Computertomographie und Magnetresonanztomographie beim Schlaganfall

  • H. Urbach
  • S. Flacke


Nach der klinischen Untersuchung ist die Untersuchung mit bildgebenden Verfahren der in der Regel nächste und wichtigste Untersuchungsschritt beim Schlaganfallpatienten. Es werden verschiedene, z.T. komplementäre Untersuchungsverfahren eingesetzt. Welches Verfahren gewählt wird, hängt nicht nur von der Fragestellung, sondern auch von der Verfügbarkeit ab.


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  1. 1.
    Baird AE, Warach S (1998) Magnetic resonance imaging of acute stroke. J Cereb Blood Flow Metab 18:583–609PubMedCrossRefGoogle Scholar
  2. 2.
    Bassingthwaighte JB, Chan IS, Goldstein AA (1988) An efficient method for smoothing indicator-dilution and other unimodal curves. Comput Biomed Res 21:192–202PubMedCrossRefGoogle Scholar
  3. 3.
    Becker H, Desch H, Hacker H, Pencz A (1979) CT fogging effect with ischemic cerebral infarcts. Neuroradiology 18:185–192PubMedCrossRefGoogle Scholar
  4. 4.
    Bendszus M, Urbach H, Meyer B, Schultheiß R, Solymosi L (1997) Improved CT diagnosis of acute middle cerebral artery territory infarctions with the density-difference analysis. Neuroradiology 39:127–131PubMedCrossRefGoogle Scholar
  5. 5.
    Bendszus M, Urbach H, Ries F, Solymosi L (1998) Outcome after local intra-arterial fibrinolysis compared with the natural course of patients with a dense middle cerebral artery on early CT. Neuroradiology 40:54–58PubMedCrossRefGoogle Scholar
  6. 6.
    Bourquain H, Eisner E, Gerber J, Müller A, Straube T, von Kummer R (1998) Prospektiver Wert der frühen CT bei zerebraler Ischämie. Klin Neuroradiol 8:135–136Google Scholar
  7. 7.
    Boxerman JL, Rosen BR, Weisskoff RM (1997) Signal-to-noise analysis of cerebral blood volume maps from dynamic NMR imaging studies. J Magn Reson Imaging 7:528–537PubMedCrossRefGoogle Scholar
  8. 8.
    Bradley WG (1993) MR appearance of hemorrhage in the brain. Radiology 189:15–26PubMedGoogle Scholar
  9. 9.
    Davenport R (1983) The derivation of the gamma-variate relationship for tracer dilution curves. J Nucl Med 24:945–948PubMedGoogle Scholar
  10. 10.
    Dettmers C, Solymosi L, Hartmann A, Buermann J, Hagendorff A (1997) Confirmation of CT criteria to distinguish pathophysiologic subtypes of cerebral infarction. AJNR Am J Neuroradiol 18:335–342PubMedGoogle Scholar
  11. 11.
    Dumoulin CL, Souza SP, Walker MF, Wagle W (1989) Three-dimensional phase contrast angiography. Magn Reson Med 1989 9:139–145PubMedCrossRefGoogle Scholar
  12. 12.
    Duong TQ, Ackerman JJH, Ying HS, Neil JJ (1998) Evaluation of extra and intracellular apparent diffusion in normal and globally ischemic rat brain via 19FNMR. Magn Reson Med 40:1–13PubMedCrossRefGoogle Scholar
  13. 13.
    Ernst T, Chang L, Itti L, Speck O (1999) Correlation of regional cerebral blood flow from perfusion MRI and spect in normal subjects. Magn Reson Imaging 17:349–354PubMedCrossRefGoogle Scholar
  14. 14.
    Executive Committee for the asymptomatic Carotid atherosclerosis study (1995) Endarterectomy for asymptomatic stenosis. JAMA 282:1421–1428Google Scholar
  15. 15.
