电磁脉冲对培养大鼠大脑皮层神经元细胞内和培养上清LDH及培养上清CHE、K+、Na+浓度的影响

目的 :以体外原代培养的乳鼠皮层神经元为研究对象 ,测定电磁脉冲辐照神经细胞前后细胞内LDH和培养上清中LDH、CHE、K+、Na+浓度与时间的关系 ,探讨电磁脉冲对大脑神经细胞膜损伤的机制及其时相性。方法 :Wistar大鼠大脑皮层神经细胞在 6孔板中进行原代培养 ,在培养第 12～ 14天时 ,用高场强EMP模拟源 (场强为 6× 10 4 V·m-1,脉冲上升时间为 2 0ns,脉宽为 3 0 μs) ,2min内辐照 5次。并于辐照后 0 (即刻 )、1、6、12和 2 4h应用中生公司生化检测试剂盒测定细胞内和培养上清中LDH及培养上清中CHE、K+、Na+浓度。结果 :电磁脉冲辐照后即刻、1、6和 12h培养上清LDH明显升高 ;辐照后各时间点细胞内LDH明显降低 ,而培养上清中CHE、K+和Na+明显升高 ;辐照后 2 4h所有上述指标基本恢复。结论 :电磁脉冲辐照后可能损伤大鼠皮层神经元细胞膜     

电磁脉冲辐照对培养大鼠垂体细胞上清中LDH、AST、CHE、K+ 和Na+ 的影响

对Wistar大鼠垂体细胞在6孔板中进行原代培养,在培养第4天时,用高场强EMP模拟源(场强为6×104 V/m,脉冲上升时间为20ns,脉宽为30μs),2min内辐照5次.并于辐照后0(即刻)、1、6、12和24h应用中生公司生化检测试剂盒测定培养上清中LDH、AST、CHE、K+、Na+浓度,探讨电磁脉冲对垂体细胞损伤的机制.结果表明,电磁脉冲辐照后即刻就可引起培养上清LDH和CHE明显升高;辐照后1和6h培养上清中LDH、AST、CHE、和K+明显升高;辐照后12h培养上清中LDH、AST和K+明显升高;辐照后24h所有上述指标基本恢复.结果提示,电磁脉冲辐照后可引起大鼠垂体细胞膜的损伤.     

电磁脉冲对海马C—FOS表达的影响

目的 :本研究拟通过观察电磁脉冲 (EMP)辐照大鼠后其海马C FOS表达的改变 ,初步探讨EMP致海马损伤的机制。方法 :用高场强电磁脉冲模拟源 (所产生的脉冲上升时间为 2 0ns ,脉宽为30 μs) ,在 2min内辐照大鼠 5次 ,并设对照组 ,辐照后于 1,6,12 ,2 4和 4 8h活杀动物 ,采用免疫组织化学SP方法显示C FOS的表达并在光镜 10× 4 0倍视野下 ,应用CMIAS Ⅱ图像分析仪对阳性细胞的图像学参数 积分光密度和平均光密度测定分析 ,最后结果经SPSS8.0统计软件统计分析。结果 :被辐照组大鼠在 6～ 12h时海马锥体细胞及齿状回颗粒细胞C FOS均呈高表达 ,积分光密度和平均光密度值在 12h时最大 ,且显著高于对照组 (P <0 .0 5和P <0 .0 1)。结论 :EMP可引起C FOS在海马锥体细胞及齿状回颗粒细胞的高表达 ,且C FOS可能在EMP致大鼠的脑损伤中起重要作用     

高功率微波辐照对大鼠血睾屏障通透性的影响

目的 探讨高功率微波（HPM）辐照大鼠睾丸对血睾屏障的影响。方法 雄性SD大鼠35只，随机分为7组，每组5只。6组为辐照组，1组为对照组。于辐照后2、6、12、4．8、96h和8d活杀大鼠后取双侧睾丸组织各约1mm^3，镧-醛固定液固定后制备电镜标本，在透射电镜下进行观察。结果 对照组可见硝酸镧主要沉积在曲细精管基膜部和精原细胞周围，未越过紧密连接；辐照后2-6h电镜下所见与对照组大致相同；辐照后12-96h，从基底部到管腔面的各层生精细胞之间、支持细胞内都有大量的镧颗粒沉积；辐照后8d，仍可见细胞间隙增大，部分区域靠近精子表面的镧颗粒沉积甚至比前面时间点的更为严重。结论 高功率微波辐照能够改变细胞的通透性，破坏血睾屏障的保护作用。     

