Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
Ann N Y Acad Sci. 2012 Sep;1268:63-71. doi: 10.1111/j.1749-6632.2012.06732.x.
Ischemic stroke is a very heterogeneous disease that limits the efficacy of acute stroke treatments. Future trials will require advanced imaging to select patients for specific treatments. The most well-established imaging tools are the use of CT to exclude hemorrhage and diffusion-weighted MRI to demonstrate ischemia. While perfusion imaging is one option for patient selection, it has unresolved issues, including standardization and validation, that limit its value. As an alternative to mismatch when addressing stroke, one needs to know the size of the initial irreversible lesion (core), the presence and site/extent of occlusion (clot), and presence of leptomeningeal back filling and Willisian filling (collaterals). These can be summarized as the "3C" approach of core, clot, and collateral interpretation, which together can represent an imaging sweet spot, particularly for time-efficient endovascular treatment trial design.
缺血性脑卒中是一种非常异质性的疾病，限制了急性脑卒中治疗的效果。未来的试验将需要先进的影像学来为特定的治疗选择患者。最成熟的影像学工具是使用 CT 排除出血和弥散加权 MRI 显示缺血。虽然灌注成像也是患者选择的一种选择，但它存在尚未解决的问题，包括标准化和验证，这限制了它的价值。在解决脑卒中时，除了不匹配之外，还需要知道初始不可逆损伤（核心）的大小、闭塞（血栓）的存在和部位/程度以及软脑膜回流和 Willisian 充盈（侧支循环）的存在。这些可以概括为核心、血栓和侧支循环解释的“3C”方法，它们共同构成了一个影像学的理想选择，特别是对于高效的血管内治疗试验设计。
