2011, Número 3
Usefulness of diffusion-perfusion analysis by magnetic resonance imaging for ischemic penumbra detection in brain stroke
Martínez-Martínez LÁ, Roldán-Valadez E, Fernández LY, Corona-Cedillo R, Martínez-López M
Idioma: Ingles.
Referencias bibliográficas: 29
Paginas: 139-147
Archivo PDF: 535.09 Kb.
RESUMEN
El accidente cerebrovascular es la principal causa de mortalidad y
morbilidad en el mundo desarrollado. El avance tecnológico actual
permite no sólo una representación del tejido infartado, sino también
de los tejidos adyacentes con oligemia, es decir, la región de
la penumbra. Se considera que la resonancia magnética (RM) es el
mejor método para el estudio y evaluación de infarto cerebral y la
penumbra. En la actualidad, imágenes convencionales son sólo un
complemento en el análisis de difusión-perfusión, permiten cuantificar
el flujo sanguíneo cerebral y el volumen (CBF y CBV), así
como el tiempo-a-pico (TTP) tras la administración de contraste.
Estos tres parámetros constituyen las variables hemodinámicas que
se alteran en un infarto cerebral. En este trabajo se presentan los
hallazgos típicos de la RM en el caso clínico de un paciente con
infarto cerebral hiperagudo que muestra la pérdida de flujo sanguíneo
de la arteria cerebral media, una importante zona de penumbra,
disminución de ADC de 40 a 70%, disminución de la CBF y
CBV, aumento de MTT, y TTP con retraso de 10 a 13 s.
REFERENCIAS (EN ESTE ARTÍCULO)
Schlaug G, Benfield A, Baird AE, Siewert B, Lovblad KO, Parker RA, et al. The ischemic penumbra: operationally defined by diffusion and perfusion MRI. Neurology 1999; 53(7): 1528-37.
Sanchez-Almazan N. Enfermedad Cerebro-Vascular en México. Epidemiología y pronóstico. Rev Ministerio de Salud 2008: 1-5.
Rowley HA. The four Ps of acute stroke imaging: parenchyma, pipes, perfusion, and penumbra. AJNR Am J Neuroradiol 2001; 22(4): 599-601.
Astrup J, Siesjo BK, Symon L. Thresholds in cerebral ischemiathe ischemic penumbra. Stroke 1981; 12(6): 723-5.
Sorensen AG, Buonanno FS, Gonzalez RG, Schwamm LH, Lev MH, Huang-Hellinger FR, et al. Hyperacute stroke: evaluation with combined multisection diffusion-weighted and hemodynamically weighted echo-planar MR imaging. Radiology 1996; 199(2): 391-401.
Furlan AJ, Eyding D, Albers GW, Al-Rawi Y, Lees KR, Rowley HA, 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.
Tomandl BF, Klotz E, Handschu R, Stemper B, Reinhardt F, Huk WJ, et al. Comprehensive imaging of ischemic stroke with multisection CT. Radiographics 2003; 23(3): 565-92.
Bryan RN, Levy LM, Whitlow WD, Killian JM, Preziosi TJ, Rosario JA. Diagnosis of acute cerebral infarction: comparison of CT and MR imaging. AJNR Am J Neuroradiol 1991; 12(4): 611-20.
The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333(24): 1581-7.
Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA 1995; 274(13): 1017-25.
Saini M, Butcher K. Advanced imaging in acute stroke management- Part II: Magnetic resonance imaging. Neurol India 2009; 57(5): 550-8.
Sorensen AG, Copen WA, Ostergaard L, Buonanno FS, Gonzalez RG, Rordorf G, et al. Hyperacute stroke: simultaneous measurement of relative cerebral blood volume, relative cerebral blood flow, and mean tissue transit time. Radiology 1999; 210(2): 519-27.
Ribo M, Molina CA, Rovira A, Quintana M, Delgado P, Montaner J, et al. Safety and efficacy of intravenous tissue plasminogen activator stroke treatment in the 3- to 6-hour window using multimodal transcranial Doppler/MRI selection protocol. Stroke 2005; 36(3): 602-6.