三种波段电磁辐射对大鼠心脏组织形态的影响

目的 探讨3种不同波段电磁辐射[X波段、S波段、电磁脉冲(EMP)]对大鼠心脏损伤的病理学改变及损伤程度差异。方法 采用二级Wistar大鼠180只,应用电脑随机法分为对照组(36只)、EMP辐照组(48只)、S波段微波辐照组(48只)、X波段微波辐照组(48只)。分别于照后6 h、1、3、7、14、28 d、6和12个月活杀,切取大鼠心脏组织标本行组织学及组织化学观察。结果 与对照组比较3种波段辐照组大鼠心脏呈现不同程度损伤,变化规律相似,以6 h~7 d心脏损伤呈加重趋势,心肌纤维排列紊乱,糖原颗粒减少,核染色质浓缩,蒲肯野纤维溶解,间质水肿,心肌间有浆液渗出。14~28d后心脏呈修复恢复期。6~12个月心脏组织与对照组基本相似。比较同一时间点3种波段辐照组X波段辐照心脏损伤最重、S波段次之、EMP组最轻。正常对照组心脏组织结构基本正常。结论 3种不同波段的电磁辐射均会造成不同程度的心脏损伤,X波段>S波段>EMP,提示波长越短、频率越高致心脏损伤越重,且恢复时间越长。     

电磁脉冲辐照对培养大鼠小脑神经细胞内LDH和培养上清中LDH,CHE,K+和Na+浓度的影响

目的以体外原代培养的小脑颗粒细胞为对象,测定电磁脉冲辐照神经细胞前后细胞内LDH和培养上清中LDH,CHE,K+和Na+浓度及与时间的关系,研究电磁脉冲(场强为6×104 V/m)辐照后早期对小脑颗粒细胞损伤的可能机制.方法在培养12～14d时,高场强EMP模拟源(有界波模拟源),场强为6×104 V/m,脉冲上升时间为20ns,脉宽为30μs,频率包含0～100MHz,以2.5次/min,辐照2min.并于辐照后0(即刻),1,6,12和24h应用生化检测试剂盒测定细胞内和培养上清中LDH及培养上清中CHE,K+和Na+浓度.结果电磁脉冲辐照后即刻就可引起培养上清LDH明显升高;辐照后1h细胞内LDH明显降低,而培养上清中LDH,CHE和K+明显升高;辐照后6h细胞内LDH明显降低,而培养上清中LDH,CHE,K+ 和Na+明显升高;辐照后12h细胞内LDH明显降低,培养上清中CHE,K+ 和Na+明显升高;辐照后24h所有上述指标基本恢复.结论电磁脉冲辐照后可损伤大鼠海马神经元细胞膜.     

电磁脉冲辐射对小鼠睾丸结构的影响

目的 :探讨不同场强的电磁脉冲辐射对睾丸结构的影响。方法 :二级昆明雄性小鼠 114只 ,随机分为辐射组和对照组。辐射组小鼠分别接受 8× 10 3 ,2× 10 4,6× 10 4V/m电磁脉冲 5次重复全身照射 ,于照射后 6h ,1d ,3d ,7d ,14d和 2 8d观察睾丸和附睾病理学改变。结果 :3种场强的电磁脉冲辐射均未引起小鼠肛温和阴囊皮肤温度的明显升高 ,但睾丸却发生显著的各级生精细胞水肿、坏死和脱落 ,曲细精管内成熟精子稀少和缺失 ;最敏感的靶细胞是精原细胞和精子细胞 ;周边部曲细精管病变最明显 ;病变的严重程度与场强的大小呈正相关。结论 :8× 10 3 ～ 6× 10 4V/m电磁脉冲 5次重复全身照射小鼠 ,可引起小鼠睾丸严重的非热效应性生精细胞结构损伤。     

电磁脉冲对眼辐射损伤的研究

目的 :通过电磁脉冲 (EMP)辐照成年犬 ,长期动态观察角膜、晶状体及视网膜的病理变化 ,探讨EMP对视觉系统的影响。方法 :高场强 (2～ 12 )× 10 4V/m的EMP、1～ 30次辐照实验犬 ,采用Feulgen ,AgNOR和PI染色方法 ,以激光扫描共聚焦显微镜 (LSCM)和图像分析技术进行检测。结果 :EMP辐射可使晶状体上皮细胞AgNOR和DNA含量下降 ,前皮质水肿 ,白内障发生。对EMP损伤敏感程度依次为 :晶状体 >角膜 >视网膜。损伤具有剂量 效应相关性。结论 :高场强EMP可引起犬晶状体前皮质混浊、白内障发生 ,损伤具有剂量 效应相关性。     

