多模式MRI指导的超急性期缺血性脑卒中静脉溶栓治疗

2008

磁共振多模式快速成像指导缺血性脑卒中溶栓八例 [其它论文] -中华神经科杂志2008

2.0.TX;2-J.aspx'>Treatment of acute ischemic stroke [其它论文] 2000

Extending the time window for thrombolysis:evidence from acute stroke trials 2005

The evolving role of acute stroke imaging in intravenous thrombolytic therapy:patient selection and outcomes assessment 2005

Schellinger PD.Thomalla G.Fiehler J MRI-basod and CTbased thrombolytic therapy in acute stroke within and beyond established time windows:an analysis of 1210 patients [其它论文] 2007

卫生部疾病控制司.中华医学会神经科学会 中国脑血管病防治指南 2005

Thomalla G.Schwark C.Sobesky J Outeome and symptomatic bleeding complications of intravenous thrombolysis within 6 hours in MRI-selected stroke patients:comparison of a german multicenter study with the pooled data of ATLANTIS,ECASS and NINDS rt-PA trials [其它论文] 2006

Warach S.Dashe JF.Edelman RR Clinical outcome in iachemic stroke predicted by early diffusion-weighted and perfusion magnetic resonance imaging:a preliminary analysis 1996

Barber PA.Darby DG.Desmond PM Prediction of stroke outcome with echoplanar perfusion-and diffusion-weighted MRL 1998

薛静.高培毅.林燕 MR血管成像在急性缺血性脑卒中溶栓治疗中的价值 [其它论文] -中华放射学杂志2008

Donnan GA.Howells DW.Markus R Can the time window for administration of thrombolyties in stroke be increased? 2003

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急性缺血性脑卒中的动脉内溶栓治疗

本文对急性缺血性脑卒中动脉内溶栓治疗的历史与现状,溶栓治疗时机,临床研究进展包括适应证、禁忌证、操作技术、用药、并发症、疗效评价等方面进行综合回顾.     

MRI在中青年缺血性脑卒中rt-PA静脉溶栓治疗中的价值

目的:探讨MRI在中青年缺血性脑卒中静脉溶栓治疗前后的价值.方法:83例中青年缺血性脑卒中患者均在MRI指导下行rt-PA静脉溶栓治疗,记录患者治疗前后颅内动脉狭窄评分、神经功能缺损评分(NIHSS评分)、生活质量评分(BI评分)及功能恢复评分(mRS评分),并进行统计学分析.结果:83例患者治疗后颅内动脉狭窄评分、NIHSS评分、BI评分及mRS评分均较治疗前明显好转,溶栓治疗前后差异有统计学意义(P<0.05);发病在12h内不同时间段(≤4.5h和>4.5h)的脑梗死患者行静脉溶栓治疗前后NIHSS评分差异无统计学意义(P>0.05).结论:MRI指导的中青年脑梗死静脉溶栓治疗安全有效,≤4.5h和4.5~12.0h脑梗死患者在MRI界定下具有相同的组织窗时疗效差异无统计学意义.准确而及时的MRI评估在缺血性脑卒中患者治疗中起着重要的指导作用.     

多模式MRI指导下动脉溶栓治疗急性缺血性脑卒中

目的:评价发病4.5～9h、MRI上有PWI/DWI不匹配、且MRA有责任血管闭塞或重度狭窄的急性缺血性卒中患者动脉溶栓(IAT)的疗效及安全性。方法:回顾性分析发病4.5～9h、MRI上有PWI/DWI不匹配、且有责任血管闭塞或重度狭窄的急性缺血性卒中患者48例,分为IAT组22例及对照组26例,比较其症状性出血率及3个月mRS。结果:IAT组与对照组症状性出血率为9.1%(2/22)与3.8%(1/26),P=0.454。IAT组结局良好,3个月mRS 0～2者占59.1%(13/22),多于对照组30.8%(8/26),P=0.049。结论:对于时间窗为4.5～9h、MRI上有PWI/DWI不匹配、且MRA上有责任血管闭塞或重度狭窄的急性缺血性卒中患者,组织型纤溶酶原激活剂(rt-PA)IAT可提高血管再通率,改善预后。     

造影增强MR血管成像对急性缺血性中风患者血管状况的评估价值

目的:探讨CE-MRA在急性缺血性中风患者血管状况评估中的可行性。方法:27例大脑中动脉供血区急性缺血性中风患者在发病后6h内进行了TOF-MRA和CE-MRA检查,根据随访结果,对TOF-MRA和CE-MRA在急性缺血性中风患者血管状况的评估价值进行了对比分析。结果:①在27例患者中,有11例患者在TOF-MRA上表现为大脑中动脉完全闭塞而在CE-MRA上仍可见残余血流,随访结果与CE-MRA结果一致;②CE-MRA的扫描时间明显短于TOF-MRA;③CE-MRA可以在不增加扫描时间的情况下对颈部动脉和颅内动脉同时成像。结论:CE-MRA能够及时、准确地对急性缺血性中风患者血管状况进行评估,优于常规的TOF-MRA,由于急性缺血性中风患者需要紧急处理,在应用MR评估血管状况时CE-MRA应为首选。     

