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Báo cáo y học: "Clinical review: Imaging in ischaemic stroke – implications for acute management"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Clinical review: Imaging in ischaemic stroke – implications for acute management. | Available online http ccforum.eom content 11 5 227 Review Clinical review Imaging in ischaemic stroke - implications for acute management Ramez Reda Moustafa and Jean-Claude Baron Department of Clinical Neurosciences University of Cambridge Cambridge CB2 2QQ UK Corresponding author Jean-Claude Baron jcb54@cam.ac.uk Published 11 September 2007 This article is online at http ccforum.com content 11 5 227 2007 BioMed Central Ltd Critical Care 2007 11 227 doi 10.1186 cc5973 Abstract Imaging has become a cornerstone of stroke management translating pathophysiological knowledge to everyday decision-making. Plain computed tomography is widely available and remains the standard for initial assessment the technique rules out haemorrhage visualizes the occluding thrombus and identifies early tissue hypodensity and swelling which have different implications for thrombolysis. Based on evidence from positron emission tomography PET however multimodal imaging is increasingly advocated. Computed tomography perfusion and angiography provide information on the occlusion site on recanalization and on the extent of salvageable tissue. Magnetic resonance-based diffusion-weighted imaging DWI has exquisite sensitivity for acute ischaemia however and there is increasingly robust evidence that DWI combined with perfusion-weighted magnetic resonance imaging PWI and angiography improves functional outcome by selecting appropriate patients for thrombolysis small DWI lesion but large PWI defect and by ruling out those who would receive no benefit or might be harmed very large DWI lesion no PWI defect especially beyond the 3-hour time window. Combined DWI-PWI also helps predict malignant oedema formation and therefore helps guide selection for early brain decompression. Finally DWI-PWI is increasingly used for patient selection in therapeutic trials. Although further methodological developments are awaited implementing the individual pathophysiologic diagnosis based on multimodal imaging is .