电磁脉冲辐射后小鼠免疫器官损伤的病理研究

目的 :研究电磁脉冲 (EMP)照射后小鼠脾脏和胸腺的组织病理变化。方法 :198只小鼠经 6× 10 4V/m电磁脉冲辐照后 6h、1d、3d、7d、14d、2 8d、3个月、6个月、9个月和 12个月共 10个时相点活杀取脾脏和胸腺 ,分别应用光镜和电镜进行组织学和超微结构观察。结果 :电磁脉冲辐照后早期 :脾脏脾小体结构不清 ,体积缩小 ,生发中心不明显 ;淋巴细胞核固缩、崩解 ;红髓中巨噬细胞增多 ,血窦扩张、充血明显。照后中期 :脾脏红髓纤维化 ;胸腺皮质细胞变性坏死 ,髓质内可见灶状出血 ,出血灶周围细胞核固缩。照后后期 :脾脏出现“假小叶”状纤维化 ,胸腺皮质变薄 ,髓质变宽 ,皮髓质比例倒置 ,髓质内纤维组织增生甚至纤维化。照后晚期 :脾脏被膜增厚 ,胸腺出现萎缩 ,脾脏和胸腺中的淋巴细胞均有所恢复。在透射电镜下 ,脾脏和胸腺内淋巴细胞均出现典型的凋亡图像。结论 :电磁脉冲辐照后脾脏和胸腺发生明显损伤 ,脾脏损伤更为严重和迅速 ,其病变具有进行性、阶段性及缓慢恢复性特点 ,表明免疫系统器官为EMP辐照敏感组织之一。     

电磁脉冲诱导大鼠心肌闰盘间隙开放及其机制

目的 探讨电磁脉冲(EMP)诱导心肌闰盘(ID)的改变及其作用机制。方法 用EMP模拟发生器,场强为50~400 kV/m,脉冲次数200次,雌性SD大鼠30只,随机分为5组,每组6只。照后12 h时采用硝酸镧示踪法和透射电子显微镜观察心肌ID结构的改变,用基因芯片检测受照心肌差异基因表达谱。结果 照后12 h,辐照组的ID间隙随着EMP场强的增加而逐渐增宽,ID间隙中沉积的镧颗粒随着EMP场强的增加而逐渐增多。200 kV/m 组与对照组相比差异表达基因有108个,其中表达上调基因有synaptorin、VGF、HSP70等51条,下调基因有NAD、FGF、Tff3等57条。结论 在场强为50~400 kV/m EMP范围内辐照可诱导心肌ID间隙开放,且随场强的增加而增宽,以400 kV/m时最为显著,受照心肌有108个基因差异表达。     

快速进入高原后的心功能变化

本实验采用多阶踏阶方法在平原和高原测定运动后即刻心率和耗氧量,用功率与心率、功率与耗氧量间的线性关系,计算出6种劳动强度对应的心率、耗氧量测量值的直线回归方程,推算出人体工作能力(PWC_(170))、亚极量踏阶心率(HR_(720))、亚极量踏阶耗氧量(■_2_(172))、工作效率(E)等指标,并计算氧脉搏(O_2P)。通过在平原和到达高原后不同天数所得数据的比较,得出在所观测的两周里从平原快速空运进入高原后各项指标的变化特点:在高原人体的亚极量踏阶运动心率和耗氧量上升;人体工作能力和工作效率降低;氧脉搏增加。认为快速进入高原后5～7天心功能由快速反应性的下降转变为高原适应期的适应性下降。     

