Rudkin Scott, Cerejo Russell, Tayal Ashis, Goldberg Michael F
Department of Radiology, Division of Neuroradiology, Allegheny Health Network, 320 E. North Ave, Pittsburgh, PA, 15212, USA.
Department of Neurology, Comprehensive Stroke Center, Allegheny Health Network, 320 E. North Ave, Pittsburgh, PA, 15212, USA.
Emerg Radiol. 2018 Dec;25(6):659-672. doi: 10.1007/s10140-018-1623-x. Epub 2018 Jul 6.
For decades, imaging has been a critical component of the diagnostic evaluation and management of patients suspected of acute ischemic stroke (AIS). With each new advance in the treatment of AIS, the role of imaging has expanded in scope, sophistication, and importance in selecting patients who stand to benefit from potential therapies. Although the field of stroke imaging has been evolving for many years, there have been several major recent changes. Most notably, in late 2017, the window for treatment expanded to 24 h from onset of stroke symptoms in selected patients. Furthermore, for those patients in expanded time windows, guidelines issued in early 2018 now recommend the use of "advanced" imaging techniques in the acute setting, including CT perfusion and MRI, to guide therapeutic decision-making. With these and other changes, the emergency radiologist must be prepared to handle a growing volume and complexity of AIS imaging. This article reviews the various imaging modalities and techniques employed in the imaging of AIS patients, with an emphasis on recommendations from recent randomized controlled trials and national consensus guidelines.
几十年来，影像学一直是疑似急性缺血性卒中（AIS）患者诊断评估和管理的关键组成部分。随着AIS治疗方面的每一项新进展，影像学在选择可能从潜在治疗中获益的患者方面的作用在范围、复杂性和重要性上都有所扩大。尽管卒中影像学领域多年来一直在发展，但最近有几个重大变化。最显著的是，2017年末，部分患者的治疗时间窗从卒中症状出现后延长至24小时。此外，对于那些处于延长时间窗的患者，2018年初发布的指南现在推荐在急性情况下使用“先进”的影像学技术，包括CT灌注成像和MRI，以指导治疗决策。随着这些以及其他变化，急诊放射科医生必须做好准备，应对日益增多且复杂的AIS影像学检查。本文回顾了用于AIS患者成像的各种成像模式和技术，重点介绍了近期随机对照试验和国家共识指南中的建议。
