中国卒中杂志 ›› 2024, Vol. 19 ›› Issue (4): 459-467.DOI: 10.3969/j.issn.1673-5765.2024.04.009
郝曼均1,王利圆1,熊云云1,2,3
收稿日期:
2023-04-10
出版日期:
2024-04-20
发布日期:
2024-04-20
通讯作者:
熊云云 xiongyunyun@bjtth.org
基金资助:
HAO Manjun1, WANG Liyuan1, XIONG Yunyun1,2,3
Received:
2023-04-10
Online:
2024-04-20
Published:
2024-04-20
Contact:
XIONG Yunyun, E-mail: xiongyunyun@bjtth.org
摘要: 目前,以缺血半暗带为靶点的再灌注治疗是急性缺血性卒中的首选治疗措施。缺血半暗带的神经影像学评估方法不断更新,为组织窗指导再灌注治疗提供了更多依据。本文对缺血半暗带理论50年来的重要进展进行梳理,重点综述了现有的缺血半暗带神经影像学评估方法(如目前被广泛使用的缺血低灌注-梗死核心或临床症状-梗死核心错配、新兴的多时相CTA及ASL等),并对目前市场上5款主流影像自动后处理软件进行对比,以期为临床再灌注诊疗工作提供参考。
中图分类号:
郝曼均, 王利圆, 熊云云. 再灌注治疗的神经影像学评估[J]. 中国卒中杂志, 2024, 19(4): 459-467.
HAO Manjun, WANG Liyuan, XIONG Yunyun. Neuroimaging Evaluation of Reperfusion Therapy[J]. Chinese Journal of Stroke, 2024, 19(4): 459-467.
[1] NOGUEIRA R G,JADHAV A P,HAUSSEN D C,et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct[J]. N Engl J Med,2018,378(1):11-21. [2] ALBERS G W,MARKS M P,KEMP S,et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging[J]. N Engl J Med,2018,378(8):708-718. [3] SYMON L,BRANSTON N M,STRONG A J,et al. The concepts of thresholds of ischaemia in relation to brain structure and function[J/OL]. J Clin Pathol Suppl(R Coll Pathol),1977,11:149-154[2023-01-11]. https://doi.org/10.1136/jcp.s3-11.1.149. [4] HOSSMANN K A,KLEIHUES P. Reversibility of ischemic brain damage[J]. Arch Neurol,1973,29(6):375-384. [5] ASTRUP J,SIESJÖ B K,SYMON L. Thresholds in cerebral ischemia—the ischemic penumbra[J]. Stroke,1981,12(6):723-725. [6] JONES T H,MORAWETZ R B,CROWELL R M,et al. Thresholds of focal cerebral ischemia in awake monkeys[J]. J Neurosurg,1981,54(6):773-782. [7] BARON J C,ROUGEMONT D,SOUSSALINE F,et al. Local interrelationships of cerebral oxygen consumption and glucose utilization in normal subjects and in ischemic stroke patients:a positron tomography study[J]. J Cereb Blood Flow Metab,1984,4(2):140-149. [8] MARKUS R,REUTENS D C,KAZUI S,et al. Hypoxic tissue in ischaemic stroke:persistence and clinical consequences of spontaneous survival[J]. Brain,2004,127(6):1427-1436. [9] ERMINE C M,BIVARD A,PARSONS M W,et al. The ischemic penumbra:from concept to reality[J]. Int J Stroke,2021,16(5):497-509. [10] KOGA M,YAMAMOTO H,INOUE M,et al. Thrombolysis with alteplase at 0.6 mg/kg for stroke with unknown time of onset:a randomized controlled trial[J]. Stroke,2020,51(5):1530-1538. [11] MA H,CAMPBELL B C V,PARSONS M W,et al. Thrombolysis guided by perfusion imaging up to 9 hours after onset of stroke[J]. N Engl J Med,2019,380(19):1795-1803. [12] RINGLEB P,BENDSZUS M,BLUHMKI E,et al. Extending the time window for intravenous thrombolysis in acute ischemic stroke using magnetic resonance imaging-based patient selection[J]. Int J Stroke,2019,14(5):483-490. [13] THOMALLA G,SIMONSEN C Z,BOUTITIE F,et al. MRI-guided thrombolysis for stroke with unknown time of onset[J]. N Engl J Med,2018,379(7):611-622. [14] 刘丽萍,周宏宇,段婉莹,等. 中国脑血管病临床管理指南(第2版)(节选)——第4章 缺血性脑血管病临床管理推荐意见[J]. 