Skip to main content

Advertisement

SpringerLink
Log in

MR-Diffusion und -Perfusion beim Schlaganfall

Diffusion and perfusion MR imaging in stroke

  • Schlaganfall
  • Published:
Der Radiologe Aims and scope Submit manuscript

Zusammenfassung

Die Schlaganfall-MRT ermöglicht es, bei akuter zerebraler Ischämie den bereits initial entstandenen Infarkt darzustellen. Mittels Perfusions-MRT kann erfasst werden, welches Gewebe zusätzlich gefährdet ist, durch eine persistierende Minderdurchblutung zu infarzieren. Die MRT ermöglicht auch Untersuchern mit begrenzter Erfahrung einen zuverlässigen Infarktnachweis. Die wichtigste Differenzialdiagnose der zerebralen Ischämie, die intrazerebrale Blutung, kann ebenfalls sicher mit der MRT erkannt werden. Obwohl Diffusions- und Perfusions-MRT die Pathophysiologie der zerebralen Ischämie nur annäherungsweise darstellen, eignet sich die Methode, um Patienten zu erkennen, die von einer Reperfusionstherapie profitieren können. Ob die MRT auch geeignet ist, das Risiko einer sekundären Einblutung in einen Infarkt zu prognostizieren, ist noch nicht geklärt.

Abstract

Magnetic resonance imaging (MRI) in stroke makes it possible to visualize the initial infarct in cases of acute cerebral ischemia. Perfusion MRI serves to determine which tissues are additionally at risk of infarction due to persistent hypoperfusion. MRI also allows those examiners with limited experience to reliably confirm an infarct. The most important differential diagnosis of cerebral ischemia, intracerebral hemorrhage, can likewise be recognized with certainty using MRI. Although diffusion and perfusion MRI only demonstrate the pathophysiology of cerebral ischemia approximately, the method is suited for identifying those patients who would profit from reperfusion therapy. Whether MRI is also appropriate as an aid to reaching a prognosis on the risk of secondary hemorrhage has not yet been resolved.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1a–d
Abb. 2a–c

Literatur

  1. DeLaPaz RL, Shibata D, Steinberg GK, Zarnegar R, George C (1991) Acute cerebral ischemia in rabbits: correlation between MR and histopathology. AJNR Am J Neuroradiol 12:89–95

    CAS  PubMed  Google Scholar 

  2. Derex L, Nighoghossian N, Hermier M et al. (2004) Thrombolysis for ischemic stroke in patients with old microbleeds on pretreatment MRI. Cerebrovasc Dis 17:238–241

    Article  CAS  PubMed  Google Scholar 

  3. Fiebach J, Schellinger P, Jansen O et al. (2002) CT and diffusion-weighted MR imaging (DWI) in randomized order: DWI results in higher accuracy and lower interrater variability in the diagnosis of hyperacute ischemic stroke. Stroke 33:2206–2210

    Article  CAS  PubMed  Google Scholar 

  4. Fiebach JB, Schellinger PD, Gass A et al. (2004) Stroke MRI is accurate in hyperacute intracerebral hemorrhage. A multicenter study on the validity of stroke imaging. Stroke 35:502–507

    Article  PubMed  Google Scholar 

  5. Fiehler J, Knudsen K, Kucinski T et al. (2004) Predictors of apparent diffusion coefficient normalization in stroke patients. Stroke 35:514–519

    Article  PubMed  Google Scholar 

  6. Hacke W, Donnan G, Fieschi C et al. (2004) Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 363:768–774

    PubMed  Google Scholar 

  7. Hacke W, Albers G, Al-Rawi Y et al. (2005) The Desmoteplase in Acute Ischemic Stroke Trial (DIAS): a phase II MRI-based 9-hour window acute stroke thrombolysis trial with intravenous desmoteplase. Stroke 36:66–73

    Article  CAS  PubMed  Google Scholar 

  8. Kidwell C, Saver J, Villablanca J et al. (2002) Magnetic resonance imaging detection of microbleeds before thrombolysis: an emerging application. Stroke 33:95–98

    Article  PubMed  Google Scholar 

  9. Kidwell CS, Alger JR, Saver JL (2003) Beyond mismatch: evolving paradigms in imaging the ischemic penumbra with multimodal magnetic resonance imaging. Stroke 34:2729–2735

    Article  PubMed  Google Scholar 

  10. Kucinski T, Vaterlein O, Glauche V et al. (2002) Correlation of apparent diffusion coefficient and computed tomography density in acute ischemic stroke. Stroke 33:1786–1791

    Article  PubMed  Google Scholar 

  11. Latour L, Kang DW, Ezzeddine M, Chalela JA, Warach S (2004) Early blood-brain barrier disruption in human focal brain ischemia. Ann Neurol, in press

  12. Li F, Han SS, Tatlisumak T et al. (1999) Reversal of acute apparent diffusion coefficient abnormalities and delayed neuronal death following transient focal cerebral ischemia in rats. Ann Neurol 46:333–342

    Article  CAS  PubMed  Google Scholar 

  13. Li F, Liu KF, Silva MD et al. (2000) Transient and permanent resolution of ischemic lesions on diffusion-weighted imaging after brief periods of focal ischemia in rats : correlation with histopathology. Stroke 31:946–954

    CAS  PubMed  Google Scholar 

  14. Neumann-Haefelin T, Wittsack HJ, Wenserski F et al. (1999) Diffusion- and perfusion-weighted MRI — the DWI/PWI mismatch region in acute stroke. Stroke 30:1591–1597

    CAS  PubMed  Google Scholar 

  15. Nighoghossian N, Hermier M, Adeleine P et al. (2002) Old microbleeds are a potential risk factor for cerebral bleeding after ischemic stroke: a gradient-echo t2*-weighted brain MRI study. Stroke 33:735–742

    Article  CAS  PubMed  Google Scholar 

  16. Röther J, Schellinger PD, Gass A et al. (2002) Effect of intravenous thrombolysis on MRI parameters and functional outcome in acute stroke <6 hours. Stroke 33:2438–2445

    PubMed  Google Scholar 

  17. Saur D, Kucinski T, Grzyska U et al. (2003) Sensitivity and interrater agreement of CT and diffusion-weighted MR imaging in hyperacute stroke. AJNR Am J Neuroradiol 24:878–885

    PubMed  Google Scholar 

  18. Thijs VN, Somford DM, Bammer R, Robberecht W, Moseley ME, Albers GW (2004) Influence of arterial input function on hypoperfusion volumes measured with perfusion-weighted imaging. Stroke 35:94–98

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen

    J. B. Fiebach & M. Schlamann

  2. Neurologische Klinik, Universitätsklinikum Heidelberg

    P. D. Schellinger

  3. Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum, Hufelandstr. 55, 45147, Essen

    J. B. Fiebach

Authors
  1. J. B. Fiebach
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Schlamann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. D. Schellinger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. B. Fiebach.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fiebach, J.B., Schlamann, M. & Schellinger, P.D. MR-Diffusion und -Perfusion beim Schlaganfall. Radiologe 45, 412–419 (2005). https://doi.org/10.1007/s00117-005-1213-2

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00117-005-1213-2

Schlüsselwörter

Keywords

Search

Navigation