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CT-Diagnostik bei akuter zerebraler Ischämie

CT in acute ischemic stroke

  • Schlaganfall
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Zusammenfassung

Obwohl die Magnetresonanztomographie (MRT) gegenüber der Computertomographie (CT) Vorteile bei der Frühdiagnostik der akuten zerebralen Ischämie bietet, wird der überwiegende Anteil von Patienten mit frischen Schlaganfällen in Kliniken eingeliefert, denen nur ein CT zur Verfügung steht. In dieser Übersichtsarbeit wird die diagnostische Wertigkeit des „Schlaganfall-CT-Protokolls“, bestehend aus Nativ-CT, Perfusions-CT und CT-Angiographie (CTA) anhand mehrerer Beispiele diskutiert. Mit der Perfusions-CT kann der Diagnostiker therapierelevante Informationen über die zerebralen Perfusionsverhältnisse (zerebraler Blutfluss, zerebrales Blutvolumen und Transitzeit des Blutes) erhalten. Die CTA liefert wertvolle Informationen über den Gefäßstatus; die Analyse der CTA-Quellbilder bietet zusätzliche Informationen über die Größe des Infarktkerns. Diese Untersuchungstechniken führen nur zu einer minimalen Verzögerung in der Therapie, können dafür jedoch entscheidende Hilfe bei der Patientenselektion für eine Thrombolysetherapie sein.

Abstract

The advent of new MRI techniques such as perfusion- (PWI) and diffusion- (DWI) weighted imaging has improved diagnostic imaging in stroke. However, CT scanners are more widely available and less expensive than MRI scanners and are often located in the emergency departments even of smaller community hospitals.

Topic of this article is CT-based diagnosis of patients with hyperacute ischemic stroke. In hyperacute stroke, a multiparametric CT protocol allows a comprehensive diagnosis by combining non-contrast enhanced CT (NECT), perfusion CT (PCT), and CT angiography (CTA). PCT can render important information about the hypoperfused brain tissue, CTA provides further important information about the vessel status. When stroke MRI is not available, multiparametric stroke CT can give nearly equivalent information, and can help to identify patients for thrombolytic therapy.

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  1. Abteilung Neuroradiologie, Neurologische Klinik, Universitätsklinikum Heidelberg

    P. Schramm

  2. Abteilung Neuroradiologie, Neurologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg

    P. Schramm

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Schramm, P. CT-Diagnostik bei akuter zerebraler Ischämie. Radiologe 45, 420–429 (2005). https://doi.org/10.1007/s00117-005-1206-1

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  • DOI: https://doi.org/10.1007/s00117-005-1206-1

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