Identification of major ischemic change - Diffusion-weighted imaging versus computed tomography
Identification of major ischemic change - Diffusion-weighted imaging versus computed tomography
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DOI：
10.1161/01.str.30.10.2059
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发表时间：
1999-10-01
期刊：
影响因子：
8.3
通讯作者：
Davis, SM
中科院分区：
文献类型：
--
作者：
Barber, PA;Darby, DG;Davis, SM
背景和目的-不建议对近期出现重大梗死CT改变的患者进行溶栓治疗，这种改变被定义为涉及大脑中动脉区域>33%的衰减减少或脑水肿（欧洲急性卒中合作研究[ECASS]标准）。弥散加权成像（DWI）在检测急性缺血方面比CT更敏感，并且DWI、MR灌注成像和MR血管造影相结合可以提供单一信息的额外信息考试。我们试图确定 DWI 是否可以像 CT 一样识别超急性中风患者中严重缺血的存在和程度。方法 - 在症状出现 6 小时内对 17 名疑似半球中风患者进行 CT 和 DWI 研究。没有人接受溶栓治疗。扫描结果由 2 名神经放射科医生以盲法分别检查缺血性改变和脑水肿，分级为正常（MCA 区域的 33%）。中风的最终诊断是通过使用标准临床标准和第 90 天的 T2 加权成像来确定的。结果-17 名患者中有 16 名最终诊断为中风。所有 16 例 DWI 均观察到急性缺血性改变（敏感性 100%），16 例中有 12 例 CT 观察（敏感性 75%）。 DWI 在 CT 上识别出了所有 6 名严重缺血的患者，两种成像技术之间具有极好的一致性（kappa=0.88）。一名符合 ECASS CT 标准溶栓的患者在 DWI 上出现严重缺血。结论：DWI 在识别急性缺血方面比 CT 更敏感，并且比 CT 更容易显示严重缺血。
Background and Purpose-Thrombolytic therapy is not recommended in patients with CT changes of recent major infarction, which has been defined as reduced attenuation or cerebral edema involving >33% of the middle cerebral artery territory (European Cooperative Acute Stroke Study [ECASS] criteria).Diffusion-weighted imaging (DWI) is more sensitive than CT in detecting acute ischemia, and the combination of DWI, MR perfusion imaging, and MR angiography provides additional information from a single examination. We sought to determine whether DWI could identify the presence and extent of major ischemia as we:ll as CT in hyperacute stroke patients.Methods-Seventeen suspected hemispheric stroke patients were studied with both CT and DWI within 6 hours of symptom onset. None received thrombolytic therapy. The scans were examined separately by 2 neuroradiologists in a blinded fashion for ischemic change and cerebral edema, graded as normal, 33% of the MCA territory. Final diagnosis of stroke was determined with the use of standard clinical criteria and T2-weighted imaging at day 90,Results-Sixteen of 17 patients had a final diagnosis of stroke. Acute ischemic changes were seen in all 16 on DWI (100% sensitivity) and in 12 of 16 on CT (75% sensitivity). DWI identified all 6 patients with major ischemia on CT, with excellent agreement between the 2 imaging techniques (kappa=0.88). One patient eligible for thrombolysis on the ECASS CT criteria had major ischemia on DWI.Conclusions-DWI is more sensitive than CT in the identification of acute ischemia and can visualize major ischemia more easily than CT.