中国卒中杂志,2023,18(8):910-933. LIU L P,ZHOU H Y,DUAN W Y,et al. Chinese Stroke Association guidelines for clinical management of cerebrovascular diseases(second edition)(excerpt)—chapter four clinical management of ischaemic cerebrovascular diseases[J]. Chin J Stroke,2023,18(8):910-933. [15] POWERS W J,RABINSTEIN A A,ACKERSON T,et al. Guidelines for the early management of patients with acute ischemic stroke:2019 update to the 2018 guidelines for the early management of acute ischemic stroke:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J/OL]. Stroke,2019,50(12):e344-e418[2023-01-11]. https://doi.org/10.1161/STR.0000000000000211. [16] BERGE E,WHITELEY W,AUDEBERT H,et al. European Stroke Organisation(ESO)guidelines on intravenous thrombolysis for acute ischaemic stroke[J/OL]. Eur Stroke J,2021,6(1):Ⅰ- LⅩⅡ[2023-01-11]. https://doi.org/10.1177/2396987321989865. [17] MONTEIRO A,CORTEZ G M,GRECO E,et al. Hypoperfusion intensity ratio for refinement of elderly patient selection for endovascular thrombectomy[J]. J Neurointerv Surg,2022,14(3):242-247. [18] MOHAMMADEN M H,HAUSSEN D C,PISANI L,et al. Baseline ASPECTS and hypoperfusion intensity ratio influence the impact of first pass reperfusion on functional outcomes[J]. J Neurointerv Surg,2021,13(2):124-129. [19] Late breaking abstracts[J/OL]. Eur Stroke J,2021,6(1 Suppl):514-543[2023-01-11]. https://doi.org/10.1177/23969873211044666. [20] YU Y N,HAN Q,DING X F,et al. Defining core and penumbra in ischemic stroke:a voxel-and volume-based analysis of whole brain CT perfusion[J/OL]. Sci Rep,2016,6:20932[2023-01-11]. https://doi.org/10.1038/srep20932. [21] CAMPBELL B C,MITCHELL P J,KLEINIG T J,et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection[J]. N Engl J Med,2015,372(11):1009-1018. [22] MARTINS S O,MONT’ALVERNE F,REBELLO L C,et al. Thrombectomy for stroke in the public health care system of Brazil[J]. N Engl J Med,2020,382(24):2316-2326. [23] NAGARAJA N,FORDER J R,WARACH S,et al. Reversible diffusion-weighted imaging lesions in acute ischemic stroke:a systematic review[J]. Neurology,2020,94(13):571-587. [24] 张苗,卢洁. 急性脑梗死患者影像学缺血半暗带的临床评价策略[J]. 中国脑血管病杂志,2021,18(4):217-222. ZHANG M,LU J. Clinical evaluation of ischemic penumbra in acute cerebral infarction[J]. Chinese Journal of Cerebrovascular Disases,2021,18(4):217-222. [25] OLTHUIS S G H,PIRSON F A V,PINCKAERS F M E,et al. Endovascular treatment versus no endovascular treatment after 6-24 h in patients with ischaemic stroke and collateral flow on CT angiography(MR CLEAN-LATE)in the Netherlands:a multicentre,open-label,blinded-endpoint,randomised,controlled,phase 3 trial[J]. Lancet,2023,401(10385):1371-1380. [26] VAGAL A,MENON B K,FOSTER L D,et al. Association between CT angiogram collaterals and CT perfusion in the interventional management of stroke Ⅲ trial[J]. Stroke,2016,47(2):535-538. [27] VAN DEN WIJNGAARD I R,HOLSWILDER G,WERMER M J,et al. Assessment of collateral status by dynamic CT angiography in acute MCA stroke:timing of acquisition and relationship with final infarct volume[J]. AJNR Am J Neuroradiol,2016,37(7):1231-1236. [28] ARENILLAS J F,CORTIJO E,GARCÍA-BERMEJO P,et al. Relative cerebral blood volume is associated with collateral status and infarct growth in stroke patients in SWIFT PRIME[J]. J Cereb Blood Flow Metab,2018,38(10):1839-1847. [29] 李晗,王希明. 基于多模态CT评估缺血性脑卒中侧支循环的研究进展[J]. 中国中西医结合影像学杂志,2021,19(2):184-187. LI H,WANG X M. Research progress in the evaluation of collateral circulation in ischemic stroke based on multimodal CT[J]. Chinese Imaging Journal of Integrated Traditional and Western Medicine,2021,19(2):184-187. [30] 叶浩翊,刘志锋,阮耀钦,等. 基于多时相CTA预测急性缺血性脑卒中患者静脉溶栓预后的可行性研究[J]. 