Download PDF
Nervenheilkunde 2006; 25(11): 927-932
DOI: 10.1055/s-0038-1626801
Originaler Artikel
Schattauer GmbH

MR-Bildgebung beim akuten Schlaganfall

Ergebnisse aus dem ImagingNet im Kompetenznetz SchlaganfallMR-Imaging in acute strokeResults from the ImagingNet of the Competence Net Stroke
G. J. Jungehülsing
1   Klinik und Poliklinik für Neurologie und Berlin NeuroImaging Center, Charité Universitätsmedizin Berlin
,
C. H. Nolte
1   Klinik und Poliklinik für Neurologie und Berlin NeuroImaging Center, Charité Universitätsmedizin Berlin
,
P. Brunecker
1   Klinik und Poliklinik für Neurologie und Berlin NeuroImaging Center, Charité Universitätsmedizin Berlin
,
A. Villringer
1   Klinik und Poliklinik für Neurologie und Berlin NeuroImaging Center, Charité Universitätsmedizin Berlin
› Author Affiliations
Further Information

Publication History

Publication Date:
18 January 2018 (online)

    Permissions and Reprints

Zusammenfassung

Im Rahmen multizentrischer Studien im Subnetz „Bildgebende Verfahren beim akuten Schlaganfall“ (ImagingNet) im Kompetenznetz Schlaganfall wurden wichtige Fragen zur Pathophysiologie der akuten zerebralen Ischämie und zum Stellenwert der MR-Bildgebung für Therapieentscheidungen beantwortet. Erstens kann man heute davon ausgehen, dass die Kernspintomographie (MRT) der Computertomographie im Nachweis akuter zerebraler Blutungen mindestens gleichwertig, bei der Darstellung chronischer „Mikrobleeds” aber überlegen ist. Zweitens hat sich die diffusionsgewichtete MRT (DW-MRT) als hoch sensitives Instrument in der sehr frühen Darstellung akuter zerebraler Ischämien erwiesen. Drittens bildet die Kombination aus DW-MRT und perfusionsgewichteter MRT (PW-MRT) ein zuverlässiges operationales Mismatch-Konzept zum Verständnis der Pathophysiologie der zerebralen Ischämie. Die Anwendung des Schlaganfall-MRT ist relevant für Therapieentscheidungen auch außerhalb des 3-Stundenfensters.

Summary

Studies from the ImagingNet within the Competence Net Stroke were important steps towards acceptance of stroke MRI and understanding of pathophysiology of ischemic stroke. It could be shown that MRI is at least as good as CT in the detection of early acute cerebral hemorrhage, but it may be even better in the detection of “chronic microbleeds”. Secondly, diffusion-weighted MRI (DWI) is now proven highly sensitive in the detection of early ischemic infarction. Finally, the combination of DWI and perfusionweighted Imaging (PWI) givesa useful operational „mismatch”-definition and new insights into the pathophysiology of ischemic stroke which is relevant for therapeutic decisions outside the 3-hour-time-window for systemic thrombolysis.

