ULOGA KOMPJUTERIZOVANE TOMOGRAFIJE U EVALUACIJI AKUTNOG ISHEMIJSKOG MOŽDANOG UDARA

  • Radiša Vojinović University of Kragujevac, Serbia, Faculty of Medical Sciences, Department of Radiology
  • Valentina D Opancina Fakultet medicinskih nauka, Univerzitet u Kragujevcu
Ključne reči: early signs||, ||rani znaci, ischemic stroke||, ||ishemijski moždani udar, acute||, ||akutni, computed tomography||, ||kompjuterizovana tomografija,

Sažetak


Moždani udar je nagli gubitak funkcije mozga koji se dešava zbog prekida cerebralne cirkulacije. Odlikuje se ekspeditivnim razvojem kliničkih simptoma tokom 24 sata, koji kod nekih pacijenata dovode do smrti. U više od 80% pacijenata sa moždanim udarom, uzrok je vaskularna insuficijencija i ova vrsta moždanog udara je ishemijska. To je hitno stanje kod kojeg je neophodno ubrzano zbrinjavanje radi optimalne prognoze. Evaluacija ishemijskog moždanog udara se u većini slučajeva postiže kompjuterizovanom tomografijom, bez upotrebe kontrasta, zahvaljujući njenoj  širokoj upotrebi.

Detaljan pretraga literatura kroz Medline i EBSCO baze podataka je izvršen, koristeći sledeće ključne reči: (kompjuterska tomografija) i (akutni ishemijski moždani udar) i (rani znaci). Izabrani su originalni radovi, meta-analize i pregledni papiri iz poslednjih 10 godina, sa pristupačnim tekstovima, na engleskom jeziku, kao i značajne reference koje mogu doprineti shvatanju čitalaca. Nakon detaljnog pregleda literature, izdvojili smo i opisali sledeće rane znake akutnog ishemijskog moždanog udara: znak insularne trake, potamnjenje nucleus lentiformisa, znak hiperdenziteta arterija, hipodenzitet hemisfera i fokalna hipoatenuacija.  Ovi znaci su povezani sa posledicama ćelijske hipoperfuzije i citotoksičnim edemom.

Cilj ovog rada je bio pregled literature o ulozi kompjuterizovane tomografije kod pacijenata sa ranim znacima akutnog ishemijskog moždanog udara i da služi kao edukativni materijal koji ilustruje te nalaze.

Reference

Alawneh JA, Clatworthy PL, Morris RS, Warburton E. Stroke management. Clin Evid 2011;6:201.

World Health Organization. The world health report. Geneva, Switzerland 2004.

Lloyd-Jones D, Adams RJ, Brown TM, et al. Executive summary: heart disease and stroke statistics--2010 update: a report from the American Heart Association. Circulation 2010;121(7):948–54.

Malaysian Society of Neuroscience. Clinical Practice Guidelines: Management of ischaemic stroke. second edition ed. 2011.

Tharakan J. Stroke registry-relevance and contributions. Medical Journal of Malaysia 2012; 67: 251-2.

Astrup J, Siesjo BK, Symon L. Thresholds in cerebral ischemia - the ischemic penumbra. Stroke 1981;12(6):723–5.

Hossmann KA. Viability thresholds and the penumbra of focal ischemia. Ann Neurol 1994;36(4):557–65.

Hossmann KA. Neuronal survival and revival during and after cerebral ischemia. Am J Emerg Med 1983;1(2):191–7.

Leiva-Salinas C, Wintermark M. Imaging of Ischemic Stroke. Neuroimaging Clin N Am 2010 ; 20(4): 455–468.

Mayer TE, Hamann GF, Baranczyk J, et al. Dynamic CT perfusion imaging of acute stroke. AJNR Am J Neuroradiol 2000;21(8):1441–9.

Read SJ, Hirano T, Abbott DF, et al. The fate of hypoxic tissue on 18F fluoromisonidazole positron emission tomography after ischemic stroke. Ann Neurol 2000;48(2):228–35.