    Flacke S, Keller E, Hartmann A, Mürtz P, Textor J, Urbach H, Folkers P, Träber F, Gieseke J, Block W, Leutner C, Pauleit D, Schild HH (1998) Verbesserte Diagnostik des frühen Hirninfarktes durch den kombinierten Einsatz von Diffusions-und Perfu-sionsbildgebung. Fortschr Röntgenstr 168:493–501CrossRefGoogle Scholar
  16. 16.
    Flacke S, Urbach H, Keller E, Hartmann A, Block W, Traeber F, Gieseke J, Schild HH (1999) Zeitliche Veränderungen der Diffusionskoeffizienten beim Schlaganfall. Fortschr Röntgenstr 170:290–297Google Scholar
  17. 17.
    Flacke S, Wüllner U, Keller E, Hamzei F, Urbach H (2000) Reversible changes of echoplanar perfusion and diffusion weighted MRI during status epilepticus. Neuroradiology 42:92–95PubMedCrossRefGoogle Scholar
  18. 18.
    Flacke S, Urbach H, Keller E, Träber F, Hartmann A, Textor J, Gieseke J, Block W, Folkers PJM, Schild HH (2000) The middle cerebral artery susceptibility sign on susceptibility-based perfusion MRI: clinical significance and comparison with the hyperdense middle cerebral artery sign on CT. Radiology 215:476–482PubMedGoogle Scholar
  19. 19.
    Graeber MC, Jordan E, Mishra SK, Nadeau E (1992) Watershed infarction on computed tomo-graphic scan. An unreliable sign of hemodynamic stroke. Arch Neurol 49:311–313PubMedCrossRefGoogle Scholar
  20. 20.
    Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R, Boysen G, Bluhmki E, Höxter G, Mahagne MH, Hennerici M (1995) Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. JAMA 274:1017–1025PubMedCrossRefGoogle Scholar
  21. 21.
    Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R (1996) Malignant middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol 53:309–315PubMedCrossRefGoogle Scholar
  22. 22.
    Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, Larrue V, Bluhmki E, Davis S, Donnan G, Schneider D, Diez-Tejedor E, Trouillas P (1998) Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Lancet 352:1245–1251PubMedCrossRefGoogle Scholar
  23. 23.
    Hahn EL (1960) Detection of sea-water motion by nuclear precession. J Geophys Res 65:776CrossRefGoogle Scholar
  24. 24.
    Hasegawa Y, Fisher M, Latour LL, Dardzinski BJ, Sotak CH (1994) MRI diffusion mapping of reversible and irreversible ischemic injury in focal brain ischemia. Neurology 44:1484–1490PubMedCrossRefGoogle Scholar
  25. 25.
    Hatazawa J, Shimosegawa E, Toyoshima H, Ardekani BA, Suzuki A, Okudera T, Miura Y (1999) Cerebral Blood Volume in acute brain infarction. A combined study with dynamic susceptibility contrast MRI and 99mTc-HMPAO-SPECT. Stroke 30:800–806PubMedCrossRefGoogle Scholar
  26. 26.
    Hornig C, Dorndorf W, Agnoli AL (1986) Hemorrhagic cerebral infarction — a prospective study. Stroke 17:179–185PubMedCrossRefGoogle Scholar
  27. 27.
    Jansen O, Schellinger P, Fiebach J, Hacke W, Sartor K (1999) Early recanalisation in acute ischaemic stroke saves tissue at risk defined by MRI. Lancet 353:2036–2037PubMedCrossRefGoogle Scholar
  28. 28.
    Keller E, Flacke S, Gieseke J, Sommer T, Brechtels-bauer D, Gass S, Pauleit D, Textor J, Schild HH (1997) Kraniozervikale Dissektionen: Untersuchungsstrategien in der MR-Tomographie und MR-Angiographie. Fortschr Röntgenstr 167:565–571CrossRefGoogle Scholar
  29. 29.