Schlüsselwörter

Schlaganfall - MRT - Bildgebung

Keywords

Stroke - MRI - imaging
 

  • Literatur

  • 1 Ay H, Oliveira-Filho J, Buonanno FS, Schaefer PW, Furie KL, Can Y, Rordor G, Schwamm LH, Gonzalez RG, Koroshetz WJ. Footprints of Transient Ischemic Attacks: A diffusion-weighted MRI Study. Cerebrovasc Dis 2002; 14: 177-86.
    CrossrefPubMedGoogle Scholar
  • 2 Baird AE, Warach S. Magnetic resonance imaging of acute stroke. J Cereb Blood Flow Metab 1998; Jun; 18: 583-609.
    CrossrefPubMedGoogle Scholar
  • 3 Bohner G, Forschler A, Hamm B, Lehmann R, Klingebiel R. Quantitative perfusion imaging by multi-slice CT in stroke patients. Rofo 2003; 175: 806-13.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Doege CA, Kerskens CM, Romero BI, Brunecker P, von Pannwitz W, Jungehülsing J, Müller B, Villringer A. MRI of small human stroke shows reversibl diffusion changes in subcortical gray matter. Neuroreport 2000; 11: 2021-4.
    CrossrefPubMedGoogle Scholar
  • 5 Doege CA, Kerskens CM, Romero BI, Brunecker P, Jungehülsing J, von Pannwitz W, Müller B, Villringer A. Assessment of diffusion and perfusion deficits in patients with small subcortical ischemia. Am J Neuroradiol 2003; 02: 1355-63.
    Google Scholar
  • 6 Donnan GA, Davis SM. Neuoimaging, the ischaemic penumbra, and selection of patients for acute stroke therapy. Lancet Neurology 2002; 01: 417-25.
    CrossrefPubMedGoogle Scholar
  • 7 Engelter ST, Provenzale JM, Petrella JR, Alberts MJ. Diffusion MR imaging and transient ischemic attacks. Stroke 1999; 30: 2762-3.
    PubMedGoogle Scholar
  • 8 Fiebach JB, Schellinger PD, Gass A, Kucinski T, Siebler M, Villringer A, Olkers P, Hirsch JG, Heiland S, Wilde P, Jansen O, Rother J, Hacke W, Sartor K. Kompetenznetzwerk Schlaganfall B5. Stroke magnetic resonance imaging is accurate in hyperacute intracerebral hemorrhage: a multicenter study on the validity of stroke imaging. Stroke 2004; 35: 502-6.
    CrossrefPubMedGoogle Scholar
  • 9 Fiebach JB, Schellinger PD, Jansen O, Meyer M, Wilde P, Bender J, Schramm P, Juttler E, Oehler J, Hartmann M, Hahnel S, Knauth M, Hacke W, Sartor K. CT and diffusion-weighted MR imaging in randomized order: diffusion-weighted imaging results in higher accuracy and lower interrater variability in the diagnosis of hyperacute ischemic stroke. Stroke 2002; 33: 2206-10.
    CrossrefPubMedGoogle Scholar
  • 10 Fiehler J, Fiebach JB, Gass A, Hoehn M, Kucinski T, Neumann-Haefelin T, Schellinger PD, Siebler M, Villringer A, Rother J. Diffusion-weighted imaging in acute stroke--a tool of uncertain value?. Cerebrovasc Dis 2002; 14: 187-96.
    CrossrefPubMedGoogle Scholar
  • 11 Fiehler J, Foth M, Kucinski T, Schleper B, Knab R, Foth M, von Bezold M, Weiller C, Zeumer H, Röther J. Severe ADC decreases do not predict irreversible tissue damage. Stroke 2002; 22: 79-86.
    Google Scholar
  • 12 Gass A, Ay H, Szabo K, Koroshetz WJ. Diffusionweighted MRI for the “small stuff “: the details of acute cerebral ischaemia. Lancet Neurol 2004; 03: 39-45.
    CrossrefPubMedGoogle Scholar
  • 13 Kidwell CS, Chalela JA, Saver JL, Starkman S, Hill MD, Demchuk AM, Butman JA, Patronas N, Alger JR, Latour LL, Luby ML, Baird AE, Leary MC, Tremwel M, Ovbiagele B, Fredieu A, Suzuki S, Villablanca JP, Davis S, Dunn B, Todd JW, Ezzeddine MA, Haymore J, Lynch JK, Davis L, Warach S. Comparison of MRI and CT for detection of acute intracerebral hemorrhage. JAMA 2004; 292: 1823-30.
    CrossrefPubMedGoogle Scholar
