MR-Bildgebung beim akuten Schlaganfall

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

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