Continuum (Minneap Minn). 2023 Feb 1;29(1):54-72. doi: 10.1212/CON.0000000000001185.
This article describes imaging modalities used in the evaluation of patients presenting with symptoms of acute ischemic stroke.
The year 2015 marked the beginning of a new era in acute stroke care with the widespread adoption of mechanical thrombectomy. Subsequent randomized controlled trials in 2017 and 2018 brought the stroke community even further into this new territory with the expansion of the eligibility window for thrombectomy using imaging-based patient selection, which led to an increase in the use of perfusion imaging. Now, after several years of routine use, the debate is ongoing as to when this additional imaging is truly required and when it results in unnecessary delays in time-sensitive stroke care. At this time, more than ever, a robust understanding of neuroimaging techniques, applications, and interpretation is essential for the practicing neurologist.
CT-based imaging is the first step in most centers for the evaluation of patients presenting with symptoms of acute stroke because of its wide availability, speed, and safety. Noncontrast head CT alone is sufficient for IV thrombolysis decision making. CT angiography is very sensitive for the detection of large-vessel occlusion and can be used reliably to make this determination. Advanced imaging including multiphase CT angiography, CT perfusion, MRI, and MR perfusion can provide additional information useful for therapeutic decision making in specific clinical scenarios. In all cases, it is essential that neuroimaging be performed and interpreted rapidly to allow for timely reperfusion therapy.
本文介绍了用于评估出现急性缺血性脑卒中症状患者的影像学检查方法。
2015 年，随着机械取栓术的广泛应用，急性脑卒中治疗进入了一个新纪元。2017 年和 2018 年的后续随机对照试验，通过基于影像学的患者选择扩大了取栓的适应证窗口，进一步将卒中领域引入了这一新领域，这导致灌注成像的应用增加。经过几年的常规应用，目前的争论焦点是何时真正需要这种额外的影像学检查，以及何时会导致对时间敏感的卒中治疗不必要的延误。此时，对于从事神经科工作的医生来说，比以往任何时候都更需要深入了解神经影像学技术、应用和解读。
由于 CT 具有广泛的可用性、快速性和安全性，因此在大多数中心，CT 检查是评估出现急性脑卒中症状患者的第一步。单纯头部 CT 平扫足以用于 IV 溶栓决策。CT 血管造影对大血管闭塞的检测非常敏感，可用于可靠地做出这一判断。多相 CT 血管造影、CT 灌注、MRI 和 MR 灌注等高级影像学检查可以为特定临床情况下的治疗决策提供有用的信息。在所有情况下，都必须快速进行神经影像学检查和解读，以实现及时的再灌注治疗。
