von Kummer R, Meyding-Lamadé U, Forsting M, Rosin L, Rieke K, Hacke W, Sartor K
Department of Neuroradiology, University of Heidelberg, Germany.
AJNR Am J Neuroradiol. 1994 Jan;15(1):9-15; discussion 16-8.
To investigate the incidence and prognostic value of local brain swelling, the extent of parenchymal hypodensity, and the hyperdense middle cerebral artery sign as shown by CT within the first 5 hours after the onset of symptoms in patients with angiographically proved middle cerebral artery trunk occlusions.
Fifty-three patients were studied prospectively with CT 46 to 292 minutes (median, 120; mean, 134 +/- 59) after symptom onset and scored clinically at admission and 4 weeks later. All patients were treated with recombinant tissue plasminogen activator (30 to 100 mg).
Early CT showed parenchymal hypodensity in 43 patients (81%), local brain swelling in 20 patients (38%), and hyperdensity of the middle cerebral artery trunk in 25 patients (47%). Hypodensity covering more than 50% of the middle cerebral artery territory had an 85%, local brain swelling a 70%, and the hyperdense middle cerebral artery sign a 32% positive predictive value for fatal clinical outcome. Specificity of these findings for fatal outcome was 94%, 83%, and 51%, respectively, and sensitivity was 61%, 78% and 44%, respectively.
Early CT in acute middle cerebral artery trunk occlusion is highly predictive for fatal clinical outcome if there is extended hypodensity or local brain swelling despite aggressive therapeutic attempts such as thrombolysis or decompressive surgery.
研究经血管造影证实大脑中动脉主干闭塞的患者在症状发作后5小时内CT所示的局部脑肿胀、实质低密度范围及大脑中动脉高密度征的发生率和预后价值。
对53例患者在症状发作后46至292分钟（中位数为120分钟；平均为134±59分钟）进行前瞻性CT检查，并在入院时及4周后进行临床评分。所有患者均接受重组组织型纤溶酶原激活剂（30至100毫克）治疗。
早期CT显示43例患者（81%）有实质低密度，20例患者（38%）有局部脑肿胀，25例患者（47%）有大脑中动脉主干高密度。大脑中动脉供血区低密度超过50%、局部脑肿胀及大脑中动脉高密度征对致命临床结局的阳性预测值分别为85%、70%和32%。这些发现对致命结局的特异性分别为94%、83%和51%，敏感性分别为61%、78%和44%。
在急性大脑中动脉主干闭塞中，即使进行了积极的治疗尝试，如溶栓或减压手术，若早期CT显示有广泛低密度或局部脑肿胀，则对致命临床结局具有高度预测性。