Hacke W, Albers G, Al-Rawi Y, Bogousslavsky J, Davalos A, Eliasziw M, et al. The Desmoteplase in acute ischemic stroke trial (DIAS): a phase II MRI-based 9-hour window acute stroke thrombolysis trial with intravenous desmoteplase. Stroke 2005; 36(1): 66-73.
Leys D, Pruvo JP, Godefroy O, Rondepierre P, Leclerc X. Prevalence and significance of hyperdense middle cerebral artery in acute stroke. Stroke 1992; 23(3): 317-24.
Schellinger PD, Chalela JA, Kang DW, Latour LL, Warach S. Diagnostic and prognostic value of early MR Imaging vessel signs in hyperacute stroke patients imaged < 3 hours and treated with recombinant tissue plasminogen activator. AJNR Am J Neuroradiol 2005; 26(3): 618-24.
Castillo M. Prethrombolysis brain imaging: trends and controversies. AJNR Am J Neuroradiol 1997; 18(10): 1830-4.
Inoue Y, Takemoto K, Miyamoto T, Yoshikawa N, Taniguchi S, Saiwai S, et al. Sequential computed tomography scans in acute cerebral infarction. Radiology 1980; 135(3): 655-62.
Libman RB, Wirkowski E, Alvir J, Rao TH. Conditions that mimic stroke in the emergency department. Implications for acute stroke trials. Arch Neurol 1995; 52(11): 1119-22.
Riggs JE. Tissue-type plasminogen activator should not be used in acute ischemic stroke. Arch Neurol 1996; 53(12): 1306-8.
Fox AJ, Bogousslavsky J, Carey LS, Barnett HJ, Vinitski S, Karlik SJ, et al. Magnetic resonance imaging of small medullary infarctions. AJNR Am J Neuroradiol 1986; 7(2): 229-33.
Beaulieu CF, Zhou X, Cofer GP, Johnson GA. Diffusion-weighted MR microscopy with fast spin-echo. Magn Reson Med 1993; 30(2): 201-6.
Liu G, van Gelderen P, Duyn J, Moonen CT. Single-shot diffusion MRI of human brain on a conventional clinical instrument. Magn Reson Med 1996; 35(5): 671-7.
Lansberg MG, Thijs VN, O’Brien MW, Ali JO, de Crespigny AJ, Tong DC, et al. Evolution of apparent diffusion coefficient, diffusion- weighted, and T2-weighted signal intensity of acute stroke. AJNR Am J Neuroradiol 2001; 22(4): 637-44.
Tong DC, Yenari MA, Albers GW, O’Brien M, Marks MP, Moseley ME. Correlation of perfusion- and diffusion-weighted MRI with NIHSS score in acute (< 6.5 hour) ischemic stroke. Neurology 1998; 50(4): 864-70.
Ostergaard L. Principles of cerebral perfusion imaging by bolus tracking. J Magn Reson Imaging 2005; 22(6): 710-7.
Albers GW, Thijs VN, Wechsler L, Kemp S, Schlaug G, Skalabrin E, et al. Magnetic resonance imaging profiles predict clinical response to early reperfusion: the diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study. Ann Neurol 2006; 60(5): 508-17.
Sobesky J, Zaro Weber O, Lehnhardt FG, Hesselmann V, Thiel A, Dohmen C, et al. Which time-to-peak threshold best identifies penumbral flow? A comparison of perfusion-weighted magnetic resonance imaging and positron emission tomography in acute ischemic stroke. Stroke 2004; 35(12): 2843-7.
Schwamm LH, Koroshetz WJ, Sorensen AG, Wang B, Copen WA, Budzik R, et al. Time course of lesion development in patients with acute stroke: serial diffusion- and hemodynamic-weighted magnetic resonance imaging. Stroke 1998; 29(11): 2268-76.
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