中风与神经疾病杂志,2022,39(7):605-608. YE H Y,LIU Z F,RUAN Y Q,et al. The feasibleness study of forecasting the prognostic of sick person acute ischemic stroke by intravenous thromboly-sis based on multi-phase CTA[J]. Journal of Apoplexy and Nervous Diseases,2022,39(7):605-608. [31] MCDOUGALL C C,CHAN L,SACHAN S,et al. Dynamic CTA-derived perfusion maps predict final infarct volume:the simple perfusion reconstruction algorithm[J]. AJNR Am J Neuroradiol,2020,41(11):2034-2040. [32] VERDOLOTTI T,PILATO F,COTTONARO S,et al. ColorViz,a new and rapid tool for assessing collateral circulation during stroke[J/OL]. Brain Sci,2020,10(11):882[2023-01-11]. https://doi.org/10.3390/brainsci10110882. [33] HALLER S,ZAHARCHUK G,THOMAS D L,et al. Arterial spin labeling perfusion of the brain:emerging clinical applications[J]. Radiology,2016,281(2):337-356. [34] BAMBACH S,SMITH M,MORRIS P P,et al. Arterial spin labeling applications in pediatric and adult neurologic disorders[J]. J Magn Reson Imaging,2022,55(3):698-719. [35] BIVARD A,KRISHNAMURTHY V,STANWELL P,et al. Arterial spin labeling versus bolus-tracking perfusion in hyperacute stroke[J]. Stroke,2014,45(1):127-133. [36] THOMALLA G,ROSSBACH P,ROSENKRANZ M,et al. Negative fluid-attenuated inversion recovery imaging identifies acute ischemic stroke at 3 hours or less[J]. Ann Neurol,2009,65(6):724-732. [37] MIRASOL R V,BOKKERS R P,HERNANDEZ D A,et al. Assessing reperfusion with whole-brain arterial spin labeling:a noninvasive alternative to gadolinium[J]. Stroke,2014,45(2):456-461. [38] THOMALLA G,BOUTITIE F,MA H,et al. Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging:systematic review and meta-analysis of individual patient data[J]. Lancet,2020,396(10262):1574-1584. [39] SCHELDEMAN L,WOUTERS A,BOUTITIE F,et al. Different mismatch concepts for magnetic resonance imaging-guided thrombolysis in unknown onset stroke[J]. Ann Neurol,2020,87(6):931-938. [40] GUNASEKERA L,CHURILOV L,MITCHELL P,et al. Automated estimation of ischemic core prior to thrombectomy:comparison of two current algorithms[J]. Neuroradiology,2021,63(10):1645-1649. [41] DÁVALOS A,BLANCO M,PEDRAZA S,et al. The clinical-DWI mismatch:a new diagnostic approach to the brain tissue at risk of infarction[J]. 2004,62(12):2187-2192. [42] NANNONI S,STRAMBO D,SIRIMARCO G,et al. Eligibility for late endovascular treatment using DAWN,DEFUSE-3,and more liberal selection criteria in a stroke center[J]. J Neurointerv Surg,2020,12(9):842-847. [43] DESAI S M,ORTEGA-GUTIERREZ S,SHETH S A,et al. Clinically approximated hypoperfused tissue in large vessel occlusion stroke[J]. Stroke,2021,52(6):2109-2114. [44] 柯伟,邓小容,李文澜,等. 临床-ASPECTS评分不匹配在急性颈内动脉或大脑中动脉主干闭塞8~14 h再通治疗中的探讨[J]. 卒中与神经疾病,2018,25(5):510-516. KE W,DENG X R,LI W L,et al. The evaluation of clinical-ASPCTS mismatch in intra-arterial treatment for acute internal carotid artery or middle cerebral artery tunk occlusion within 8-14 hours[J]. Stroke Nervo Dis,2018,25(5):510-516. [45] FARZIN B,FAHED R,GUILBERT F,et al. Early CT changes in patients admitted for thrombectomy:intrarater and interrater agreement[J]. Neurology,2016,87(3):249-256. [46] 中华医学会急诊医学分会,急性缺血性脑卒中侧支循环评估与干预中国急诊专家共识组. 急性缺血性脑卒中侧支循环评估与干预中国急诊专家共识[J]. 中华急诊医学杂志,2022,31(10):1310-1318. Chinese Society of Emergency Medicine,Experts Group of Chinese Consensus on Collateral Circulation Assessment and Intervention of Acute Ischemic Stroke. Chinese experts consensus on collateral circulation assessment and intervention of acute ischemic stroke[J]. Chin J Emerg Med,2022,31(10):1310-1318. [47] TAO C R,NOGUEIRA R G,ZHU Y Y,et al. Trial of endovascular treatment of acute basilar-artery occlusion[J]. N Engl J Med,2022,387(15):1361-1372. [48] JOVIN T G,LI C H,WU L F,et al. Trial of thrombectomy 6 to 24 hours after stroke due to basilar-artery occlusion[J]. N Engl J Med,2022,387(15):1373-1384. [49] LIU X F,DAI Q L,YE R D,et al. Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion(BEST):an open-label,randomised controlled trial[J]. Lancet Neurol,2020,19(2):115-122. [50] LANGEZAAL L C M,VAN DER HOEVEN E J R J,MONT’ALVERNE F J A. Endovascular therapy for stroke due to basilar-artery occlusion[J]. N Engl J Med,2021,384(20):1910-1920. [51] SARRAJ A,HASSAN A E,ABRAHAM M G,et al. Trial of endovascular thrombectomy for large ischemic strokes[J]. N Engl J Med,2023,388(14):1259-1271. [52] HUO X C,MA G T,TONG X,et al. Trial of endovascular therapy for acute ischemic stroke with large infarct[J]. N Engl J Med,2023,388(14):1272-1283. [53] XIONG Y Y,HUANG C C,FISHER M,et al. Comparison of automated CT perfusion softwares in evaluation of acute ischemic stroke[J/OL]. J Stroke Cerebrovasc Dis,2019,28(12):104392[2023-01-11]. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104392. [54] LU Q Q,FU J Y,LV K,et al. Agreement of three CT perfusion software packages in patients with acute ischemic stroke:a comparison with RAPID[J/OL]. Eur J Radiol,2022,156:110500[2023-01-11]. https://doi.org/10.1016/j.ejrad.2022.110500. [55] XIONG Y Y,LUO Y,WANG M M,et al. Evaluation of diffusion-perfusion mismatch in acute ischemic stroke with a new automated perfusion-weighted imaging software:a retrospective study[J]. Neurol Ther,2022,11(4):1777-1788. [56] ALBERS G W,CAMPBELL B C,LANSBERG M G,et al. A Phase Ⅲ,prospective,double-blind,randomized,placebo-controlled trial of thrombolysis in imaging-eligible,late-window patients to assess the efficacy and safety of tenecteplase(TIMELESS):rationale and design[J]. Int J Stroke,2023,18(2):237-241. [57] PÉREZ-PELEGRÍ M,BIARNÉS C,THIÓ-HENESTROSA S,et al. Higher agreement in endovascular treatment decision-making than in parametric quantifications among automated CT perfusion software packages in acute ischemic stroke[J]. J Xray Sci Technol,2021,29(5):823-834. [58] DE SILVA D A,BREKENFELD C,EBINGER M,et al. The benefits of intravenous thrombolysis relate to the site of baseline arterial occlusion in the echoplanar imaging thrombolytic evaluation trial(EPITHET)[J]. Stroke,2010,41(2):295-299. [59] HUANG X Y,CHERIPELLI B K,LLOYD S M,et al. Alteplase versus tenecteplase for thrombolysis after ischaemic stroke(ATTEST):a phase 2,randomised,open-label,blinded endpoint study[J]. Lancet Neurol,2015,14(4):368-376. [60] BIVARD A,ZHAO H,CHURILOV L,et al. Comparison of tenecteplase with alteplase for the early treatment of ischaemic stroke in the melbourne mobile stroke unit(TASTE-A):a phase 2,randomised,open-label trial[J]. Lancet Neurol,2022,21(6):520-527. [61] XU J,WANG A X,MENG X,et al. Edaravone dexborneol versus edaravone alone for the treatment of acute ischemic stroke:a phase Ⅲ,randomized,double-blind,comparative trial[J]. Stroke,2021,52(3):772-780. [62] XIONG Y Y,CAMPBELL B C V,FISHER M,et al. Rationale and design of tenecteplase reperfusion therapy in acute ischaemic cerebrovascular events Ⅲ(TRACE Ⅲ):a randomised,phase Ⅲ,open-label,controlled trial[J]. Stroke Vasc Neurol,2024,9(1):82-89. |
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