Annals of Clinical and Experimental NeurologyAnnals of Clinical and Experimental NeurologyАнналы клинической и экспериментальной неврологии2075-54732409-2533Eco-Vector39710.17816/psaic397TechnologiesТехнологииUnknownCT-perfusion in acute ischemic strokeМетодика перфузионной компьютерной томографии в диагностике острого ишемического инсультаhttps://orcid.org/0000-0002-9130-1292SergeevDmitry V.СергеевДмитрий Владимирович
Russian Federation

Cand. Sci. (Med.), neurologist, Neurorehabilitation department with TMS group

к.м.н., врач-невролог отд. анестезиологии-реанимации с палатами реанимации и интенсивной терапии

krotenkova_mrt@mail.ruLavrentyevaA. N.ЛаврентьеваA. Н.
Russian Federation
krotenkova_mrt@mail.ruhttps://orcid.org/0000-0003-3820-4554KrotenkovaMarina V.КротенковаМарина Викторовна
Russian Federation

D. Sci. (Med.), Head, Department of radiation diagnostics, Institute of Clinical and Preventive Neurology

д.м.н., зав. отделением лучевой диагностики Института клинической и профилактической неврологии

krotenkova_mrt@mail.ruResearch Center of NeurologyФГБНУ «Научный центр неврологии»1409200823303707022017Copyright ©; 2008, Sergeev D.V., Lavrentyeva A.N., Krotenkova M.V.Copyright ©; 2008, Sergeev D.V., Lavrentyeva A.N., Krotenkova M.V.2008Sergeev D.V., Lavrentyeva A.N., Krotenkova M.V.Sergeev D.V., Lavrentyeva A.N., Krotenkova M.V.https://creativecommons.org/licenses/by/4.0https://annaly-nevrologii.com/pathID/article/view/397

Current approaches to the diagnostics of acute stroke rely on methods of visualization that assess not only anatomical changes of the ischemic brain, but also allow to evaluate the potential effectiveness and safety of thrombolytic therapy beyond therapeutic “time window” and to study pathophysiological features of cerebral ischemia. Perfusion CT (PCT) is discussed herein as a reliable and easily available tool for acute ischemic stroke diagnostics, used as an add on to conventional CT scanning. PCT rapidly distinguishes the volume of irreversible damaged tissue and penumbra, and hence to choose optimal treatment approach and to assess its effectiveness. Technical and clinical features of PCT are reviewed, along with interpretation of PCT results in the view of pathophysiological mechanisms of cerebral ischemia, advantages and disadvantages of the technique and perspectives of its further development.

В настоящее время в диагностике острого инсульта все большее значение приобретают методы, позволяющие не только исследовать состояние анатомических структур мозга, но и оценить потенциальную эффективность и безопасность тромболитической терапии вне зависимости от временных рамок, а также изучить патофизиологические особенности развития заболевания. В статье рассматривается методика перфузионной компьютерной томографии (ПКТ) – надежного и доступного инструмента диагностики ишемического инсульта в острейшем периоде, которая проводится в качестве необременительного дополнения к традиционному КТ-исследованию. ПКТ позволяет определить распространенность зоны дисгемии и разграничить зону необратимо поврежденной ткани и пенумбру, что дает возможность быстро выбрать тактику дальнейшего лечения и в дальнейшем оценить его эффективность. Описаны технические и клинические аспекты применения ПКТ, интерпретация ее результатов в свете представлений о патофизиологии нарушения мозгового кровообращения, преимущества и недостатки, а также перспективы дальнейшего развития метода.

