Application of Multimodal CT in Diagnosis and Treatment of Ischemic Stroke

doi:10.3969/j.issn.1673-5765.2017.08.010

Abstract

Abstract:

Ischemic stroke has become a major disease endangering human beings’ health, which is in urgent need for a rapid and effective imaging method to help diagnose, guide the treatment, predict the cause and judge the prognosis. Multimodal computed tomography (CT) examination can obtain brain tissue structure, blood vessels and blood perfusion and other aspects of information at the same time, which provides objective imaging evidence for individualized treatment of ischemic stroke patients and secondary prevention. This article reviews the application of multimodal CT in the diagnosis and treatment of ischemic stroke.

Key words: Ischemic stroke; CT angiography; CT perfusion; Hemorrhagic transformation; Etiological prediction

摘要：

缺血性卒中已成为危害人类健康的主要疾病，急需一种快速有效的影像学检查协助诊断、指导治疗、预测病因、判断预后。多模式计算机断层扫描（computed tomography，CT）检查可一次性获取脑组织结构、血管及血流灌注等方面信息，为缺血性卒中患者个体化治疗及二级预防提供客观的影像学依据。文章就多模式CT在缺血性卒中诊疗中的应用进行综述。

关键词: 缺血性卒中; CT血管成像; CT灌注成像; 出血转化; 病因预测

GAO Yuan-Yuan, XU Yun. Application of Multimodal CT in Diagnosis and Treatment of Ischemic Stroke[J]. Chinese Journal of Stroke, 2017, 12(08): 706-709.

高圆圆，徐运. 多模式CT在缺血性卒中诊疗中的应用[J]. 中国卒中杂志, 2017, 12(08): 706-709.

References

[1] LANZINO G，BROWN R D J R. Introduction：

management of ischemic cerebrovascular disease[J].

Neurosurg Focus，2014，36（1）：1-2.

[2] MURRAY C J，LOPEZ A D. Mortality by cause for

eight regions of the world：Global Burden of Disease

Study[J]. Lancet，1997，349（9061）：1269-1276.

[3] POWERS W J，DERDEYN C P，BILLER J，et al.

2015 American Heart Association/American Stroke

Association Focused Update of the 2013 Guidelines

for the Early Management of Patients With Acute

Ischemic Stroke Regarding Endovascular Treatment

A Guideline for Healthcare Professionals From

the American Heart Association/American Stroke

Association[J]. Stroke，2015，46（10）：3020-3035.

[4] KLOSKA S P，NABAVI D G，GAUS C，et al. Acute

stroke assessment with CT：do we need multimodal

evaluation?[J]. Padiology，2004，233（1）：79-86.

[5] DE LUCAS E M，SÁNEHEZ E，GUTIÉRREZ A，

et al. CT protocol for acute stroke：tips and tricks for

general radiologists[J]. Radiographics，2008，28（6）：

1673-1687.

[6] HOKSBERGEN A W，FÜLESDI B，LEGEMATE D

A，et al. Collateral configuration of the circle of Willis：

transcrania color-coded duplex ultrasonography and

comparison with postmortem anatomy[J]. Stroke，

2000，31（6）：1346-1351.

[7] MILES K A. Measurement of tissue perfusion by

dynamic computed tomography[J]. Br J Radiol，1991，

64（761）：409-412.

[8] EASTWOOD J D，ALEXANDER M J，PETRELLA

J R，et al. Dynamic CT perfusion imaging with

acetazolamide challenge for the preprocedural

evaluation of a patient with symptomatic middle

cerebral artery occlusive disease[J]. AJNR Am J

Neuroradiol，2002，23（2）：285-287.

[9] BIESBROEK J M，NIESTEN J M，DANKBAAR

J W，et al. Diagnostic accuracy of CT perfusion

imaging for detecting acute ischemic stroke：a

systematic review and meta-analysis[J]. Cerebrovasc

Dis，2013，35（6）：493-501.

[10] SCHAEFER P W，ROCCATAGLIATA L，

LEDEZMA C，et al. First-pass quantitative CT

perfusion identifies thresholds for salvageable

penumbra in acute stroke patients treated with intraarterial

therapy[J]. AJNR Am J Neuroradiol，2006，

27（1）：20-25.

