Lin Michelle P, Liebeskind David S
Continuum (Minneap Minn). 2016 Oct;22(5, Neuroimaging):1399-1423. doi: 10.1212/CON.0000000000000376.
This article provides an overview of cerebrovascular hemodynamics, acute stroke pathophysiology, and collateral circulation, which are pivotal in the modern imaging of ischemic stroke that guides the care of the patient with stroke.
Neuroimaging provides extensive information on the brain and vascular health. Multimodal CT and MRI delineate the hemodynamics of ischemic stroke that may be used to guide treatment decisions and prognosticate regarding expected outcomes. Mismatch imaging with either CT or MRI may identify patients with salvageable regions who are at risk and likely to benefit from reperfusion therapy, even if they are outside the standard time window. Imaging of collateral circulation and determination of collateral grade may predict greater reperfusion, lower hemorrhage risk, and better functional outcome. Current neuroimaging technology also enables the identification of patients at high risk of hemorrhagic transformation or those who may be harmed by treatment or unlikely to benefit from it.
This article reviews the use and impact of imaging for the patient with ischemic stroke, emphasizing how imaging builds upon clinical evaluation to establish diagnosis or etiology, reveal key pathophysiology, and guide therapeutic decisions.
本文概述了脑血管血流动力学、急性卒中病理生理学和侧支循环，这些在缺血性卒中的现代影像学中至关重要，可指导卒中患者的治疗。
神经影像学提供了有关大脑和血管健康的广泛信息。多模态CT和MRI描绘了缺血性卒中的血流动力学，可用于指导治疗决策并预测预期结果。CT或MRI的不匹配成像可识别出有可挽救区域、有风险且可能从再灌注治疗中获益的患者，即使他们超出了标准时间窗。侧支循环成像和侧支分级的确定可预测更大程度的再灌注、更低的出血风险和更好的功能结局。当前的神经影像学技术还能够识别出血性转化高风险患者或那些可能因治疗而受到伤害或不太可能从治疗中获益的患者。
本文回顾了影像学对缺血性卒中患者的应用及影响，强调了影像学如何基于临床评估来确立诊断或病因、揭示关键病理生理学并指导治疗决策。
