Moderne Bildgebung beim ischämischen Schlaganfall

Zusammenfassung

Die Einführung der Thrombolyse zur Behandlung des akuten ischämischen Schlaganfalls stellt hohe Anforderungen an die bildgebende Diagnostik. Neben dem sicheren Blutungsausschluss muss auch das Ausmaß der bereits erfolgten irreversiblen Schädigung (Infarkt) abgeschätzt werden. Zusätzlich ist eine Information über den Gefäßstatus sinnvoll. Gesicherte Ergebnisse über den Wert einer thrombolytischen Therapie gibt es derzeit nur in Verbindung mit nativen CT-Untersuchungen. Die modernen Untersuchungsverfahren Mehrschicht-Spiral-CT und MRT erlauben zusätzliche Perfusionsund Gefäßstudien in kurzer Zeit. Zusätzlich erlaubt die MRT auch diffusionsgewichtete Aufnahmen, die auch kleinste Infarktareale mit hoher Sensitivität zeigen.

Ziel dieses Artikels ist eine Einführung in die modernen bildgebenden Verfahren und deren voraussichtliche Wertigkeit in der Diagnostik des ischämischen Schlaganfalls mit einem Schwerpunkt bei der heute noch häufiger durchgeführten CT-Diagnostik.

Summary

The introduction of thrombolysis for the therapy of hyperacute ischemic stroke offers new challenges for diagnostic imaging. In addition to excluding intracranial hemorrhage the estimation of already irreversibly damaged areas of brain (infarction) is necessary. In addition information about the arterial supply to the brain is desirable. Currently reliable results about the value of thrombolytic therapy only exist with the use of plain CT. Modern techniques like multisection CT and MRI allow to study brain perfusion and to visualize extraand intracranial arteries. In addition MRI offers diffusion-weighted imaging where even very small infarctions are shown with high sensitivity.

The aim of this article is an introduction to these new imaging-techniques and an assessment of their value for therapeutical decisions in patients with ischemic stroke.

Schlüsselwörter

Diagnostik - ischämischer Schlaganfall - Computertomographie - Magnetresonanztomographie

Keywords

Diagnostic - ischemic stroke - computed tomography - magnetic resonance imaging

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