他组织灌注成像技术，可能会遇到同样的困难。事实上，除了在急性情况下存在弥散-灌注不匹配外，许多其他因素可能在中风后数天内决定或影响最终的组织命运，并进而影响临床结果。许多潜在的影响因素正开始从中风后不同时间使用不同形式的影像学研究中显现出来。本综述将探讨目前从大动脉缺血性脑卒中的影像学研究中涌现出的信息，总结目前的知识，并指出未来有待解决的问题。
