Warach S, Dashe J F, Edelman R R
Department of Neurology, Beth Israel Hospital, Harvard Medical School, Boston, Massachusetts 02215, USA.
J Cereb Blood Flow Metab. 1996 Jan;16(1):53-9. doi: 10.1097/00004647-199601000-00006.
Perfusion and diffusion-weighted magnetic resonance imaging (MRI) can demonstrate, respectively, cerebral ischemia and ischemic brain injury in the first several hours after onset of symptoms, when proton density and T2-weighted MRI may appear normal. It is hypothesized that these techniques could distinguish regions destined for infarction from those that will not progress to infarction. We provide preliminary evidence from an analysis of 19 patients with severely disabling clinical deficits attributable to ischemia in at least an entire division of the middle cerebral artery, that initial perfusion and diffusion MRI were more accurate than conventional MRI in predicting no, partial or complete improvement--17 of 19 cases (p < 0.0001) versus 10 of 19 cases, respectively. In the subset of patients studied within 6 h of onset, diffusion/perfusion MRI was an even better predictor than conventional MRI--11 of 12 versus four of 12, respectively. In this small sample of patients with severe clinical deficits, perfusion and diffusion MRI were highly accurate in distinguishing those who would improve from those who would not. These results need to be confirmed in a larger prospective study, which may support a future role in the initial screening, selection, and evaluation of patients with stroke for acute pharmacologic interventions.
灌注加权磁共振成像（MRI）和弥散加权磁共振成像在症状出现后的最初几个小时内，可分别显示脑缺血和缺血性脑损伤，此时质子密度加权磁共振成像和T2加权磁共振成像可能显示正常。据推测，这些技术能够区分注定会发生梗死的区域和不会进展为梗死的区域。我们对19例因至少大脑中动脉一个完整分支缺血而导致严重致残性临床缺陷的患者进行分析，得出初步证据，即初始灌注加权磁共振成像和弥散加权磁共振成像在预测无改善、部分改善或完全改善方面比传统磁共振成像更准确——分别为19例中的17例（p < 0.0001）和19例中的10例。在发病6小时内接受研究的患者亚组中，弥散/灌注加权磁共振成像比传统磁共振成像更是一个更好的预测指标——分别为12例中的11例和12例中的4例。在这个患有严重临床缺陷的小样本患者中，灌注加权磁共振成像和弥散加权磁共振成像在区分哪些患者会改善和哪些患者不会改善方面非常准确。这些结果需要在更大规模的前瞻性研究中得到证实，这可能会支持其在对中风患者进行急性药物干预的初始筛查、选择和评估中发挥未来作用。
