Akut serebral infarktta MR perfüzyon bulguları ve penumbra değerlendirilmesinde kullanılan perfüzyon parametreleri
Küçük Resim Yok
Tarih
2016
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmanın amacı serebral iskemi sonrası erken tanı ve tedavide manyetik rezonans (MR) perfüzyonun önemini vurgulamak ve penumbra belirlenmesinde güvenilir perfüzyon haritalarını tartışmaktır.Gereç ve Yöntem: Serebrovasküler olay tanısı ile Radyoloji anabilim dalına gönderilen ve beyin MR incelemede akut infarkt saptanan 20 hastaya 1.5 T MR cihazı (Magnetom Vision, Siemens, Erlangen, Almanya ) ile standart kafa sargısı ile dinamik suseptibilite kontrast (DSK) görüntüleme yapıldı. Kontrastlı perfüzyon incelemede 0,1mmol/kg Gadolinium 3ml/sn injeksiyon hızıyla bolus infüzyon şeklinde verildi. T2* relaksasyon zamanındaki değişiklikleri gözlemlemek adına Multishot echoplanar imaging (EPI) görüntüleme yapıldı. Postprosesing aşamasında DSK perfüzyon parametreleri ve fonksiyon haritaları çıkarılarak değerlendirildi. Perfüzyon haritaları ile difüzyon ağırlıklı görüntüleme görsel olarak karşılaştırılarak penumbra varlığı saptandı. Bulgular: Hastaların %79'unda infarkt alanında karşı hemisfere göre cerebral blood volume (CBV) ve cerebral blood flow (CBF) azalmakta iken %11'lik kesimde karşı hemisfere göre fark saptanmadı. %5'lik bir kesimde ise kan akımındaki artış dikkat çekici bulundu. Bu durum beynin otoregulasyonu açısından anlamlı olarak yorumlandı. Beklenildiği üzere %90'lık bir grupta kontrast geçiş zamanı ve pik zamanında uzama izlendi. Difüzyon ve perfüzyon haritalarının karşılaştırılmasında ise mean transit time (MTT) ve time to pik (TTP) haritalarına göre 4, CBF haritasına göre 3 ve CBV haritasına göre ise 1 hastada penumbra saptandı. Sonuç: Akut iskemik inmenin erken tanısı ve tedavisi hastanın yaşam kalitesini belirgin bir biçimde etkilemektedir. Perfüzyon MRG'nin kullanılması akut infarkt tanı ve tedavisinde yol gösterici olmaktadır. Penumbra dinamik bir dokudur, varlığının erken dönemde saptanabilmesi ve tedavisi hastanın prognozunu belirlemektedir. Penumbra varlığının saptanmasında en güvenilir perfüzyon haritası hala tartışmalı olup bu konuda daha çok araştırma yapılmalıdır. Yapılan araştırmalara ve kendi yaptığımız çalışmaya göre TTP ve MTT haritaları kullanılarak saptanan penumbra alanının daha geniş olduğu göze çarpmaktadır. Bu durum şiddetli arteriyel oklüziv değişiklikte iskemik penumbranın benign oligemiye sekonder daha abartılı görünümüne bağlıdır. Son infarkt alanının gösterilmesinde literatüre göre en güvenilir haritalar relative cerebral blood volume (rCBV) ve relative cerebral blood flow (rCBF) haritalarıdır. Bizim bulgularımız da bu yöndedir.