D-二聚体、纤溶酶原激活物抑制物在急性肾衰竭患者血液净化中的临床意义

目的探讨急性肾衰竭(ARF)时D-二聚体(D-D)、纤溶酶原激活物抑制物(PAI)在不同的血液净化方法中的动态变化及临床意义。方法对我院2007年1月—2010年3月急诊住院58例ARF患者血液净化前、净化后4 h及38例健康人进行血浆中D-D含量及PAI水平测定。ARF患者血液净化方法随机采用血液透析(HD)(31例)、血液透析滤过(HDF)(27例)。结果 ARF患者D-D含量及PAI水平较对照组明显升高[D-D(0.83±0.04)与(0.48±0.03)mg/L,P=0.000 2;PAI(14.95±0.73)与(8.03±0.30)103kat/L,P<0.0001;]HD治疗4 h后D-D含量和PAI活性较治疗前升高[D-D(0.89±0.05)与(1.48±0.37)mg/L,P=0.018;PAI(14.89±1.78)与(22.10±3.56)103kat/L,P=0.025],而HDF治疗后D-D含量和PAI无明显变化[D-D(0.91±0.06)与(1.12±0.09)mg/L,P=0.65;PAI(15.81±1.98)与(16.10±2.56)103kat/L,P=0.86]。结论 ARF患者D-D、PAI水平升高,存在凝血-纤溶系统的紊乱,HD可以加重这种改变,而采用HDF治疗可避免对患者凝血机能的影响,在急性肾衰竭治疗中有一定临床价值。     

Anterior interosseous nerve lession and distal myoclonus revealing a parsonage turner syndrome associated with hashimoto thyroiditys

Parsonage-Turner Syndrome (PTS), also known as brachial neuritis or neuralgic amyotrophy, is a rare disorder affecting 2 to 3 individuals per 100,000 each year. Abrupt onset shoulder pain, followed by motor weakness, paresthesia and hypoesthesia, is usually reported, lasting several months with variable recovery. The etiology of the disease may be idiopathic or triggered by an underlying autoimmune disease in genetically susceptible individuals. Our report addresses a unique case of Parsonage-Turner Syndrome in a patient suffering from concurrent Hashimoto Thyroiditis. A previously healthy A 22 year-old female was referred to the Department of Neurology after complaints of sudden-onset motor weakness in her left upper limb. On physical examination, the patient could not make an “Ok sign” with her thumb and distal phalanx or form a complete fist, revealing weakness within the anterior interosseous branch of the median nerve. Further testing with electromyography demonstrated muscular atrophy within the arm''s anterior compartment, forearm, and triceps brachii of the posterior compartment. Additional imaging and physical examination were unremarkable, confirming our diagnosis of PTS. Furthermore, lab reports revealed elevated levels of anti-thyroglobulin and anti-thyroid peroxidase antibodies and our patient was concurrently diagnosed with Hashimoto''s thyroiditis.This case aims to highlight the rare co-occurrence of Hashimoto''s thyroiditis with Parsonage-Turner Syndrome in an otherwise healthy patient. A 2014 study published by Nugent et al. had also shed light on brachial neuritis in a patient suffering from autoimmune connective tissue disease, and through this case study, we hope to add to the growing literature regarding the correlation between PTS and autoimmune diseases. Symptoms of PTS can easily be misdiagnosed given its similarity to other peripheral neuropathies, and careful assessment and thorough understanding of the disease is required to successfully distinguish it from other neurological pathologies.     

Validity of apparent diffusion coefficient (ADC) value in diagnosis and follow-up of multiple sclerosis patients in different clinical subtypes

Background

Multiple sclerosis (MS) is a chronic disease with a wide range of pathologic changes that modify the apparent diffusion coefficient (ADC) value.

The therapeutic impact of abdominal ultrasound in patients with acute abdominal symptoms

AIM: The technical performance of abdominal ultrasound in the investigation of acute abdominal pain has been thoroughly investigated but its therapeutic effects are less well understood. We aimed to determine the therapeutic effect of abdominal ultrasound in the investigation of acute abdominal pain. MATERIAL AND METHODS: A pre- and post-intervention observational study design was used to determine the diagnostic and therapeutic effects of abdominal ultrasound for acute abdominal pain. Referring clinicians completed a pre-ultrasound questionnaire that detailed their leading diagnosis, confidence in this and intended management in 100 consecutive adult patients. Following ultrasound a second questionnaire was completed. This again detailed the leading diagnosis, confidence in this and their intended management. Clinicians quantified the management contribution of ultrasound both for the individual case in question and in their clinical experience generally. RESULTS: The leading diagnosis was either confirmed or rejected in 72 patients and a new diagnosis provided where no prior differential diagnosis existed in 10. Diagnostic confidence increased significantly following ultrasound (mean score 6.5 pre-ultrasound vs 7.6 post-ultrasound, P < 0.001). Intended management changed following ultrasound in 22 patients; 15 intended laparotomies were halted and a further seven patients underwent surgery where this was not originally intended. Ultrasound was rated either 'very' or 'moderately' helpful in 87% of patients, with 99% of clinicians finding it either 'very' or 'moderately' helpful generally. CONCLUSION: Abdominal ultrasound has considerable diagnostic and therapeutic effect in the setting of acute abdominal pain.     

