Uloga nekontrastne magnetno-rezonantne perfuzije u dijagnostici, terapiji i prognozi kliničkog ishoda akutnog ishemijskog moždanog udara
2020
Acute ischemic stroke (AIS) is an emergency condition causing the interruption of blood flow through one or more cerebral blood vessels. The discovery and application of advanced magnetic-resonance (MRI) techniques in clinical practice has significantly improved diagnostic accuracy in early detection of AIS, whereas the introduction of noncontrast arterial spin labeling (ASL) perfusion sequence is a significant milestone in neuroradiology.
This research aimed to demonstrate MRI as the method of choice in early diagnostics of AIS that provides insight into diagnostic and prognostic parameters. We examined the influence of a specific ASL sequence findings on the AIS functional outcome, in correlation with other protocol sequences findings.
The research was conducted as a prospective cross-sectional study at the Department of Radiology, Clinical Center Nis and the Department of Neuroradiology, University Hospital Pitie‐Salpetriere, Paris.
The study included 205 patients of both sexes (aged ≥18 years) fulfilling clinical criteria for the diagnosis of AIS of the anterior cerebral circulation. All patients were examined on GE MRI scanners (field strength of 3T), using an ischemia protocol.
Results showed high efficiency of MRI in the detection of early hyperacute and acute ischemic lesions. The ASL perfusion sequence allows the detection of favorable AIS outcome predictors, primarily higher absolute cerebral blood flow (aCBF) values, the presence of arterial transient artifacts, and luxury perfusion. Significant certainty
Aleksandra Z. Aracki-Trenkic DOKTORSKA DISERTACIJA 7
in the detection of the occlusion site is achieved through the correlation of ASL and susceptibility weighted angiography (SWAN) sequence findings with the possibility of assessing the etiological type of AIS. A multivariate logistic regression analysis found the most significant predictors of favorable functional outcome were the involvement of the territory on the diffusion sequence and aCBF values.
In addition to early diagnosis of AIS, MRI with modern advanced sequences enables functional outcome prediction, thus influencing the choice of adequate therapy.
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