Piliszek Agnieszka, Witkowski Grzegorz, Sklinda Katarzyna, Szary Cezary, Ryglewicz Danuta, Dorobek Małgorzata, Walecki Jerzy
Diagnostic Radiology Department, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
1st Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.
Neurol Neurochir Pol. 2016 Jul-Aug;50(4):241-50. doi: 10.1016/j.pjnns.2016.04.009. Epub 2016 Apr 27.
Stroke is the third cause of death worldwide. In recent decade there has been a marked progress in treatment and prevention of stroke, which was possible largely due to modern neuroimaging techniques. Early radiological confirmation of the diagnosis allows for introduction of fibrinolytic therapy and evaluation of ischaemic penumbra.
We have analysed clinical and imaging data of 92 patients with early stages of stroke. The sensitivity, specificity and possible influence on the choice of treatment were assessed for different neuroimaging techniques, including diffusion weighted and perfusion imaging in patients with hyperacute and acute stroke.
A non-contrast computed tomography (CT) allowed for the detection of early ischaemic changes with an overall sensitivity of 38% and 42% in patients in hyperacute phase. In a perfusion CT study the perfusion abnormalities in the area corresponding to the clinical symptoms were present in 79% of patients. The sensitivity of diffusion weighted imaging (DWI) alone was 95% and in conjunction with perfusion MR reached 100%.
Our study proves that advanced neuroimaging modalities allow for a substantial increase of sensitivity when detecting changes in patients with acute ischaemic strokes and confirming the clinical diagnosis. We believe that MR in combination with DWI should be the imaging methods of choice in diagnosing acute stroke patients. Perfusion adds significant diagnostic value to structural techniques, particularly in clinically ambiguous cases. In cases with a clear clinical picture the data provided by a non-contrast CT study is sufficient for therapeutic decision making.
中风是全球第三大致死原因。近十年来，中风的治疗和预防取得了显著进展，这在很大程度上得益于现代神经成像技术。早期通过影像学确诊可使纤维蛋白溶解疗法得以应用，并能对缺血半暗带进行评估。
我们分析了92例中风早期患者的临床和影像数据。对不同神经成像技术的敏感性、特异性及其对治疗选择的可能影响进行了评估，这些技术包括超急性和急性中风患者的弥散加权成像和灌注成像。
非增强计算机断层扫描（CT）能够检测到早期缺血性改变，在超急性期患者中的总体敏感性为38%，在急性期患者中为42%。在灌注CT研究中，79%的患者在与临床症状相对应的区域出现灌注异常。单纯弥散加权成像（DWI）的敏感性为95%，与灌注磁共振成像联合使用时达到100%。
我们的研究证明，先进的神经成像方式在检测急性缺血性中风患者的变化并确认临床诊断时，能显著提高敏感性。我们认为，磁共振成像与DWI联合应是诊断急性中风患者的首选成像方法。灌注为结构成像技术增加了重要的诊断价值，尤其是在临床情况不明确的病例中。在临床表现明确的病例中，非增强CT研究提供的数据足以用于治疗决策。