    Knauth M, von Kummer R, Jansen O, Hähnel S, Dörfler A, Sartor K (1997) Potential of CT Angio-graphy in acute ischemie stroke. Am J Neuroradiol 18:1001–1010PubMedGoogle Scholar
  30. 30.
    Koenig M, Klotz E, Luka B, Venderink DJ, Spittler JF, Heuser L (1998) Perfusion CT of the brain. New diagnostic approach for early detection of ischemie stroke. Radiology 209:85–93PubMedGoogle Scholar
  31. 31.
    Kwong KK, Chesler DA, Weisskoff RM, Donahue KM, Davis TL, Ostergaard L, Campbell TA, Rosen BR (1995) MR perfusion studies with Tl-weighted echo planar imaging. Magn Reson Med 34:878–887PubMedCrossRefGoogle Scholar
  32. 32.
    Lansberg MG, O’Brien MW, Norbash AM, Moseley ME, Morrell M, Albers GW (1999) MRI abnormalities associated with partial status epilepticus. Neurology 52:1021–1027PubMedCrossRefGoogle Scholar
  33. 33.
    Le Bihan D, Breton E, Lallemand D, Grenier P, Cabanis E, Laval-Jeantet M (1986) MR imaging of in-travoxel incoherent motions: application to diffusion and perfusion in neurologic disorders. Radiology 161:401–407PubMedGoogle Scholar
  34. 34.
    Liu G, Sobering G, Duyn J, Moonen C (1993) A functional MRI technique combining principles of echo-shifting with a train of observations (PRESTO). Magn Reson Med 30:764–768PubMedCrossRefGoogle Scholar
  35. 35.
    Manelfe C, Larrue V, von Kummer R, Bozzao L, Ringleb P, Bastianello S, Iweins F, Lesaffre E (1999) Association of hyperdense middle cerebral artery sign with clinical outcome in patients treated with tissue type plasminogen activator. Stroke 30:769–772PubMedCrossRefGoogle Scholar
  36. 36.
    Mansfield P, Coxon R, Glover P (1994) Echo-planar imaging of the brain at 3.0T: first normal volunteer results. J Comput Assist Tomogr 18:339–343PubMedCrossRefGoogle Scholar
  37. 37.
    Marks MP, Tong DC, Beulieu C, Albers GW, de Crespigny A, Moseley ME (1999) Evaluation of early reperfusion and iv tPA therapy using diffusion and perfusion-weighted MRI. Neurology 52:1792–1798PubMedCrossRefGoogle Scholar
  38. 38.
    Marquardt DW (1963) An algorithm for least squares estimation of non-linear parameters. J Soc Ind Appl Math 11:431–441CrossRefGoogle Scholar
  39. 39.
    Mellies JK, Calabrese P, Roth H, Gehlen W (1999) CADASIL. Klinik, Neuroradiologie, Genetik und Diagnose. Fortschr Neurol Psychiat 67:426–433PubMedCrossRefGoogle Scholar
  40. 40.
    Miles KA (1991) Measurement of tissue perfusion by dynamic computed tomography 64:409–412Google Scholar
  41. 41.
    Moseley M, Cohen Y, Mintorovitch J, Chileuitt L, Shimizu H, Kucharczyk J, Wendland MF, Weinstein PR (1990) Early detection of regional cerebral ischemia in cats: comparison of diffusion-and T2-weighted MRI and spectroscopy. Magn Reson Med 14:330–346PubMedCrossRefGoogle Scholar
  42. 42.
    Miirtz P, Flacke S, Träber F, Keller E, Gieseke J, Folkers P, Schild HH (1998) Diffusion-weighted MR imaging: Navigated multi-shot SE EPI technique for clinical use. Fortschr Röntgenstr 168:580–588CrossRefGoogle Scholar
  43. 43.