MR高分辨血管壁成像技术在预测缺血性脑卒中中的应用价值

目的:利用3.0 T MR高分辨血管壁成像(HRVWI)技术分析缺血性脑卒中(IS)患者颅内动脉斑块T2WI序列和增强扫描的信号特征及其与IS之间的关系.方法:回顾性分析42例IS患者的HRVWI资料,T2WI序列斑块信号强度按高、等低分2个等级;增强扫描强化程度分为无强化、轻度强化和明显强化3个等级.根据DWI上是否...     

MR磁敏感成像技术在脑部血管性病变中的应用

目的探讨MR磁敏感成像（SWI）技术在脑部血管性病变中的应用价值。方法搜集23例脑血管性病变患者，其中海绵状血管瘤7例，静脉血管畸形4例，小动静脉畸形（AVM）3例，Sturge-Weber综合征1例，静脉窦血栓形成2例及陈旧性脑梗死6例。行T1WI、T2WI、SWI序列及增强T1WI和MR血管成像（MRA）检查，计算病灶与正常对照区的校正相位值（CP），评价SWI与其他序列及MRA在显示血管性病变细节的优越性。结果病灶与正常对照区的CP值分别为-0．112±0．032及-0．013±0．004，差异有统计学意义（t=2．167，P〈0．05）。7例海绵状血管瘤，SWI能鉴别出血与血管瘤体，发现更多的小出血灶。4例静脉血管畸形，SWI能发现更多细小的髓静脉向粗大的引流静脉集中。3例小AVM，SWI较MRA更好地显示小供血动脉。1例Sturge-Weber综合征，SWI可清晰显示钙化及脑表面异常的静脉血管网。2例静脉窦血栓形成，SWI可清晰地显示深部引流静脉及脑表面静脉网广泛增粗扩张迂曲，其中1例能发现早期脑出血灶。6例陈旧性脑梗死，SWI可更好地显示病变内陈旧性出血。结论SWI对低流量血管畸形及血管瘤、多发细小出血的显示、静脉窦血栓形成后深部静脉的扩张及早期并发出血以及脑梗死并发出血等具有常规MRI及MRA检查无可比拟的优越性，并能提供病变与正常组织的相位对比改变。     

磁共振血管成像在脑血管病中的诊断价值

目的:探讨三维时间飞跃法MR血管成像(3D TOF MRA)和三维增强MR血管造影(3D CE-MRA)检查技术,评价两种方法对脑血管病的诊断价值。方法:磁共振血管成像检查150例,全部行3D TOF MRA检查;9例进行3D CE-MRA检查,钆对比剂(Gd-DTPA)0.2mmol/kg,注射流率3ml/s,增强前、增强后动脉期及静脉期3次扫描;所有MRA图像进行三维重建,同期12例行DSA检查。常规MRI包括横断面T1WI、T2WI,矢状面T1WI。结果:56例中颅内血管显示正常56例,颅内动脉狭窄或闭塞者46例,颅内动脉瘤22例,颅内动静脉畸形21例,颈内动脉海绵窦瘘3例,烟雾病(moyamoya dis-ease)2例。结论:3D TOF MRA和3D CE-MRA是无创、快速、有效的检查技术,对诊断脑血管病有较高的价值,结合原始图像和常规MRI检查,一次检查即能为临床提供较为全面的信息,可作为脑血管病的筛选和首选诊断方法。     

磁共振血管成像在脑血管疾病中的诊断价值

目的：探讨磁共振血管成像（MRA）技术在脑血管疾病中的诊断价值。方法：对23例脑血管疾病患者进行影像分析。结果：经MRA证实脑梗塞10例；动静脉畸形（AVM）2例，动脉瘤5例；脑肿瘤3例；椎动脉供血不足2例；烟雾病1例。结论：在不同血管疾病中适当地选择应用MRA不同成像技术，可以提高对各种脑血管疾病评价的准确性和诊断价值。     

MR灌注加权成像在缺血性脑血管病中的应用价值

MR灌注加权成像可以反映组织的微血管结构和血流灌注情况,提供血流动力学方面多参数的信息,对早期诊断和治疗缺血性脑血管病有重要意义.就其原理及在缺血性脑血管病中的应用进行综述.     

