Sequenzspezifische MR-Bildgebungsbefunde als Hilfsmittel zur Datierung des ischämischen Schlaganfalls^[1]

Zusammenfassung

Nach einem ischämischen Schlaganfall kommen Patienten zu unterschiedlichen Zeitpunkten ins Krankenhaus. Viele werden erst Wochen nach Auftreten von neurologischen Ausfallerscheinungen vorstellig. Dies ist oft bei älteren Patienten und Patienten in Pflegeheimen der Fall. Die Altersbestimmung eines ischämischen Schlaganfalls bietet Patienten, deren Familien und dem medizinischen Team hilfreiche klinische Informationen. Häufig wird keine Perfusionsbildgebung durchgeführt; dann können die Befunde der pulssequenzspezifischen Magnetresonanzbildgebung dazu beitragen, das Alter des Infarkts zu bestimmen. Die beim Apparent-Diffusion-Coefficient-Mapping, in diffusionsgewichteten und in Fluid-attenuated-Inversion-Recovery-Sequenzen sowie in der nativen und kontrastmittelverstärkten T1-gewichteten und der T2-gewichteten Gradientenecho- und suszeptibilitätsgewichteten Magnetresonanzbildgebung beobachteten Befunde können die Bestimmung des relativen Alters eines Hirninfarkts unterstützen. Schlaganfälle lassen sich in folgende Gruppen einteilen und datieren: früh hyperakut, spät hyperakut, akut, subakut oder chronisch. Jüngere Daten lassen darauf schließen, dass ein weniger als 6 h zurückliegender Zeitpunkt des Schlaganfalls bei vielen Patienten mit Diffusionseinschränkungen und keinen Veränderungen auf Fluid-attenuated-Inversion-Recovery-Aufnahmen wahrscheinlicher als zunächst angenommen ist. Das Zeitfenster für die intravenöse Verabreichung eines Gewebeplasminogenaktivators beträgt derzeit 4,5 h ab dem letzten Beobachtungszeitpunkt vor Beginn der ersten Symptome. Bei Infarkten im vorderen Stromgebiet beträgt das Zeitfenster für die intraarterielle Verabreichung des Gewebeplasminogenaktivators 6 h ab dem letzten Beobachtungszeitpunkt vor Beginn der ersten Symptome. Aus diesem Grund ist die Bestimmung des genauen Zeitpunkts bei Patienten mit ischämischem Schlaganfall wichtig.

Abstract

Patients may present to the hospital at various times after an ischemic stroke. Many present weeks after a neurologic deficit has occurred, as is often the case with elderly patients and those in a nursing home. The ability to determine the age of an ischemic stroke provides useful clinical information for the patient, his or her family, and the medical team. Many times, perfusion imaging is not performed, and pulse sequence-specific magnetic resonance (MR) imaging findings may help determine the age of the infarct. The findings seen at apparent diffusion coefficient mapping and diffusion-weighted, fluid-attenuated inversion recovery (FLAIR) and unenhanced and contrast material-enhanced T1 – and T2-weighted gradient-echo and susceptibility-weighted MR imaging may help determine the relative age of a cerebral infarct. Strokes may be classified and dated as early hyperacute, late hyperacute, acute, subacute, or chronic. Recent data indicate that in many patients with restricted diffusion and no change on FLAIR images, it is more likely than was initially thought that the stroke is less than 6 hours old. The time window to administer intravenous tissue plasminogen activator is currently 4.5 hours from the time when the patient was last seen to be normal, and for anterior circulation strokes, the time window for administering intraarterial tissue plasminogen activator is 6 hours from when the patient was last seen to be normal. For this reason, accurate dating is important in patients with ischemic stroke.

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