Whitney Eric, Khan Yasir R, Alastra Anthony, Schiraldi Michael, Siddiqi Javed
Neurosurgery, Desert Regional Medical Center, Palm Springs, USA.
Neurosurgery, Redlands Community Hospital, Redlands, USA.
Cureus. 2020 Sep 23;12(9):e10616. doi: 10.7759/cureus.10616.
Mechanical thrombectomy (MT) for cerebral revascularization in acute stroke is now considered standard of care in select patients. Patients are assessed routinely after MT with CT scanning. The phenomenon of contrast staining is well documented in the literature and is posited to be related to increased blood-brain barrier (BBB) permeability of susceptible and/or infarcting brain tissue allowing angiographic contrast to be visualized outside the normal cerebral vasculature. In some cases, this can progress to include frank blood/contrast extravasation or even more seriously lead to intraparenchymal hemorrhage (IPH) with less favorable clinical outcomes. The relationship of this staining phenomenon and how it may have a cause or effect relationship with progression to hemorrhage is unclear. Many studies have been performed trying to better characterize this radiographic finding in terms of accurate diagnosis and potential for influencing prognosis. A literature review included a glaring lack of standardization in the application of terminology and quantitative/qualitative analysis. Dual energy CT (DECT) appears to be the best imaging modality to differentiate blood from contrast, but its application is limited since it is not as available as conventional CT. The possibility that risk factors are associated with progression of mixed density (blood and contrast) extravasations to frank IPH with resultant poorer outcomes is suggested in some studies. Overall, there remains a lack of consensus on how to best interpret this radiographic finding in altering any future stroke treatment(s). Recommendations of how to overcome this are postulated by the authors, which include standardization of terminology, progression toward more DECT use.
急性卒中时进行机械取栓术（MT）以实现脑血运重建，目前在特定患者中被视为标准治疗方法。MT术后患者会常规接受CT扫描评估。造影剂染色现象在文献中有充分记载，据推测这与易感和/或梗死脑组织的血脑屏障（BBB）通透性增加有关，使得血管造影剂能在正常脑血管系统外显影。在某些情况下，这种情况可能会发展为明显的血液/造影剂外渗，甚至更严重地导致脑实质内出血（IPH），临床预后较差。这种染色现象与出血进展之间的因果关系尚不清楚。许多研究试图从准确诊断和影响预后的可能性方面更好地描述这一影像学表现。文献综述显示，在术语应用以及定量/定性分析方面明显缺乏标准化。双能CT（DECT）似乎是区分血液和造影剂的最佳成像方式，但其应用有限，因为它不像传统CT那样普及。一些研究表明，危险因素可能与混合密度（血液和造影剂）外渗进展为明显的IPH并导致更差的预后有关。总体而言，对于如何最好地解读这一影像学表现以改变未来的卒中治疗，目前仍缺乏共识。作者提出了如何克服这一问题的建议，包括术语标准化，增加DECT的使用。