Schröder J, Thomalla G. A critical review of alberta stroke program early CT score for evaluation of acute stroke imaging. Front Neurol 2017; 7:245.

Darby DG, Barber PA, Gerraty RP, et al. Pathophysiological topography of acute ischemia by combined diffusion-weighted and perfusion MRI. Stroke 1999;30(10):2043–52.

Hacke W, Donnan G, Fieschi C, et al. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 2004; 363(9411):768–74.

Abul-Kasim K, Brizzi M, Petersson J, Sundgren PC. Added diagnostic utility of CT perfusion and CT angiography in acute ischemic stroke. Evaluation of three different patient categories. Funct Neurol 2009;24(2):93-8.

Bader MK, Palmer S. What's the "hyper" in hyperacute stroke? Strategies to improve outcomes in ischemic stroke patients presenting within 6 hours. AACN Adv Crit Care 2006;17(2):194-214.

Schellinger PD, Warach S. Therapeutic time window of thrombolytic therapy following stroke. Curr Atheroscler Rep 2004;6(4):288–94.

Sperber C, Karnath HO. Topography of acute stroke in a sample of 439 right brain damaged patients. Neuroimage Clin 2015; 10:124-8.

González RG, Schwamm LH. Imaging acute ischemic stroke. Handb Clin Neurol 2016;135:293-315.

Ambrose J. Computerized transverse axial scanning (tomography): part 2. Clinical application. Br J Radiol 1973; 46:1023-47.

Ambrose J. Computerized x-ray scanning of the brain. J Neurosurg 1974; 40:679-95.

Cronquist S, Brismar J, Jellin K. Computer assisted axial tomography in cerebrovascular lesions. Acta Radiol Diagn 1975; 16:135-41.

Rodríguez-Rivera IV, Santiago F, Estapé ES, González-Sepúlveda L, Brau R. Impact of day of the week and time of arrival on ischemic stroke management. P R Health Sci J 2015; 34(3):164-9.

Eastwood JD, Lev MH, Azhari T et al. CT perfusion scanning with deconvolution analysis: pilot study in patients with acute middle cerebral artery stroke. Radiology 2002; 222:227-36.

Kloska SP, Fischer T, Nabavi DG, Dittrich R, Ditt H, Klotz E, Fischbach R, Ringelstein EB, Heindel W. Color-coded perfused blood volume imaging using mutidetector CT: initial results of whole-brain perfusion analysis in acute cerebral ischemia. Eur Radiol, 2007; 17(9):2352-8.

Lev MH, Farkas J, Rodriguez VR et al. CT angiography in the rapid triage of patients with hyperacute stroke to intraarterial thrombolysis: accuracy in the detection of large vessel thrombus. J Comput Assist Tomogr 2001; 25:520-8

Camargo EC, Furie KL, Singhal AB, Roccatagliata L, Cunnane ME, Halpern EF, Harris GJ, Smith WS, Gonzalez RG, Koroshetz WJ, Lev MH. Acute brain infarct: detection and delineation with CT angiographic source images versus nonenhanced CT scans. Radiology 2007; 244(2):541-8.

Radhiana H, Syazarina S O, Shahizon Azura M M, Hilwati H, Sobri M A. Non-contrast computed tomography in acute ischaemic stroke: a pictorial review. Med J Malaysia 2013 ;68(1):93-100.

Schaefer PW, Ozsunar Y, He J, Hamberg LM, Hunter GJ, Sorensen AG, Koroshetz WJ, Gonzalez RG. Assessing tissue viabillity with MR diffusion and perfusion imaging. Am J Neuroradiol 2003; 24:436-43.

Wu O, Koroshetz WJ, Ostergaard L et al. Predicting tissue outcome in acute human cerebral ischemia using combined diffusion- and perfusion-weighted MR imaging. Stroke 2001; 32:933-42.

Dimic N, Vojinovic R. Rani CT znaci infarkta mozga – ucestalost i znacaj. PONS 2012; 10(1):3-6.

Hacke W, Kaste M, Fieschi C, et al. Randomised double-blind placebo controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II): Second Europian-Australian acute stroke study investigators. Lancet 1998; 352: 1245-51.