  • 14 Kidwell CS, Saver JL, Villablanca JP, Duckwiler G, Fredieu A, Gough K, Leary MC, Starkman S, Gobin YP, Jahan R, Vespa P, Liebeskind DS, Alger JR, Vinuela F. Magnetic resonance imaging detection of microbleeds before thrombolysis: an emerging application. Stroke 2002; 33: 95-8.
    CrossrefPubMedGoogle Scholar
  • 15 Koennecke HC. Cerebral microbleeds on MRI: prevalence, associations, and potential clinical implications. Neurology 2006; 66: 165-71.
    CrossrefPubMedGoogle Scholar
  • 16 Neumann-Haefelin T, du Mesnil Rde Rochemont, Fiebach JB, Gass A, Nolte C, Kucinski T, Rother J, Siebler M, Singer OC, Szabo K, Villringer A, Schellinger PD. Kompetenznetz Schlaganfall Study Group. Effect of incomplete (spontaneous and postthrombolytic) recanalization after middle cerebral artery occlusion: a magnetic resonance imaging study. Stroke 2004; 35: 109-14.
    CrossrefPubMedGoogle Scholar
  • 17 Patel MR, Edelman RR, Warach S. Detection of hyperacute primary intraparenchymal hemorrhage by magnetic resonance imaging. Stroke 1996; 27: 2321-4.
    CrossrefPubMedGoogle Scholar
  • 18 Rother J, Schellinger PD, Gass A, Siebler M, Villringer A, Fiebach JB, Fiehler J, Jansen O, Kucinski T, Schoder V, Szabo K, Junge-Hulsing GJ, Hennerici M, Zeumer H, Sartor K, Weiller C, Hacke W. Kompetenznetzwerk Schlaganfall Study Group. Effect of intravenous thrombolysis on MRI parameters and functional outcome in acute stroke < 6 hours. Stroke 2002; 33: 2438-45.
    CrossrefPubMedGoogle Scholar
  • 19 Schramm P, Schellinger PD, Klotz E, Kallenberg K, Fiebach JB, Kulkens S, Heiland S, Knauth M, Sartor K. Comparison of perfusion computed tomography and computed tomography angiography source images with perfusion-weighted imaging and diffusion-weighted imaging in patients with acute stroke of less than 6 hours duration. Stroke 2004; 35: 1652-8.
    CrossrefPubMedGoogle Scholar
  • 20 Thomalla G, Schwark C, Sobesky J, Bluhmki E, Fiebach JB, Fiehler J, Zaro OWeber, Kucinski T, Juettler E, Ringleb PA, Zeumer H, Weiller C, Hacke W, Schellinger PD, Rother J. MRI in Acute Stroke Study Group of the German Competence Network Stroke. Outcome and symptomatic bleeding complications of intravenous thrombolysis within 6 hours in MRI-selected stroke patients: comparison of a German multicenter study with the pooled data of ATLANTIS, ECASS, and NINDS tPA trials. Stroke 2006; 37: 852-8.
    CrossrefPubMedGoogle Scholar
  • 21 von Kummer R, Meyding-Lamade U, Forsting M, Rosin L, Rieke K, Hacke W, Sartor K. Sensitivity and prognostic value of early CT in occlusion of the middle cerebral artery trunk. Am J Neuroradiol 1994; 15: 9-15.
    PubMedGoogle Scholar
  • 22 Wegener S, Gottschalk B, Jovanovic V, Knab R, Fiebach JB, Schellinger PD, Kucinski T, Jungehulsing GJ, Brunecker P, Muller B, Banasik A, Amberger N, Wernecke KD, Siebler M, Rother J, Villringer A, Weih M. MRI in Acute Stroke Study Group of the German Competence Network Stroke. Transient ischemic attacks before ischemic stroke: preconditioning the human brain? A multicenter magnetic resonance imaging study. Stroke 2004; 35: 616-21.
    CrossrefPubMedGoogle Scholar
  • 23 Werring DJ, Coward LJ, Losseff NA, Jager HR, Brown MM. Cerebral microbleeds are common in ischemic stroke but rare in TIA. Neurology 2005; 65: 1914-8.
    CrossrefPubMedGoogle Scholar
  • 24 Wintermark M, Reichhart M, Thiran JP, Maeder P, Chalaron M, Schnyder P, Bogousslavsky J, Meuli R. 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: 417-32.
    CrossrefPubMedGoogle Scholar
  • 25 Thomalla G. et al. Das Subnetz „Klinische Studien” im Kompetenznetz Schlaganfall. Nervenheilkunde 2006; 25: 911-8.
    Article in Thieme ConnectGoogle Scholar