Investigation of stroke in sickle cell disease by1H nuclear magnetic resonance spectroscopy

Summary Localized proton nuclear magnetic resonance spectroscopy (MRS), obtained with stimulated echo and spin echo sequences, MR imaging (MRI) and MR angiography (MRA) were used to study the brain in 13 children and adolescents with sickle cell disease. Regions of interest (ROI) studied by MRS included regions appearing normal on MRI as well as regions showing complications of sickle cell disease, including focal deep white matter areas of high signal intensity (deep white matter ischemia, DWMI) seen on long TR images, focal atrophic brain areas, and infarcts. The findings in these studies are summarized as follows: Normal-appearing regions on MRI have normal MRS. In ROI including small areas of DWMI, lactate elevation was not detected, but the levels ofN-acetyl-aspartate (NAA) appeared slightly elevated. In areas of DWMI 1–2 cm in size, reduced blood flow could be seen on MRA and lactate elevation could be detected with MRS. When blood flow to a DWMI region was normal, NAA was reduced and there was little lactate elevation, as cell death had already occurred. ROI consisting of atrophic tissue had reduced NAA levels but total creatine levels were not changed. Sometimes lipids, presumably from broken cell membrane, could be detected. In regions of past massive stroke, all metabolites were absent except for small amounts of lactate or lipids.     

强制性使用运动疗法治疗卒中上肢偏瘫患者的脑功能MRI研究

.626,P<0.05).CIMT治疗后右手运动时左侧中央前回手部支配区激活强度明显增加,双侧纹状体、丘脑及小脑半球激活增加,右侧大脑半球顶叶可见激活.结论 CIMT可以有效改善患者上肢的运动功能障碍,患肢的强制使用诱导出了大脑皮层功能区的重组和代偿,fMRI可以检测到这种变化,提供CIMT治疗后神经元重组与代偿的证据.     

MRI预测急性脑梗死后出血的价值

目的探讨急性脑梗死患者MR早期增强T1WI中脑实质强化及大脑中动脉高信号（HMCA）征与继发性脑出血（HT）的关系。方法回顾性分析24例发病6．0h内[平均（4．3±1．4）h]的急性脑梗死患者首次T1WI及随后1周内复查的MRI和（或）CT资料，了解首次增强T1WI脑实质强化和HMCA征与HT的关系。早期脑实质强化为脑梗死6．0h内缺血的脑组织区域在增强T1WI出现高信号；HMCA征为增强T1WI上大脑中动脉增粗（与对侧相比）、出现边缘模糊的高信号。结果24例患者中10例发展为HT（出血组），其中6例首次T1WI可见脑实质强化，5例出现HMCA征；14例未出现HT（无出血组），均未发现脑实质强化和（或）HMCA征。2组相比，T1WI脑实质强化、HMCA征出现率差异均有统计学意义（P值均〈0．01）。结论T1WI早期脑实质强化和HMCA征有可能预测急性脑梗死后HT。     

磁共振SWI在诊断脑血管病微出血灶中的应用价值

目的 探讨分析磁共振磁敏感加权成像技术(SWI)在脑血管病微出血灶检出中的应用价值.方法 选取本院常规MRI扫描(T1WI、T2WI、T2-FLAIR)、DWI及SWI扫描,且SWI脑微出血灶检出阳性的脑血管病患者55例,探讨常规MRI序列、DWI及SWI在微出血灶检出阳性及检出病灶数目方面的差异.结果 55例患者微出...     

Brainstem and cerebellar changes after cerebrovascular accidents: magnetic resonance imaging

We illustrate the various types of secondary degeneration in the brainstem and/or cerebellum detected on magnetic resonance (MR) images obtained after cerebrovascular accidents. The changes include: (a) ipsilateral nigral degeneration after striatal infarction; (b) Wallerian degeneration of the pyramidal tract in the brainstem after supratentorial pyramidal tract or motor cortex injury; (c) Wallerian degeneration of the corticopontine tract in the brainstem after frontal lobe infarction; (d) ipsilateral brainstem atrophy and crossed cerebellar atrophy due to an extensive supratentorial lesion; (e) ipsilateral superior cerebellar peduncle atrophy, contralateral rubral degeneration, contralateral inferior olivary degeneration and ipsilateral cerebellar atrophy after dentate nucleus hemorrhage; (f) ipsilateral inferior olivary degeneration after pontine tegmentum hemorrhage; (g) bilateral wallerian degeneration of the pontocerebellar tracts after ventromedial pontine infarction or basis pontis hemorrhage; and (h) ipsilateral cerebellar atrophy after middle cerebellar peduncle hemorrhage.     

Imaging in acute stroke

Stroke is a syndrome characterized by a sudden neurological deficit caused by intracranial hemorrhage or ischemia. Computed tomography (CT) maintains a primary role in the evaluation of patients with acute stroke. The optimal magnetic resonance imaging (MRI) protocol in acute stroke includes diffusion-weighted imaging (DWI) to show acute ischemic lesion and MR perfusion study to estimate brain perfusion. Careful selection of patients for a thrombolytic therapy is crucial to improve safety and efficacy.     