MRI perfusion findings in acute cerebral infarction and perfusion parameters used in the evaluation penumbra Objective: In this trial, our objective is to emphasize the importance of the magnetic resonance perfusion in the early diagnosis and therapy of cerebral ischemia and to discuss the reliable perfusion maps for identifying peunumbra.Material and Methods: Participants of this trial have been selected among patients who applied to the Ege University Radiology Department with cerebrovascular event and had an acute infarct which was diagnosed by MR. Among 20 of these patients, dynamic suceptibilite contrast (DSC) imaging with 1.5 T MR Magnetom Vision, Siemens, Erlangen, Germany) was performed with standart head bandage. At contrast perfusion imaging a bolus of 0.1 mmol/kg Gadolinium was injected by a speed of 3ml/sec. Multishot echoplanar imaging (EPI) imaging was performed for determining the changes at T2* relaxation time. The DSC perfusion parametres and function maps were obtained and eveluated at the postprocessing stage. The precence of penumbra was diagnosed by comparing the perfusion maps with difusion images.Results: Seventy nine percent of the patients had a lesser degree of cerebral blood volume (CBV) and cerebral blood flow (CBF) at the infarcted area then contrary hemisphere but at 11% of the patients there was no difference with contrary hemisphere. Five percent of the patients had remarkable blood flow increase. This was thought to be cause of the important role of the brain´s autoregulation function. There was an expected delay at 90% of the patients in contrast passing time and peak time. By comparing the diffusion with perfusion maps, the penumbra was diagnosed at 4 patients by mean transit time (MTT) and time to pic (TTP) maps, at 3 patients by CBF map and at 1 patient by CBV map. Conclusion: The early diagnosis and evaluation of acute ischemic stroke, improves the patients' quality of life. The perfusion MR has a pathfinder role in the diagnosis and therapy of acute infarct.Penumbra is a dynamic tissue and the treatment after the early identifying of the penumbra, defines the patients prognosis. The most reliable perfusion map for determining the penumbra is controversial and much more trials are need to be done about this subject. According to recent trials and our investigation, the penumbra area seems to be larger which is determined by using the TTP and MTT maps. This condition is due to the exaggerated appearance of the ischemic penumbra secondary to the benign oligemia with severe arterial occlusive changes. In the literature the most reliable maps are relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) maps for demonstrating the last infarct area and our findings are also in the same way.
MRI perfusion findings in acute cerebral infarction and perfusion parameters used in the evaluation penumbra Objective: In this trial, our objective is to emphasize the importance of the magnetic resonance perfusion in the early diagnosis and therapy of cerebral ischemia and to discuss the reliable perfusion maps for identifying peunumbra.Material and Methods: Participants of this trial have been selected among patients who applied to the Ege University Radiology Department with cerebrovascular event and had an acute infarct which was diagnosed by MR. Among 20 of these patients, dynamic suceptibilite contrast (DSC) imaging with 1.5 T MR Magnetom Vision, Siemens, Erlangen, Germany) was performed with standart head bandage. At contrast perfusion imaging a bolus of 0.1 mmol/kg Gadolinium was injected by a speed of 3ml/sec. Multishot echoplanar imaging (EPI) imaging was performed for determining the changes at T2* relaxation time. The DSC perfusion parametres and function maps were obtained and eveluated at the postprocessing stage. The precence of penumbra was diagnosed by comparing the perfusion maps with difusion images.Results: Seventy nine percent of the patients had a lesser degree of cerebral blood volume (CBV) and cerebral blood flow (CBF) at the infarcted area then contrary hemisphere but at 11% of the patients there was no difference with contrary hemisphere. Five percent of the patients had remarkable blood flow increase. This was thought to be cause of the important role of the brain´s autoregulation function. There was an expected delay at 90% of the patients in contrast passing time and peak time. By comparing the diffusion with perfusion maps, the penumbra was diagnosed at 4 patients by mean transit time (MTT) and time to pic (TTP) maps, at 3 patients by CBF map and at 1 patient by CBV map. Conclusion: The early diagnosis and evaluation of acute ischemic stroke, improves the patients' quality of life. The perfusion MR has a pathfinder role in the diagnosis and therapy of acute infarct.Penumbra is a dynamic tissue and the treatment after the early identifying of the penumbra, defines the patients prognosis. The most reliable perfusion map for determining the penumbra is controversial and much more trials are need to be done about this subject. According to recent trials and our investigation, the penumbra area seems to be larger which is determined by using the TTP and MTT maps. This condition is due to the exaggerated appearance of the ischemic penumbra secondary to the benign oligemia with severe arterial occlusive changes. In the literature the most reliable maps are relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) maps for demonstrating the last infarct area and our findings are also in the same way.
Açıklama
Anahtar Kelimeler
Cerrahi
Kaynak
Bakırköy Tıp Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
12
Sayı
3