    Mull M, Schwarz M, Thron A (1997) Cerebral hemodynamic low-flow-infarcts in arterial occlusive disease. Lesion patterns and angiomorphological conditions. Stroke 28:118–123PubMedCrossRefGoogle Scholar
  44. 44.
    Nicholson C, Philips JM (1981) Ion diffusion modified by tortuosity and volume fraction in the extracellular micro environment of the rat cerebellum. J Physiol 312:225–257Google Scholar
  45. 45.
    Norris DG, Nierndorf T, Leibfritz D (1994) Healthy and infarcted brain tissue studied at short diffusion times: the origines of apparent restriction and the reduction in apparent diffusion coefficient. NMR in Biomedicine 7:304–310PubMedCrossRefGoogle Scholar
  46. 46.
    Ostergaard L, Weiskoff RM, Chesler DA, Gyldensted C, Rosen BR (1996) High resolution measurement of cerebral blood flow using intravascular tracer bolus passage. Part I: Mathematical approach and statistical analysis. Magn Reson Med 36:715–725PubMedCrossRefGoogle Scholar
  47. 47.
    Ostergaard L, Smith DF, Vestergaard-Poulsen P, Hansen SB, Gee AD, Gjedde A, Gyldensted C (1998) Absolute cerebral blood flow and blood volume measurements by magnetic resonance imaging bolus tracking: comparison with PET values. J Cereb Blood Flow Metab 18:425–432PubMedCrossRefGoogle Scholar
  48. 48.
    Patel MR, Edelman RR, Warach S (1996) Detection of hyperacute primary intraparenchymal hemorrhage by magnetic resonance imaging. Stroke 27:2321–2324PubMedCrossRefGoogle Scholar
  49. 49.
    Reith W, Hasegawa Y, Latour LL, Dardzinski BJ, Sotak CH, Fisher M (1995) Multislice diffusion mapping for 3-D evolution of cerebral ischemia in a rat stroke model. Neurology 45:172–177PubMedCrossRefGoogle Scholar
  50. 50.
    Reul J, Schäfer S, Isensee C, Thron A (1995) Der A. chorioidea anterior (ACHA)-Infarkt. Embo-lischer Territorialinfarkt oder Lakune? Klin Neuroradiol 5:128–134Google Scholar
  51. 51.
    Ringelstein EB, Zeumer H, Schneider R (1985) Der Beitrag der zerebralen Computertomographie zur Differentialtypologie und Differentialtherapie des ischämischen Großhirninfarkts. Fortschr Neurol Psychiat 53:315–336PubMedCrossRefGoogle Scholar
  52. 52.
    Roberts TP, Vexier Z, Derugin N, Moseley ME, Kucharczyk J (1993) High-speed MR imaging of ischemic brain injury following stenosis of the middle cerebral artery. J Cereb Blood Flow Metab 13:940–946PubMedCrossRefGoogle Scholar
  53. 53.
    Schellinger PD, Jansen O, Fiebach JB, Hacke W, Sartor K (1999). A standardized MRI stroke protocol: comparison with CT in hyperacute intracerebral hemorrhage. Stroke 30:765–768PubMedCrossRefGoogle Scholar
  54. 54.
    Schwab S, Steiner T, Aschoff A, Schwarz S, Steiner HH, Jansen O, Hacke W (1998) Early hemicra-niectomy in patients with complete middle cerebral artery infarction. Stroke 29:1888–1893PubMedCrossRefGoogle Scholar
  55. 55.
    Spatz H (1939) Pathologische Anatomie der Kreislaufstörungen des Gehirns. Z Neur 167:301–349Google Scholar
  56. 56.
    Tatu L, Moulin T, Bogousslavsky J, Duvernoy H (1996) Arterial territories of the human brain. Brainstem and cerebellum. Neurology 50:1125–1135Google Scholar
  57. 57.
    Tatu L, Moulin T, Bogousslavsky J, Duvernoy H (1998) Arterial territories of the human brain. Cerebral hemispheres. Neurology 50:1699–1708PubMedCrossRefGoogle Scholar
  58. 58.