Intra-arterial thrombolysis for acute ischemic stroke

Intra-arterial thrombolysis is a maturing treatment for acute thromboembolic stroke that shows promise in restoring cerebral blood supply. Reviewed evidence suggests that intra-arterial treatment has a longer window for treatment than intravenous t-PA and does improve outcome. A favorable outcome is dependent on careful patient selection aimed at avoiding intracranial hemorrhage. This article describes features to evaluate for patient selection and highlights factors along the treatment algorithm to maximize success. Received: 19 June 2000 Accepted: 10 July 2000     

烟雾病的MRI、MRA诊断价值

 目的探讨MRI、MRA对烟雾病(Moyamoya病)的诊断价值.方法对11例Moyamoya病患者行MRI和MRA检查,MRI包括横轴位和矢状位T1WI、T2WI、FLAIR;MRA采用3D TOF法,3例行增强MRA.结果MRI表现为:(1)Moyamoya血管:双侧3例,单侧8例;(2)脑梗死和脑软化灶11例;(3)局部脑萎缩3例.MRA表现为3例双侧颈内动脉狭窄,双侧大脑中、前动脉闭塞,大脑后动脉形成异常血管网;6例右侧颈内动脉、大脑中动脉狭窄;2例左侧颈内动脉、大脑中动脉狭窄.结论MRI能良好的显示脑内病变,MRA能较完整的显示异常血管,MRI与MRA相结合可作为烟雾病诊断的首选检查方法.     

Association of carotid atherosclerotic plaque features with acute ischemic stroke: A magnetic resonance imaging study

Background and purpose

It remains unclear whether direct vessel wall imaging can identify carotid high-risk lesions in symptomatic subjects and whether carotid plaque characteristics are more effective indicators for cerebral infarct severity than stenosis. This study sought to determine the associations of carotid plaque characteristics by MR imaging with stenosis and acute cerebral infarct (ACI) sizes on diffusion weighted imaging (DWI).

Materials and methods

One hundred and fourteen symptomatic patients underwent carotid and brain MRI. ACI volume was determined from symptomatic internal carotid artery territory on DWI images. Ipsilateral carotid plaque morphological and compositional characteristics, and stenosis were also determined. The relationships between carotid plaque characteristics, stenosis and ACIs size were then evaluated.

Results

In carotid arteries with 30–49% stenosis, 86.7% and 26.7% were found to have lipid-rich necrotic core (LRNC) and intraplaque hemorrhage, respectively. Furthermore, 45.8% of carotid arteries with 0–29% stenosis developed LRNCs. Carotid morphological measurements, such as % wall volume, and the LRNC size were significantly associated with ipsilateral ACIs volume before and after adjustment for significant demographic factors (age and LDL) or stenosis in patients with carotid plaque (all p < 0.05).

Conclusions

A substantial number of high-risk plaques characterized by vessel wall imaging exist in carotid arteries with lower grade stenosis. In addition, carotid plaque characteristics, particularly the % wall volume and LRNC size, are independently associated with cerebral infarction as measured by DWI lesions. Our findings indicate that characterizing atherosclerotic plaque by MR vessel wall imaging might be useful for stratification of plaque risk and infarction severity.     

Magnetic resonance diffusion-perfusion mismatch in acute ischemic stroke: An update

The concept of magnetic resonance perfusion-diffusion mismatch(PDM) provides a practical and approximate measure of the tissue at risk and has been increasingly applied for the evaluation of hyperacute and acute stroke in animals and patients.Recent studies demonstrated that PDM does not optimally define the ischemic penumbra;because early abnormality on diffusion-weighted imaging overestimates the infarct core by including part of the penumbra,and the abnormality on perfusion weighted imaging overestimates the penumbra by including regions of benign oligemia.To overcome these limitations,many efforts have been made to optimize conventional PDM.Various alternatives beyond the PDM concept are under investigation in order to better define the penumbra.The PDM theory has been applied in ischemic stroke for at least three purposes:to be used as a practical selection tool for stroke treatment;to test the hypothesis that patients with PDM pattern will benefit from treatment,while those without mismatch pattern will not;to be a surrogate measure for stroke outcome.The main patterns of PDM and its relation with clinical outcomes were also briefly reviewed.The conclusion was that patients with PDM documented more reperfusion,reduced infarct growth and better clinical outcomes compared to patients without PDM,but it was not yet clear that thrombolytic therapy is beneficial when patients were selected on PDM.Studies based on a larger cohort are currently under investigation to further validate the PDM hypothesis.