血清PCT、NLR及BUN水平与急性胰腺炎严重程度的相关性分析

目的探讨急性胰腺炎(acute pancreatitis,AP)患者血清降钙素原(procalcitonin,PCT)、中性粒细胞与淋巴细胞比值(neutrophil lymphocyte ratio,NLR)以及尿素氮(blood urea nitrogen,BUN)水平与疾病严重程度的关系。方法收集2014年3月—2018年5月在成都医学院第二附属医院就诊的148例AP患者。所有病例均在入院后完善血生化检查,将患者按照2012亚特兰大分类标准分为轻度急性胰腺炎(mild acute pancreatitis,MAP)、中度急性胰腺炎(moderately severe acute pancreatitis,MSAP)、重度急性胰腺炎(severe acute pancreatitis,SAP)3组。比较3组患者入院后第1天清晨血清PCT、NLR及BUN水平,使用受试者工作特征(receiver operating characteristic,ROC)曲线评价血清PCT、NLR及BUN水平预测轻度、中度、重度AP的效力。使用Ranson评分对患者进行病情评估。结果SAP组血清PCT、NLR、BUN水平及Ranson评分高于MAP组、MSAP组,且MSAP组上述指标高于MAP组,差异比较具有统计学意义(P<0.05);SAP组住院天数多于MAP组、MSAP组,MSAP组住院天数多于MAP组(P<0.05);Pearson相关分析结果显示血清PCT、NLR、BUN水平均与Ranson评分得分显著正相关((r=0.48,P<0.05;r=0.62,P<0.05;r=0.40,P<0.05);ROC曲线分析表明PCT、NLR、BUN 3者联合评估轻度、中度、重度AP的AUC分别大于PCT和BUN单项(P<0.05),与NLR差异比较无统计学意义(P>0.05)。结论血清PCT、NLR、BUN水平均与AP病情严重程度呈正相关,且对轻度、中度、重度AP预测具有一定价值,3者联合应用对评估AP病情严重程度具有较好的早期预测价值。     

中晚期肝癌化学免疫治疗与单纯TAE治疗疗效比较

本文采用肝动脉化学栓塞(TAE)后1～2周内行LAK/IL2的化学免疫治疗(Chemo-immu-notherapy CIT)中晚期肝癌(Mid-advanced HCC)42例(CIT组),TAE治疗2 7例为对照(TAE组)。结果:Ⅱ期HCC 2年生存率47.4％,Ⅱ期HCC部分缓解率(PR)和3个月、半年、1年生存率分别为39.1％、73.9％、56.5％和34.7％,显著高于TAE组Ⅱ期HCC二年生存率16.7％,(P<0.05)和Ⅱ期HCC部分缓解率为6.7％,三个月、半年、1年生存率40.0％,13.3％和6.7％,P<0.05;Ⅱ期HCC 1年内肝外转移率(25.5％)明显低于TAE组(66.7％,P<0.05)。表明化学免疫治疗能显著提高中晚期肝癌疗效。     

Application of selective saturation to image the dynamics of arterial blood flow during brain activation using magnetic resonance imaging.

A saturation-based approach is proposed to image the arterial blood flow signal with temporal resolution of 1 to 2 s and in-plane spatial resolution of a few millimeters. Using a saturation approach to suppress the undesired background stationary signal allows the blood water that enters the slice to be imaged at some specified later time. Since the blood protons that are being imaged are not restricted to the intravascular space, this technique is also sensitive to tissue perfusion signal contributions. The signal uptake characteristics of the saturation method proposed were used to study the different signal contributions as a function of the acquisition parameters. A typical perfusion acquisition (FAIR) was also used for comparison. The proposed method was demonstrated in a functional motor activation experiment and the observed signal changes were smaller than those obtained using the FAIR acquisition. The dynamics of the saturation method and FAIR temporal signal changes were investigated and time constants between 2 and 44 s were estimated. The tissue signal contribution to the saturation method's signal was small over the range of acquisition parameters that sensitized it to the arterial compartment.     

