El-Koussy Marwan, Schroth Gerhard, Brekenfeld Caspar, Arnold Marcel
Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland.
Eur Neurol. 2014;72(5-6):309-16. doi: 10.1159/000362719. Epub 2014 Oct 14.
Over 80% of strokes result from ischemic damage to the brain due to an acute reduction in the blood supply. Around 25-35% of strokes present with large vessel occlusion, and the patients in this category often present with severe neurological deficits. Without early treatment, the prognosis is poor. Stroke imaging is critical for assessing the extent of tissue damage and for guiding treatment.
This review focuses on the imaging techniques used in the diagnosis and treatment of acute ischemic stroke, with an emphasis on those involving the anterior circulation. Key Message: Effective and standardized imaging protocols are necessary for clinical decision making and for the proper design of prospective studies on acute stroke.
Each minute without treatment spells the loss of an estimated 1.8 million neurons ('time is brain'). Therefore, stroke imaging must be performed in a fast and efficient manner. First, intracranial hemorrhage and stroke mimics should be excluded by the use of computed tomography (CT) or magnetic resonance imaging (MRI). The next key step is to define the extent and location of the infarct core (values of >70 ml, >1/3 of the middle cerebral artery (MCA) territory or an ASPECTS score ≤ 7 indicate poor clinical outcome). Penumbral imaging is currently based on the mismatch concept. It should be noted that the penumbra is a dynamic zone and can be sustained in the presence of good collateral circulation. A thrombus length of >8 mm predicts poor recanalization after intravenous thrombolysis.
超过80%的中风是由于血液供应急性减少导致大脑缺血性损伤所致。约25%-35%的中风表现为大血管闭塞，这类患者常伴有严重的神经功能缺损。若不早期治疗，预后较差。中风成像对于评估组织损伤程度和指导治疗至关重要。
本综述重点关注急性缺血性中风诊断和治疗中使用的成像技术，尤其侧重于涉及前循环的技术。关键信息：有效的标准化成像方案对于临床决策和急性中风前瞻性研究的合理设计是必要的。
每延误一分钟治疗，估计会损失180万个神经元（“时间就是大脑”）。因此，中风成像必须快速高效地进行。首先，应通过计算机断层扫描（CT）或磁共振成像（MRI）排除颅内出血和类似中风的病症。下一步关键是确定梗死核心的范围和位置（体积>70 ml、超过大脑中动脉（MCA）供血区的1/3或ASPECTS评分≤7表明临床预后不良）。目前半暗带成像基于不匹配概念。应注意，半暗带是一个动态区域，在侧支循环良好的情况下可维持。血栓长度>8 mm预示静脉溶栓后再通效果不佳。