CT-perfusionacute ischemic strokeКТ-перфузияострый ишемический инсультКорниенко В.Н., Пронина И.Н. (ред.) Диагностическая нейрорадиология. М., 2006.Суслина З.А., Пирадов М.А. (ред.) Инсульт: диагностика, лечение, профилактика. М.: МЕДпресссинформ, 2008.Корниенко В. Н., Пронин И. Н., Пьяных И. С. и др. Исследование тканевой перфузии головного мозга методом компьютерной томографии. Медицинская визуализация 2007; 2: 70–81.Суслина 3.А. (ред.) Очерки ангионеврологии. М.: Атмосфера, 2005.Суслина 3.А., Варакин Ю.Я. Эпидемиологические аспекты изучения инсульта. Время подводить итоги. Анналы клинической и экспериментальной неврологии 2007; 1(2): 22–28.Adams H.P., del Zoppo G., Alberts M.J. et al. Guidelines for the Early Management of Adults With Ischemic Stroke. Stroke 2007; 38: 1655–1711Astrup J., Siesjo B.K., Symon L. Thresholds in cerebral ischemia – the ischemic penumbra. Stroke 1981; 12: 723–725.Axel L. Cerebral blood flow determination by rapidsequence computed tomography. Radiology 1980; 137: 679–686.Baron J.C. Perfusion thresholds in human cerebral ischemia: historical perspective and therapeutic implications. Cerebrovasc. Dis. 2001; 11 (Suppl. 1): 2–8.Cenic A., Nabavi D.G., Craen R.A. et al. Dynamic CT measurement of cerebral blood flow: a validation study. Am. J. Neuroradiol. 1999; 20: 63–73.Eastwood J.D., Lev M.H.,Wintermark M. et al. Correlation of early dynamic CT perfusion imaging with wholeebrain MR diffusion and perfusion imaging in acute hemispheric stroke. Am. J. Neuroradiol.2003; 24: 1869–1875.The European Stroke Organization (ESO) Executive Committe and the ESO Writing Committee. Guidelines for Management of Ischaemic Stroke and Transient Ischaemic Attack. 2008.Hacke W., Albers G., AllRawi Y. et al. The Desmoteplase in Acute Stroke Trial (DIAS): A Phase II MRIBased 99hour Window Acute Stroke Thrombolysis Trial with Intravenous Desmoteplase. Stroke 2005; 36:66–73.Heiss W.D. Flow thresholds for functional and morphological damage of brain tissue. Stroke 1983; 14: 329–31.Heiss W.D. Ischemic penumbra: evidence from functional imaging in man. J. Cereb. Blood Flow Metab. 2000; 20: 1276–93.Hoeffner E.G., Case I., Jain R. et al. Cerebral Perfusion CT: Technique and Clinical Applications. Radiology 2004; 231: 632–644.Hossmann K.A. Viability thresholds and the penumbra of focal ischemia. Ann Neurol. 1994; 36: 557–565.Hossmann K.A. Viability thresholds and the penumbra of focal ischeemia. Ann. Neurol. 1994; Oct., 36 (4): 557–65.Latchaw R.E., Yonas H., Hunter G.J. et al. Guidelines and Recommendations for Perfusion Imaging in Cerebral Ischemia: A Scientific Statement for Healthcare Professionals by the Writing Group on Perfusion Imaging, From the Council on Cardiovascular Radiology of the American Heart Association. Stroke 2003; 34: 1084–1104.Lev M.H., Farkas J., Rodriguez V.R. 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: 520–528.Mehta N., Lev M.H., Mullins M.E. et al. Prediction of final infarct size in acute stroke using cerebral blood flow/cerebral blood volume mismatch: added value of quantitative first pass CT perfusion imaging in successfully treated versus unsuccessfully treated/untreated patients. Proceedings of the 41st Annual Meeting of the American Society of Neuroradiology. Washington DC, 2003.Miles K.A., Eastwood J.D., Konig M. (eds.) Multidetector Computed Tomography in Cerebrovascular Disease. CT Perfusion Imaging. Informa UK, 2007.Nabavi D.G., Cenic A., Craen R.A. et al. CT assessment of cerebral perfusion: experimental validation and initial clinical experience. Radiology 1999; 213: 141–149.Nabavi D.G., Cenic A., Dool J. et al. Quantitative assessment of cerebral hemodynamics using CT: stability, accuracy, and precision studies in dogs. J. Comput. Assist. Tomogr. 1999; 23: 506–515.Parsons M.W., Barber P.A., Chalk J. et al. Diffusionand perfusionweighted MRI response to thrombolysis in stroke. Ann. Neurol. 2002; 51: 28–37.Parsons M.W. Perfusion CT: is it clinically useful? International Journal of Stroke 2008; 3 (February): 41–50.Roberts H.C., Dillon W.P., Smith W.S. Dynamic CT Perfusion to Assess the Effect of Carotid Revascularization in Chronic Cerebral Ischemia. Am. J. Neuroradiol. 2000; 21: 421–425.Roccatagliata L., Lev M.H., Mehta N. et al. Estimating the size of ischemic regions on CT perfusion maps in acute stroke: is freehand visual segmentation sufficient? Proceedings of the 89th Scientific Assembly and Annual Meeting of the Radiological Society of North America. Chicago, 2003; Ill: 1292.Schaefer P.W., Ozsunar Y., He J. et al. Assessing tissue viability with MR diffusion and perfusion imaging. Am. J. Neuroradiol. 2003; 24: 436–443.Schlaug G., Benfield A., Baird A.E. et al. The ischemic penumbra: operationally defined by diffusion and perfusion MRI. Neurology 1999; 53: 1528–1537.Schramm P., Schellinger P.D., Klotz E. et al. Comparison of perfusion computed tomography and computed tomography angiography source images with perfusionnweighted imaging and diffusionnweighted imaging in patients with acute stroke of less than 6 hours’ duration. Stroke 2004; 35 (7): 1652–1658.Shetty S.H., Lev M.H. CT perfusion. In: Gonzalez R.G., Hirsch J.A., Koroshetz W.J. et al. (eds.) Acute Ischemic Stroke. Imaging and Intervention. Berlin–Heidelberg: SpringerrVerlag, 2006.Warach S. New imaging strategies for patient selection for thrombolytic and neuroprotective therapies. Neurology 2001; 57: S48–S52.Wintermark M., Reichhart M., Cuisenaire О. et al. Comparison of admission perfusion computed tomography and qualitative diffusion and perfusionnweighted magnetic resonance imaging in acute stroke patients. Stroke 2002; 33: 2025–2031.Wintermark M., Reichhart M., Thiran J.P. et al. Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients. Ann. Neurol. 2002; 51: 417–432.Wintermark M., Sesay M., Barbier E. et al. Comparative Overview of Brain Perfusion Imaging Techniques. Stroke 2005; 36: 83–99.Wintermark M., Thiran J.P., Maeder P. et al. Simultaneous measurement of regional cerebral blood flow by perfusion CT and stable xenon CT: a validation study. Am. J. Neuroradiol. 2001; 22: 905–914.