Perfusion and Diffusion Weighted MR Imaging to Identify "Tissue at Risk" for Delayed Infarction in Cerebral Vasospasm after SAH
スポンサーリンク
概要
- 論文の詳細を見る
Objective : Vasospasm and development of a delayed ischemic neurologic deficit following subarachnoid hemorrhage (SAH) is still a major reason for poor outcome of patients with successful clipped or coiled intracerebral aneurysms. We report our preliminary results of a MR-imaging protocol in patients after SAH. Perfusion (PWI) and diffusion (DWI) weighted MR imaging was utilized to identify tissue at risk for developing infarction due to vasospasm. On the basis of the results patients were selected for ballon anigoplasty or aggressive triple-H therapy.<BR>Methods : 25 patients were included in the protocol for MRI at the 1st, 3rd, and 8th day after SAH. MR imaging included PWI and DWI, MR-angiography (MRA) as well as axial T2, T2* and FLAIR sequences. To identify tissue at risk a protocol similar to that utilized in ischemic stroke was used : areas with a delay perfusion>6 sec and no elevation of signal intensity in DWI. MRA was screened for narrowing of intracranial arteries. On the basis of these findings patients were selected for aggressive triple H therapy, more invasive monitoring or-when tissue at risk was identified-for ballon angioplasty.<BR>Results : In 3 patients tissue at risk could be identified due to vasospastic narrowing of intracranial arteries. PWI and DWI showed severe missmatch in different vascular territories. With DSA segmental proximal vasospasm could be confirmed and subsequent ballon angioplasty was performed. In all three patients progression into tissue infarction could be prevented. In follow up MR imaging impaired tissue perfusion was significantly reduced.<BR>Conclusion : MR imaging utilizing perfusion and diffusion weighted imaging is a very promising noninvasive tool to detect tissue at risk for infarction in cerebral vasospasm after SAH. Appropriate measures can be taken to prevent infarction as indicated in our preliminary series.
- 一般社団法人 日本脳卒中学会の論文
一般社団法人 日本脳卒中学会 | 論文
- Two cases with aphasia in the left putaminal damage and one case with visuospatial neglect in the right putaminal damage
- Alterations of plasma von Willebrand factor activity and the influence of anti-platelet drugs in acute cerebral infarction
- Carotid endarterectomy plaques correlation of clinical events and morphology.
- Stenting for stenosis of major cerebrovascular arteries.
- Cerebral infarction following antihypertensive therapy.