Evaluation of the hyperintense acute reperfusion marker for the detection of ischemia in anterior and posterior circulation in patients with transient ischemic /neurological attack

高信号急性再灌注标志物对短暂性脑缺血/神经性发作患者前后循环缺血检测的评价

• 批准号: 376468892
• 负责人: Privatdozent Dr. Alex Förster
• 金额: --
• 依托单位: Abteilung für Neuroradiologie
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2017
• 资助国家: 德国
• 起止时间: 2016-12-31 至 2020-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/376468892?language=en
• 关键词: Evaluation; hyperintense; acute; reperfusion; marker

In the present research project we aim to evaluate the incidence of the hyperintense acute reperfusion marker (HARM) in patients with transient ischemic attack (TIA) or transient neurological attack (TNA). Initially, HARM was described after acute ischemic stroke and is caused by impairment of the blood-brain barrier after recanalization of an acute vessel occlusion and consecutive reperfusion. Disruption of the blood-brain barrier results in the accumulation of contrast agent in the subarachnoid space, which can be demonstrated superbly on fluid attenuated inversion recovery (FLAIR) images.Transient ischemic attacks are defined as a transient focal neurological deficit with a likely cerebrovascular cause. In contrast to this, transient neurological attacks are defined as a transient non-focal neurological deficit with various etiologies, which however also include cerebrovascular causes. The clinical diagnosis of a TIA is often incorrect and the differentiation of TIA and TNA can also be difficult. The MRI is the most important diagnostic procedure for the detection or exclusion of acute cerebral ischemia in patients with TIA/TNA. Acute ischemic lesions can be detected in approximately two thirds of all TIA cases and only in about one-fifth of TNA cases on diffusion-weighted imaging (DWI). Additional perfusion-weighted imaging (PWI) can only slightly increase this proportion. The hyperintense acute reperfusion marker could be complementary to DWI and PWI and could reduce the existing diagnostic gap. In particular, in the case of a TNA this could be of major clinical relevance, in order to avoid mistreatment or even dismissal without further diagnostic testing after unremarkable MRI.Therefore, the aim of this study is to evaluate the incidence of HARM in a statistically relevant number of patients with TIA and TNA and to investigate associations with symptom duration and anatomical localization. In addition, the dynamics of contrast agent accumulation in the subarachnoid space in the case of HARM will be analyzed in detail.

在本研究项目中，我们的目的是评估高信号急性再灌注标志物（HARM）在短暂性脑缺血发作（TIA）或短暂性神经系统发作（TNA）患者中的发生率。最初，HARM被描述为急性缺血性卒中后，由急性血管闭塞再通和连续再灌注后血脑屏障受损引起。血脑屏障的破坏导致造影剂在蛛网膜下腔的积聚，这可以在液体衰减反转恢复（FLAIR）图像上得到很好的显示。短暂性脑缺血发作被定义为可能由脑血管原因引起的短暂性局灶性神经功能缺损。与此相反，短暂性神经系统发作被定义为具有各种病因的短暂性非局灶性神经功能缺损，但也包括脑血管原因。TIA的临床诊断通常是不正确的，TIA和TNA的鉴别也很困难。MRI是检测或排除TIA/TNA患者急性脑缺血的最重要的诊断程序。急性缺血性病变可以检测到约三分之二的TIA病例，只有约五分之一的TNA病例的扩散加权成像（DWI）。额外的灌注加权成像（PWI）只能略微增加这一比例。高信号急性再灌注标志物可作为DWI和PWI的补充，并可缩小现有的诊断差距。特别是，在TNA的情况下，这可能是主要的临床相关性，以避免治疗不当，甚至解雇后，没有进一步的诊断测试不显着的MRI。因此，本研究的目的是评估统计相关数量的TIA和TNA患者的HARM的发生率，并调查与症状持续时间和解剖定位的关联。此外，还将详细分析HARM情况下蛛网膜下腔中造影剂积聚的动力学。