Raymond Scott B, Schaefer Pamela W
Department of Radiology, Massachusetts General Hospital, Boston, MA.
Top Magn Reson Imaging. 2017 Apr;26(2):67-75. doi: 10.1097/RMR.0000000000000123.
Leptomeningeal collaterals provide the primary source of perfusion to ischemic brain tissue following the onset of acute ischemic stroke and are becoming an important imaging biomarker for stroke therapy triage. Collateral circulation is predictive of infarct growth, end infarct volume, and response to endovascular therapy. The strength of the collateral circulation varies among patients and is partially dependent on genetic and modifiable risk factors. Collateral circulation may be assessed by standard angiographic techniques, including digital subtraction angiography, computed tomography and magnetic resonance (MR) angiography, as well as a growing array of advanced MR techniques including arterial spin labeling and dynamic MR angiography. Simple scoring systems are used to estimate the relative strength of the collateral circulation for a given patient, although there are some discrepancies in the predictive value of these systems. In this review, we discuss methods and techniques for determining the robustness of the collateral circulation and the role of the collateral circulation in acute ischemic stroke assessment and triage.
软脑膜侧支循环是急性缺血性卒中发作后缺血脑组织灌注的主要来源，正成为卒中治疗分诊的重要影像生物标志物。侧支循环可预测梗死灶扩大、最终梗死体积以及血管内治疗反应。侧支循环的强度在患者之间存在差异，部分取决于遗传和可改变的危险因素。可通过标准血管造影技术评估侧支循环，包括数字减影血管造影、计算机断层扫描和磁共振（MR）血管造影，以及越来越多的先进MR技术，包括动脉自旋标记和动态MR血管造影。虽然这些系统的预测价值存在一些差异，但仍使用简单的评分系统来估计给定患者侧支循环的相对强度。在本综述中，我们讨论了确定侧支循环稳健性的方法和技术，以及侧支循环在急性缺血性卒中评估和分诊中的作用。