[11] NABAVI D G，DITTRICH R，KLOSKA S P，et al.

Window narrowing：a new method for standardized

assessment of the tissue at risk-maximum of

infarction in CT based brain perfusion maps[J].

Neurol Res，2007，29（3）：296-303.

[12] KOENIG M，KRAUS M，THEEK C，et al.

Quantitative assessment of the ischemic brain by

means of perfusion-related parameters derived from

perfusion CT[J]. Stroke，2001，32（2）：431-437.

[13] BANG O Y，GOYAL M，LIEBESKIND D S.

Collateral circulation in ischemic stroke：assessment

tools and therapeutic strategies[J]. Stroke，2015，46

（11）：3302-3309.

[14] TURK A S，MAGARICK J A，FREI D，et al. CT

perfusion-guided patient selection for endovascular

recanalization in acute ischemic stroke：a multicenter

study[J]. J Neurointerv Surg，2013，5（6）：523-527.

[15] MACKEY J，KHATRI P，BRODERICK J P，et al.

Increasing use of CT angiography in interventional

study sites：the IMS Ⅲ experience[J]. AJNR Am J

Neuroradiol，2010，31（3）：E34.

[16] KLOTZ E，KÖNIG M. Perfusion measurements of

the brain：using dynamic CT for the quantitative

assessment of cerebral ischemia in acute stroke[J].

Eur J Radiol，1999，30（3）：170-184.

[17] MUKHERJEE S，RAGHAVAN P，PHILLIPS C D.

Computed tomography perfusion：acute stroke and

beyond[J]. Semin Roentgenol，2010，45（2）：116-

125.

[18] VON KUMMER R. Brain hemorrhage after

thrombolysis：good or bad?[J]. Stroke，2002，33（6）：

1446-1447.

[19] HAFEZ S，HODA M N，GUO X，et al. Comparative

analysis of different methods of ischemia/reperfusion

in hyperglycemic stroke outcomes：interaction with

tPA[J]. Transl Stroke Res，2015，6（3）：171-180.

[20] ÁLVAREZ-SABÍN J，MAISTERRA O，

SANTAMARINA E，et al. Factors influencing

haemorrhagic transformation in ischaemic stroke[J].

Lancet Neurol，2013，12（7）：689-705.

[21] AVIV R I，D'ESTERRE C D，MURPHY B D，et

al. Hemorrhagic transformation of ischemic stroke：

prediction with CT perfusion[J]. Radiology，2009，

250（3）：867-877.

[22] LATOUR L L，KANG D W，EZZEDDINE M A，et

al. Early blood-brain barrier disruption in human

focal brain ischemia[J]. Ann Neurol，2004，56（4）：

468-477.

[23] HOM J，DANKBAAR J W，SOARES B P，et

al. Blood-brain barrier permeability assessed by

perfusion CT predicts symptomatic hemorrhagic

transformation and malignant edema in acute

ischemic stroke[J]. AJNR Am J Neuroradiol，2011，

32（1）：41-48.

[24] SABA L，SANFILIPPO R，PIRISI R，et al.

Multidetector-row CT angiography in the study of

atherosclerotic carotid arteries[J]. Neuroradiology，

2007，49（8）：623-637.

[25] KOELEMAY M J，NEDERKOOM P J，REITSMA J

B，et al. Systematic review of computed tomographic

angiography for assessment of carotid artery

disease[J]. Stroke，2004，35（10）：2306-2312.

[26] KAMATH A，SMITH W S，POWERS W J，et al.

Perfusion CT compared to H（2）（15）O/O （15）O

PET in patients with chronic cervical carotid artery

occlusion[J]. Neuroradiology，2008，50（9）：745-

751.

[27] HE C，GU M，JIANG R，et al. Noninvasive

assessment of the carotid and cerebrovascular

atherosclerotic plaques by multidetector CT in type-

2 diabetes mellitus patients with transient ischemic

attack or stroke[J]. Diabetol Metab Syndr，2013，5

（1）：9.