Wu Xiujuan, Luo Song, Wang Ying, Chen Yang, Liu Jun, Bai Jing, Feng Jiachun, Zhang Hongliang
Neuroscience Center, Department of Neurology, The First Hospital of Jilin University Department of Neurosurgery, the Second Hospital of Jilin University, Jilin University, Changchun, China.
Medicine (Baltimore). 2017 Feb;96(6):e6091. doi: 10.1097/MD.0000000000006091.
The ischemic penumbra assessment is essential for the subsequent therapy and prediction of evolution in patients with acute ischemic infraction. Although controversial as a perfect equivalence to penumbra, perfusion-weighted imaging (PWI)-diffusion-weighted imaging (DWI) mismatch may predict the response to thrombolysis. Due to the reliance of PWI on contrast agents, noninvasive alternatives remain an unmet need.
We reported a 65-year-old man complained of paroxysmal hemiplegia of his right limbs and anepia for 2 days, whereas the symptoms lasted for about 12 hours when he admitted to the hospital.
We diagnosed it as acute ischemic stroke caused by the left middle cerebral artery stenosis.
Susceptibility-weighted imaging (SWI), multimodal magnetic resonance imaging (MRI) work-up which includes conventional MRI sequences (T1WI, T2WI, and FLAIR), DWI, PWI.
His DWI-SWI mismatch was comparable to that of DWI-PWI at admission, suggesting that DWI-SWI could predict ischemic penumbra in patient with acute infarction. He refused the digital subtraction angiography examination or stenting, and he was treated with aspirin, atorvastain, and supportive treatment. The patient received a reexamination of the conventional MRI and SWI 11 days later. Expansion of the infarction in the affected MCA territory resulted from the penumbra indicated by the mismatch between DWI-SWI.
SWI can be used as a noninvasive alternative to evaluate the ischemic penumbra. Besides, SWI can provide perfusion information comparable to PWI and SWI is sufficient to identify occlusive arteries.
缺血半暗带评估对于急性缺血性梗死患者的后续治疗及病情演变预测至关重要。尽管灌注加权成像（PWI）与扩散加权成像（DWI）不匹配作为与半暗带的完美等效指标存在争议，但它可能预测溶栓反应。由于PWI依赖于对比剂，无创替代方法仍未得到满足。
我们报告了一名65岁男性，他抱怨右肢阵发性偏瘫和失语2天，而入院时症状持续约12小时。
我们诊断为左大脑中动脉狭窄所致急性缺血性卒中。
采用磁敏感加权成像（SWI）、多模态磁共振成像（MRI）检查，包括传统MRI序列（T1WI、T2WI和FLAIR）、DWI、PWI。
入院时他的DWI-SWI不匹配与DWI-PWI相当，表明DWI-SWI可预测急性梗死患者的缺血半暗带。他拒绝了数字减影血管造影检查或支架置入，接受了阿司匹林、阿托伐他汀及支持治疗。11天后患者接受了传统MRI和SWI复查。DWI-SWI不匹配所提示的半暗带导致了患侧大脑中动脉供血区梗死范围扩大。
SWI可作为评估缺血半暗带的无创替代方法。此外，SWI可提供与PWI相当的灌注信息，且SWI足以识别闭塞动脉。
