1 Stroke & Ageing Research (STARC), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.
2 Diagnostic Imaging, Monash Health, The Royal Melbourne Hospital and the University of Melbourne, Parkville, VIC, Australia.
Int J Stroke. 2018 Apr;13(3):277-284. doi: 10.1177/1747493017743056. Epub 2017 Nov 15.
It has been 40 years since the ischemic penumbra was first conceptualized through work on animal models. The topography of penumbra has been portrayed as an infarcted core surrounded by penumbral tissue and an extreme rim of oligemic tissue. This picture has been used in many review articles and textbooks before the advent of modern imaging. In this paper, we review our understanding of the topography of the ischemic penumbra from the initial experimental animal models to current developments with neuroimaging which have helped to further define the temporal and spatial evolution of the penumbra and refine our knowledge. The concept of the penumbra has been successfully applied in clinical trials of endovascular therapies with a time window as long as 24 h from onset. Further, there are reports of "good" outcome even in patients with a large ischemic core. This latter observation of good outcome despite having a large core requires an understanding of the topography of the penumbra and the function of the infarcted regions. It is proposed that future research in this area takes departure from a time-dependent approach to a more individualized tissue and location-based approach.
自通过动物模型首次提出缺血半影区概念以来，已经过去了 40 年。半影区的拓扑结构被描绘为梗死核心周围环绕着半影组织和极边缘的低灌注组织。在现代成像技术出现之前，这种图像已被广泛用于许多综述文章和教科书中。在本文中，我们回顾了从最初的实验动物模型到当前神经影像学发展的过程中对半影区拓扑结构的理解，这些发展有助于进一步定义半影区的时空演变，并完善我们的知识。半影区的概念已成功应用于血管内治疗的临床试验中，其时间窗长达发病后 24 小时。此外，还有报道称即使在有大的缺血核心的患者中也能获得“良好”的结果。尽管存在大的核心，但仍观察到良好的结果，这需要对半影区的拓扑结构和梗死区域的功能有一个理解。有人建议，该领域的未来研究从基于时间的方法转变为更基于个体化组织和位置的方法。
