Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland.
Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland.
Eur J Radiol. 2017 Nov;96:153-161. doi: 10.1016/j.ejrad.2016.10.026. Epub 2016 Oct 26.
Acute stroke has become an increasingly treatable cause of acute neurological deficits. Indeed, over the last two decades, the introduction of first thrombolysis, and now thrombectomy has improved patient outcomes and extended the therapeutic window. Computed tomography has been established as the most simple and readily available technique for the diagnosis and management of patients with acute stroke. Indeed, CT allows easy confirmation or exclusion of acute hemorrhage on the one hand, and on the other hand the early signs are quite reliable in the detection of ischemia. In the early phase the clot can be seen as well as exchanges related to early changes in water concentration in ischemia and the surrounding penumbra. Additional techniques such as angio-CT show the location of the clot and perfusion techniques reveal local hemodynamics as well as potential tissue viability. Newer techniques such as double energy CT and late phase CT should provide information on collateral flow as well as on the presence of early hemorrhagic transformation. All these techniques should thus make available new information on tissue viability,that is indispensable in the choice of revascularization technique. Thus CT techniques allow a quick and reliable triage as well as a finer characterization of the ischemic process. The use of all these CT techniques in an optimal way should help improve patient triage and selection of the most adequate treatment with further improvements in clinical outcomes as a result.
急性脑卒中已成为急性神经功能缺损越来越可治疗的原因。事实上，在过去的二十年中，溶栓治疗的引入，现在的取栓治疗已经改善了患者的预后并延长了治疗窗口。计算机断层扫描（CT）已被确立为诊断和管理急性脑卒中患者的最简便、最易获得的技术。事实上，CT 一方面可以方便地确认或排除急性出血，另一方面，在检测缺血方面早期征象相当可靠。在早期阶段，可以看到血栓以及与缺血和周围半影中水浓度早期变化相关的交换。如血管 CT 等其他技术可以显示血栓的位置，灌注技术可以显示局部血液动力学以及潜在的组织活力。诸如双能量 CT 和晚期 CT 等新技术应提供有关侧支循环以及早期出血性转化存在的信息。所有这些技术都应该为组织活力提供新的信息，这对于选择血管再通技术是必不可少的。因此，CT 技术可以快速、可靠地进行分诊，并更精确地描述缺血过程。以最佳方式使用所有这些 CT 技术应该有助于改善患者的分诊和选择最合适的治疗方法，从而进一步改善临床结果。
