Pham Jenny, Ng Felix C
Department of Radiology, Royal Melbourne Hospital, Parkville, VIC, Australia.
Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia.
Front Neurol. 2024 Jan 31;15:1321424. doi: 10.3389/fneur.2024.1321424. eCollection 2024.
Cerebral oedema following acute ischemic infarction has been correlated with poor functional outcomes and is the driving mechanism of malignant infarction. Measurements of midline shift and qualitative assessment for herniation are currently the main CT indicators for cerebral oedema but have limited sensitivity for small cortical infarcts and are typically a delayed sign. In contrast, diffusion-weighted (DWI) or T2-weighted magnetic resonance imaging (MRI) are highly sensitive but are significantly less accessible. Due to the need for early quantification of cerebral oedema, several novel imaging biomarkers have been proposed. Based on neuroanatomical shift secondary to space-occupying oedema, measures such as relative hemispheric volume and cerebrospinal fluid displacement are correlated with poor outcomes. In contrast, other imaging biometrics, such as net water uptake, T2 relaxometry and blood brain barrier permeability, reflect intrinsic tissue changes from the influx of fluid into the ischemic region. This review aims to discuss quantification of cerebral oedema using current and developing advanced imaging techniques, and their role in predicting clinical outcomes.
急性缺血性梗死后脑水肿与功能预后不良相关，是恶性梗死的驱动机制。目前，中线移位测量和脑疝的定性评估是脑水肿的主要CT指标，但对小皮质梗死的敏感性有限，且通常是延迟征象。相比之下，扩散加权（DWI）或T2加权磁共振成像（MRI）高度敏感，但可及性显著较低。由于需要对脑水肿进行早期量化，已提出了几种新型成像生物标志物。基于占位性水肿继发的神经解剖学移位，相对半球体积和脑脊液移位等测量指标与不良预后相关。相比之下，其他成像生物特征，如净水摄取、T2弛豫测量和血脑屏障通透性，反映了液体流入缺血区域引起的内在组织变化。本综述旨在讨论使用当前和正在发展的先进成像技术对脑水肿进行量化，以及它们在预测临床结果中的作用。
