Skip to main content
SpringerLink
Log in

Diagnostik der zerebralen Ischämie: Wann CT, wann MRT?

Diagnosis of cerebral ischemia: when CT and when MRI?

  • Leitthema
  • Published:
Der Radiologe Aims and scope Submit manuscript

Zusammenfassung

Eine schnelle und effektive bildgebende Diagnostik ist eine wesentliche Voraussetzung für die Indikationsstellung zur Thrombolyse bei Patienten mit akutem ischämischem Schlaganfall. Sowohl CT als auch MRT bieten heute eine Methodenvielfalt, die es neben dem Ausschluss einer Blutung erlaubt, das Ausmaß der ischämischen Hirnschädigung und den zugrunde liegenden Gefäßprozess genau zu definieren. Es ist das Ziel dieser Arbeit, die CT- und MRT-Verfahren aus neurologisch-neuroradiologischer Sicht zu beleuchten und festzulegen, welche Untersuchungen für die Therapieentscheidung wirklich relevant sind.

Abstract

Rapid and effective diagnostic imaging is important for decision-making concerning thrombolysis in patients with acute ischemic stroke. Apart from excluding intracranial hemorrhage, CT and MRI provide multiple methodological options to define the extent of ischemic brain damage and the underlying vascular pathology. The aim of this article is to discuss the value of CT and MRI from a neurologicalneuroradiological point of view and to discuss which of the available imaging tools are really relevant for clinical decision making.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med 333(24):1581–1587

    Article  Google Scholar 

  2. Hacke W, Kaste M, Bluhmki E et al (2008) ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 359(13):1317–1329

    Article  PubMed  CAS  Google Scholar 

  3. Hacke W, Donnan G, Fieschi C et al (2004) ATLANTIS Trials Investigators; ECASS Trials Investigators; NINDS rt-PA Study Group Investigators. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 363(9411):768–774

    Article  PubMed  Google Scholar 

  4. Fiebach JB, Schellinger PD, Gass A et al (2004) Kompetenznetzwerk Schlaganfall B5. Stroke magnetic resonance imaging is accurate in hyperacute intracerebral hemorrhage: a multicenter study on the validity of stroke imaging. Stroke 35(2):502–506. Epub 2004, Jan 22

    Article  PubMed  Google Scholar 

  5. Chalela JA, Kidwell CS, Nentwich LM et al (2007) Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet 369(9558):293–298

    Article  PubMed  Google Scholar 

  6. Sobesky J, von Kummer R, Frackowiak M et al (2006) Early ischemic edema on cerebral computed tomography: its relation to diffusion changes and hypoperfusion within 6 h after human ischemic stroke. A comparison of CT, MRI and PET. Cerebrovasc Dis 21(5–6):336–339. Epub 2006, Feb 14

    Google Scholar 

  7. Kim EY, Ryoo JW, Roh HG et al (2006) Reversed discrepancy between CT and diffusion-weighted MR imaging in acute ischemic stroke. AJNR Am J Neuroradiol 27(9):1990–1995

    PubMed  CAS  Google Scholar 

  8. Wardlaw JM, Farrall AJ, Perry D et al (2007) Acute Cerebral CT Evaluation of Stroke Study (ACCESS) Study Group. Factors influencing the detection of early CT signs of cerebral ischemia: an internet-based, international multiobserver study. Stroke 38(4):1250–1256. Epub 2007, Mar 8

    Article  PubMed  Google Scholar 

  9. Neumann-Haefelin T, Wittsack HJ, Wenserski F et al (1999) Diffusion- and perfusion-weighted MRI. The DWI/PWI mismatch region in acute stroke. Stroke 30(8):1591–1597

    PubMed  CAS  Google Scholar 

  10. Singer OC, Humpich MC, Fiehler J et al (2008) MR Stroke Study Group Investigators. Risk for symptomatic intracerebral hemorrhage after thrombolysis assessed by diffusion-weighted magnetic resonance imaging. Ann Neurol 63(1):52–60

    Article  PubMed  Google Scholar 

  11. Singer OC, Sitzer M, du Mesnil de Rochemont R, Neumann-Haefelin T (2004) Practical limitations of acute stroke MRI due to patient-related problems. Neurology 62(10):1848–1849

    PubMed  Google Scholar 

  12. Barber PA, Demchuk AM, Hudon ME et al (2001) Hyperdense sylvian fissure MCA „dot“ sign: a CT marker of acute ischemia. Stroke 32(1):84–88

    PubMed  CAS  Google Scholar 

  13. Forsting M (2005) CTA of the ICA bifurcation and intracranial vessels. Eur Radiol 15 [suppl 4]:D25–D27, review

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Institut für Neuroradiologie, Hirngefäßzentrum, Klinikum der Goethe-Universität, Schleusenweg 2-16, 60528, Frankfurt am Main, Deutschland

    J. Berkefeld

  2. Klinik für Neurologie, Klinikum der Goethe-Universität, Frankfurt am Main, Deutschland

    T. Neumann-Haefelin

Authors
  1. J. Berkefeld
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Neumann-Haefelin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Berkefeld.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Berkefeld, J., Neumann-Haefelin, T. Diagnostik der zerebralen Ischämie: Wann CT, wann MRT?. Radiologe 49, 299–304 (2009). https://doi.org/10.1007/s00117-008-1770-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00117-008-1770-2

Schlüsselwörter

Keywords

Search

Navigation