Zur Rolle der Mehrschicht-CT in der Frühdiagnostik der fokalen zerebralen Ischämie

K. Kirchhof; P. Schramm; E. Klotz; K. Sartor

doi:10.1055/s-2002-33930

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Rofo 2002; 174(9): 1089-1095
DOI: 10.1055/s-2002-33930

Übersicht

Zur Rolle der Mehrschicht-CT in der Frühdiagnostik
der fokalen zerebralen Ischämie

The value of multi-slice computed tomography for early diagnosis of
focal cerebral ischemiaK. Kirchhof¹ , P. Schramm¹ , E. Klotz² , K. Sartor¹

¹Abteilung Neuroradiologie, Neurologische Klinik, Universitätsklinikum Heidelberg
²Siemens Medical Solutions, Forchheim

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Publication History

Publication Date:
09 September 2002 (online)

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Zusammenfassung

Ziel der vorliegenden Übersicht ist die Charakterisierung des derzeitigen Stellenwerts der Mehrschicht-CT (MSCT) in der Frühdiagnostik ischämischer zerebraler Insulte anhand eigener Erfahrungen und einer Literaturübersicht. Am Beispiel der kranialen Standarduntersuchung, der CT-Angiographie (CTA) und der Perfusions-CT werden die diagnostischen Möglichkeiten der MSCT mit denen der Einzelschicht-CT (ESCT) verglichen. Bei der CTA bietet die MSCT deutlich Vorteile gegenüber der ESCT. Bei der Perfusions-CT bringt die MSCT nur eine relativ geringe Verbesserung gegenüber der ESCT. Bei der Standarduntersuchung halten wir ESCT und MSCT für gleichwertig. Schlussfolgerungen: CTA und Perfusions-CT sollten bei Schlaganfallpatienten eingesetzt werden, wenn die Indikation zu einer Lysetherapie diskutiert wird, aber keine Magnetresonanztomographie (MRT) mit diffusions- und perfusionsgewichteten Aufnahmen durchgeführt werden kann. Dies gilt unabhängig davon, ob die CT-Messungen mit der Einzelschicht- oder der Mehrschichttechnik erfolgen. Sind CT und MRT mit den erforderlichen Zusatzverfahren verfügbar, sollte weiterhin der MRT der Vorzug gegeben werden.

Abstract

The aim of this survey is the characterization of the present value of multi-slice computed tomography (MSCT) for the assessment of hyperacute cerebral ischemia based on our experience and a review of the literature. MSCT is compared with single-slice CT (SSCT) as to the diagnostic value of standard cranial CT, CT angiography (CTA) and perfusion CT. CTA obtained with MSCT surpasses CTA obtained with SSCT. For perfusion CT, the value added by MSCT is small. With regard to standard cranial CT, MSCT and SSCT are considered equivalent. CTA and perfusion CT should be used in patients with acute stroke if the indication for thrombolysis is entertained but diffusion and perfusion weighted MRI cannot be carried out. This applies to both SSCT and MSCT. If advanced MRI and advanced CT are available, MRI continues to be the preferred imaging modality.

Schlüsselwörter

Mehrschicht-CT - Zerebrale Ischämie - Penumbra - Zerebraler Blutfluss (CBF) - Zerebrales Blutvolumen (CBV)

Key words

Multislice CT - cerebral ischemia - penumbra - cerebral blood flow (CBF) - cerebral blood volume (CBV)

Literatur

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Dr. K. Kirchhof

Kopfklinikum, Abteilung Neuroradiologie

Im Neuenheimer Feld 400

69120 Heidelberg

Phone: + 49-6221-567566

Fax: + 49-6221-563072