Diffusion-weighted MRI of the prostate at 3.0 T: Comparison of endorectal coil (ERC) MRI and phased-array coil (PAC) MRI—The impact of SNR on ADC measurement

Purpose

To compare ADC values measured from diffusion-weighted MR (DW-MR) images of the prostate obtained with both endorectal and phased-array coils (ERC + PAC) to those from DW-MRI images obtained with an eight-channel torso phased-array coil (PAC) at 3.0 T.

Methods

The institutional review board issued a waiver of informed consent for this HIPAA-compliant study. Twenty-five patients with biopsy-proven prostate cancer underwent standard 3-T MRI using 2 different coil arrangements (ERC + PAC and PAC only) in the same session. DW-MRI at five b-values (0, 600, 1000, 1200, and 1500 s/mm²) were acquired using both coil arrangements. On b = 0 images, signal-to-noise ratios (SNRs) were measured as the ratio of the mean signal from PZ and TZ ROIs to the standard deviation from the mean signal in an artifact-free ROI in the rectum. Matching regions-of-interest (ROIs) were identified in the peripheral zone and transition zone on ERC-MRI and PAC-MRI. For each ROI, mean ADC values for all zero and non-zero b-value combinations were computed.

Results

Mean SNR with ERC-MRI at PZ (66.33 ± 27.07) and TZ (32.69 ± 12.52) was 9.27 and 5.52 times higher than with PAC-MRI ((7.32 ± 2.30) and (6.13 ± 1.56), respectively) (P < 0.0001 for both). ADCs from DW-MR images obtained with all b-values in the PZ and TZ were significantly lower with PAC-MRI than with ERC-MRI (P < 0.001 for all).

Conclusion

Lower SNR of DW-MR images of the prostate obtained with a PAC can significantly decrease ADC values at higher b-values compared to similar measurements obtained using the ERC. To address these requirements, clinical MR systems should have image processing capabilities which incorporate the noise distribution.     

Stellenwert moderner CT-Techniken bei der Diagnostik des akuten Schlaganfalls

ZusammenfassungHintergrund Die intravenöse Thrombolyse ist die Behandlung der Wahl für akute Schlaganfallpatienten im 3-h-Zeitfenster. Metaanalysen zufolge besteht auch ein Behandlungseffekt jenseits der 3-h-Grenze, der aber kleiner ist (time is brain). Die Anwendung moderner bildgebender Verfahren kann die Patienten identifizieren, die am ehesten von einer Thrombolysetherapie auch außerhalb etablierter Zeitfenster profitieren. Moderne Schlaganfall-MRT-Protokolle sind der aktuelle Goldstandard für die akute Schlaganfalldiagnostik, sind im Gegensatz zu CT-basierter Diagnostik aber deutlich seltener verfügbar. Der Bedarf für eine optimierte CT-Diagnostik bei Schlaganfallpatienten ist offensichtlich.Methoden Grundlage dieses Übersichtsartikels ist eine ausführliche Sichtung der aktuellen Literatur über Schlaganfalldiagnostik. Die diagnostischen Stärken und Schwächen nativer CT-Techniken, von CT-Angiographie (CTA), CTA-Quellbildanalyse (CTA-QB) und Perfusions-CT (PCT) für die diagnostische Aufarbeitung akuter Schlaganfallpatienten werden kritisch reflektiert. Die Autoren präsentieren einen umfassenden diagnostischen Ansatz für akute Schlaganfallpatienten in Analogie zu Schlaganfall-MRT-Befunden, der es erlaubt, rigide Zeitfenster zu relativieren und das Patientenmanagement zu optimieren.Schlussfolgerung Der Nachweis oder Ausschluss einer intrazerebralen Blutung (ICB) mit der nativen CT und eines Gefäßverschlusses mit der CTA wird als obligatorisch für eine Thrombolyse außerhalb des 3-h-Fensters angesehen. Eine deutliche Hypodensität von mehr als 1/3 des Mediaterritoriums auf nativen CT-Bildern oder CTA-QB ist eine Kontraindikation für die Thrombolysetherapie. Der irreversibel geschädigte Infarktkern und die ischämische aber potenziell rettbare Penumbra können auf kombinierten CT/CTA/CTA-QB/PCT identifiziert werden und charakterisieren den idealen Thrombolysepatienten. Eine umfassende Aufklärung vor Einsatz der Thrombolyse außerhalb etablierter Zeitfenster ist notwendig.