Qureshi AI, Saleem MA, Aytaç E, Malik AA. The effect of diagnostic catheter angiography on outcomes of acute ischemic stroke patients being considered for endovascular treatment. J Vasc Interv Neurol 2017; 9(3):45-50.

Pavabvash S, Taleb S, Majidi S, Qureshi AI. Correlation of acute M1 middle cerebral artery thrombus location with endovascular treatment success and clinical outcome. J Vasc Interv Neurol 2017; 9(3):17-22.

Coutts SB, O`Reilly C, Hill MD, Steffenhagen N, Poppe AY, Boyko MJ, Puetz VJ, Demchuk AM. Calgari study group. Computed tomography and computed tomography angiography findings predict functional impairment in patients with minor stroke and transient ischemic attack. Int J Stroke 2009; 4(6):448-53.

Salomon EJ, Barfett J, Willems PW, et al. Dynamic CT angiography and CT perfusion employing a 320-detector row CT: protocol and current clinical applications. Klin Neuroradiol 2009;19(3):187–96.

Gomolka RS, Chrzan RM, Urbanik A, Nowinski WL. A quantitative method using head noncontrast CT scans to detect hyperacute nonvisible ischemic changes in patients with stroke. J Neuroimaging 2016; 26(6):581-7.

Noguchi K, Itoh T, Naruto N, Takashima S, Tanaka K, Kuroda S. A novel imaging technique (x-map) to identify acute ischemic lesions using noncontrast dual-energy computed tomography. J Stroke Cerebrovasc Dis 2017; 26(1):34-41.

Wardlaw JM, Mielke O. Early signs of brain infarction at CT: observer reliability and outcome after thrombolytic treatment-systematic review. Radiology 2005; 235: 444-53.

Vojinovic R. Mogućnosti kompjuterizovane tomografije u ranoj dijagnostici infarkta mozga. Doktorska disertacija. Fakultet medicinskih nauka u Kragujevcu, 2012.

Gacs G, Fox AJ, Barnett HJM et al. CT visualization of intracranial arterial thromboembolism. Stroke 1983; 14:756-62.

Somford DM, Nederkoorn PJ, Rutgers DR, Kappelle LJ, Mali WP, van der Grond J. Proximal and distal hyperattenuating middle cerebral artery signs at CT: different prognostic implications. Radiology 2002; 223(3):667-71.

Koga M, Saku Y, Toyoda K, Takaba H, Ibayashi S, Iida M. Reappraisal of early CT signs to predict the arterial occlusion site in acute embolic stroke. J Neurol Neurosurg Psychiatry 2003; 74: 649-53.

Truwit CL, Barkovich AJ, Gean-Marton A, Hibri B, Norman D. Loss of the insular ribbon: another early CT sign of acute middle cerebral artery infarction. Radiology 1990; 176: 801-06.

Furlan AJ, Eyding D, Albers GW, et al. Dose escalation of desmoteplase for acute ischemic stroke (DEDAS): evidence of safety and efficacy 3 to 9 hours after stroke onset. Stroke 2006;37(5):1227–31.

Jensen UR, Weiss M, Zimmermann P, Jansen O, Riedel C. The hyperdense anterior cerebral artery sign (HACAS) as a computed tomography marker for acute ischemia in the anterior cerebral artery territory. Cerebrovasc Dis 2010; 29(1):62-7.

Leary MC, Kidwell CS, Villablanca JP, Starkman S. Jahan R, Duckwiler GR et al. Validation of computed tomographic middle cerebral artery «dot» sign: an angiographyc correlation study. Stroke 2003; 34(11):2636-40.

Jha B, Kothari M. Pearls & oy-sters: hyperdense or pseudohyperdense MCA sign: a Damocles sword? Neurology 2009; 72(23):e116-7.

Pikija S, Magdic J, Trkulja V, et al. Intracranial thrombus morphology and composition undergoes time-dependent changes in acute ischemic stroke: a CT densitometry study. Int J Mol Sci 2016;17(11). pii: E1959.

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2017/04/19
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