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Multimodale Computertomographie beim akuten Hirninfarkt

Erfahrungen mit einem standardisierten Untersuchungsprotokoll bei 100 Patienten

Multimodal computed tomography in acute cerebral infarction

Experience with a standardized protocol in 100 patients

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Zusammenfassung

Die Computertomographie (CT) ist als Standardmethode in der Akutdiagnostik des Schlaganfalls etabliert. Die Nativaufnahme kann eine Blutung ausschließen und dem geübten Untersucher Frühzeichen einer Ischämie andeuten. Eine verlässliche Darstellung eines ischämischen Areals und des zugrunde liegenden Gefäßprozesses ist mit der CT in der Initialphase jedoch nicht möglich. Gerade für die dann notwendigen raschen Therapieentscheidungen sind aber weitere Informationen wichtig, die inzwischen mit den neuen kontrastmittelverstärkten CT-Techniken erhalten werden können. Mit der Perfusions-CT (CTP) können die Gehirndurchblutung dargestellt und dadurch irreversibel und reversibel geschädigte Gewebe im Bereich einer vermuteten Ischämie unterschieden werden. Die CT-Angiographie (CTA) kann Verschlüsse oder Stenosen der relevanten Gefäße darstellen. Durch moderne Mehrschicht-CT-Geräte (MSCT) ist es möglich, diese Modalitäten der Bildgebung zusammenzufassen und durch ein entsprechendes Protokoll alle 3 Methoden für die Notfalldiagnostik inklusive Auswertung innerhalb von 15 min durchzuführen. Trotz gewisser Einschränkungen konnte die multimodale CT (MMCT) bei den ersten 102 Patienten, die im Rahmen des Protokolls innerhalb von 6 h nach Symptombeginn in der klinischen Routine untersucht wurden, einen wesentlichen Beitrag zu Therapieentscheidungen leisten.

Summary

Computed tomography (CT) is the standard method of brain imaging in acute stroke. To an experienced examiner, nonenhanced CT will exclude hemorrhage and may indicate early ischemic signs. Reliable description of an ischemic area and the underlying vascular disease is not possible in the acute phase but is possible, particularly within the first hours, when therapeutic decisions on matters such as systemic thrombolysis are to be made. For such rapid decision-making, imaging must provide more information. Novel, contrast-enhanced CT techniques can provide this information. Perfusion CT (CTP) can show brain perfusion, allowing one to distinguish between reversible and irreversible damage in an ischemic area. Also, CT angiography (CTA) can detect occlusion or stenosis in the relevant vasculature. Using a modern, multislice CT scanner, it is now possible to combine these modalities of imaging. In a fast protocol for emergency evaluation, all three methods can be performed and evaluated to provide the crucial information within 15 min. In the first 102 patients examined within 6 h of symptom onset using this protocol, multimodal CT contributed substantially to therapeutic decisions, even though there are some limitations in these methods.

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Authors and Affiliations

  1. Neurologische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg

    R. Handschu, B. Stemper, J. G. Heckmann & B. Neundörfer

  2. Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow, Humboldt-Universität, Berlin

    S. Fateh-Moghadam

  3. Bereich Medical Solutions, Siemens AG, Forchheim

    E. Klotz

  4. Abteilung für Neuroradiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg

    A. Schmid, W. J. Huk & B. F Tomandl

  5. Neurologische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 , Erlangen

    R. Handschu

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  1. R. Handschu
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Correspondence to R. Handschu.

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Handschu, R., Fateh-Moghadam, S., Klotz, E. et al. Multimodale Computertomographie beim akuten Hirninfarkt. Nervenarzt 75, 564–576 (2004). https://doi.org/10.1007/s00115-003-1617-z

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  • DOI: https://doi.org/10.1007/s00115-003-1617-z

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