Tissue Plasminogen Activator for Cortical Embolism Stroke with Magnetic Resonance Perfusion Imaging: A Report of Two Cases
Tissue Plasminogen Activator for Cortical Embolism Stroke with Magnetic Resonance Perfusion Imaging: A Report of Two Cases
复制标题
组织纤溶酶原激活剂治疗皮质栓塞中风的磁共振灌注成像：两例报告
DOI：
10.1159/000501547
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发表时间：
2019
影响因子：
0.7
通讯作者：
Koga Masatoshi
中科院分区：
文献类型：
--
作者：
Yi Kenichiro;Inoue Manabu;Irie Kenichi;Mizoguchi Tadataka;Miwa Kaori;Toyoda Kazunori;Koga Masatoshi
计算机断层扫描（CT）或磁共振成像（MRI）对于诊断急性缺血性卒中（AIS）患者是必不可少的，这些患者是重组组织纤溶酶原激活剂（rt-PA）治疗的候选者，但关于在高级成像（包括灌注成像）后适当选择治疗的进一步研究尚未完成。2018年美国心脏协会指南建议在rt-PA前不要进行过度耗时的成像。这里我们描述了两个病例，其中再灌注治疗是根据先进的影像学决定的。第一位病例是一位70岁的女性，主诉为完全失语和右侧单侧空间忽视。MRI示弥散加权像（DWI）未见明显高信号区，磁共振血管造影（MRA）未见大血管闭塞。随后的灌注加权图像（PWI）分析显示左侧大脑中动脉（MCA）区域出现单侧灌注缺陷。另一病例为88岁男性，主诉有轻微的单侧空间忽视，右眼共轭偏差和构音障碍。MRI DWI未见明显高信号区，MRA显示右中MCA轻度狭窄。随后的PWI分析显示右侧MCA区域单侧灌注不足。两例患者在诊断为AIS后均给予静脉rt-PA治疗，患者对再灌注治疗反应良好。当DWI进行得太早时，检测缺血性核心和区分中风和中风模拟的诊断有时是困难的。在这些病例中，可以快速评估急性病例的灌注异常。虽然rt-PA可以仅通过无出血的非对比CT给予，但对于需要再灌注治疗的难以诊断的患者，先进的成像可能是一种选择。
Computerized tomography (CT) or magnetic resonance imaging (MRI) is indispensable for diagnosing acute ischemic stroke (AIS) patients who are candidates for recombinant tissue plasminogen activator (rt-PA) therapies, but further investigation concerning appropriate selection of therapy following advanced imaging including perfusion imaging has not yet been done. The 2018 AHA guidelines have recommended not to perform excessive time-consuming imaging before rt-PA. Here we describe two cases in which reperfusion therapy was decided based on advanced imaging. The first case was a 70-year-old woman with complaints of total aphasia and right unilateral spatial neglect. Her MRI revealed no apparent high signal area in diffusion-weighted image (DWI), and her magnetic resonance angiography (MRA) showed no large vessel occlusion. Subsequent perfusion-weighted image (PWI) analysis showed a unilateral perfusion deficit in the left middle cerebral artery (MCA) region. The other case was an 88-year-old man with complaints of minor unilateral spatial neglect, right conjugate deviation of the eyes, and dysarthria. His MRI also revealed no apparent high signal area in DWI, and MRA showed slight stenosis in the right middle MCA. Subsequent PWI analysis showed a unilateral perfusion deficit in the right MCA region. In both cases, intravenous rt-PA therapy was administered after the diagnosis of AIS and the patients responded well to the reperfusion therapy. When DWI is performed too early, detecting the ischemic core and differentiating between a diagnosis of stroke and stroke mimics is sometimes difficult. Evaluation of perfusion abnormalities in acute cases can be performed quickly, as shown in these cases. Although rt-PA can be given just by non-contrast CT with no hemorrhage, advanced imaging may be an option to identify difficult-to-diagnose patients who require reperfusion therapy.