Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California.
Neurosurgery. 2019 Jul 1;85(suppl_1):S23-S30. doi: 10.1093/neuros/nyz068.
Advances in neuroimaging in the last 2 decades have revolutionized the management of acute ischemic stroke (AIS). Here we review the development of computed tomography (CT) and magnetic resonance imaging (MRI) modalities used to guide treatment of patients with AIS characterized by large vessel occlusion. In particular, we highlight recent randomized trials and their patient selection methodologies to detail the progression of these selection paradigms. With advanced imaging, distinction between at-risk penumbra and ischemic core in AIS may be performed using either CT or MRI. While limitations exist for methodologies to quantify core and penumbra, commercially available fully automated software packages provide useful information to guide treatment decisions. Randomized controlled trials implementing perfusion imaging to patient selection algorithms have demonstrated marked success in improving functional outcomes in patients with large vessel occlusions. As such, imaging has become a vital aspect of AIS treatment in selecting patients who may benefit from mechanical thrombectomy.
在过去的 20 年中，神经影像学的进展彻底改变了急性缺血性脑卒中（AIS）的治疗管理方式。在这里，我们回顾了用于指导大血管闭塞性 AIS 患者治疗的计算机断层扫描（CT）和磁共振成像（MRI）技术的发展。特别是，我们强调了最近的随机试验及其患者选择方法，以详细说明这些选择范式的进展。通过先进的影像学，可以使用 CT 或 MRI 来区分 AIS 中的缺血半暗带和缺血核心。虽然用于量化核心和半暗带的方法存在局限性，但商业化的全自动软件包提供了有用的信息来指导治疗决策。实施灌注成像患者选择算法的随机对照试验已证明在改善大血管闭塞患者的功能结局方面取得了显著成功。因此，影像学已成为 AIS 治疗中选择可能从机械取栓中获益的患者的重要方面。