    Thompson HK, Starmer CF, Whalen RE, Mclntosh HD (1964) Indicator transit time considered as a gamma variate. Circ Res 14:502–515PubMedCrossRefGoogle Scholar
  59. 59.
    Unger E, Littlefield J, Gado M (1988) Water content and water structure in CT and MR signal changes: possible influence in detection of early stroke. AJNR Am J Neuroradiol 9:687–691PubMedGoogle Scholar
  60. 60.
    Urbach H, Klotz S, Solymosi L (1996) Über die Erkennbarkeit ischämischer Großhirninfarkte im CT. Akt Neurol 23:146–150CrossRefGoogle Scholar
  61. 61.
    Urbach H, Hartmann A, Hegemann J, Solymosi L (1996) Wirksamkeit und Sicherheit der lokalen intraarteriellen Fibrinolyse im Karotisstromgebiet. Klin Neuroradiol 6:226–230Google Scholar
  62. 62.
    Urbach H, Brechteisbauer D, Klotz S, Bendszus M, Solymosi L (1997) Erkennbarkeit frischer Mediainfarkte im CT: Zeitliches Auftreten von Ischämiezeichen. Fortschr Röntgenstr 166:502–506CrossRefGoogle Scholar
  63. 63.
    Urbach H, Flacke S, Keller E, Textor J, Berlis A, Hattingen J, Hartmann A, Gieseke J, Reul J, Solymosi L, Schild HH (2000) Detectability and detection rate of acute hemispheric infarcts on CT and diffusion-weigthed MRI. Neuroradiology 42:722–727PubMedCrossRefGoogle Scholar
  64. 64.
    Van der Toorn A, Dijkhuizen RM, Tulleken CAF, Nicolay K (1996) Diffusion of metabolites in normal and ischemie rat brain measured by localized 1H MRS. Magn Reson Med 36:914–922PubMedCrossRefGoogle Scholar
  65. 65.
    Van der Zwan A, Hillen B, Tulleken CA, Dujovny M, Dragovic L (1992) Variability of the territories of the major cerebral arteries. J Neurosurg 77:927–940PubMedCrossRefGoogle Scholar
  66. 66.
    Visel CR, Ackerman JL, Buxton RB, Garrido L, Belliveau JW, Rosen BR, Brady TJ (1991) MR contrast due to microscopically heterogeneous magnetic susceptibility: numerical simulations and applications to cerebral physiology. Magn Reson Med 17:336–347CrossRefGoogle Scholar
  67. 67.
    von Kummer R, Meyding-Lamade U, Forsting M, Rosin L, Rieke K, Hacke W, Sartor K (1994) Sensitivity and prognostic value of early CT in occlusion of the middle cerebral artery trunk. AJNR Am J Neuroradiol 15:9–15Google Scholar
  68. 68.
    Weisskoff RM, Chesler D, Boxerman JL, Rosen BR (1993) Pitfalls in MR measurements of tissue blood flow with intravascular tracers: which mean transit time? Magn Reson Med 23:553–559CrossRefGoogle Scholar
  69. 69.
    Wick M, Nagatomo Y, Prielmeier F, Frahm J (1995) Alteration of intracellular metabolite diffusion in rat brain in vivo during ischemia and reperfusion. Stroke 26:1930–1934PubMedCrossRefGoogle Scholar
  70. 70.
    Zierler KL (1965) Theoretical basis of indicator-dilution methods for measuring blood flow and volume. Circ Res 16:393–407CrossRefGoogle Scholar
  71. 71.
    Zülch KJ (1961) Über die Entstehung und Lokalisation der Hirninfarkte. Zentralbl Neurochir 21:158–178Google Scholar

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© Springer-Verlag Berlin Heidelberg 2001

Authors and Affiliations

  • H. Urbach
  • S. Flacke

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