Apparent diffusion coefficientを用いた急性期脳虚血領域の可逆性評価
血栓溶解療法は, 閉塞血管の再開通により急性期脳梗塞患者の神経学的予後を改善させうる1)19). 一方で, すでに脳梗塞に陥った組織を再開通させた場合, 出血性梗塞などの重大な合併症を引き起こす可能性が指摘されており9)10)18), 術前に脳虚血領域の可逆性を評価することが, 血栓溶解療法の適応を決定するうえで重要となる. 近年, diffllsion MRIにより得られるapparent diffusion coefficient(ADC)の測定が, 脳虚血領域における水分子の拡散の変化を定量的に評価できるとの報告がある21). われわれは, 臨床上問題となる拡散強調画像(DWI)で淡い高...
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| Published in | 脳卒中の外科 Vol. 33; no. 1; pp. 30 - 34 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脳卒中の外科学会
2005
日本脳卒中の外科学会 |
| Online Access | Get full text |
| ISSN | 0914-5508 1880-4683 |
| DOI | 10.2335/scs.33.30 |
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| Abstract | 血栓溶解療法は, 閉塞血管の再開通により急性期脳梗塞患者の神経学的予後を改善させうる1)19). 一方で, すでに脳梗塞に陥った組織を再開通させた場合, 出血性梗塞などの重大な合併症を引き起こす可能性が指摘されており9)10)18), 術前に脳虚血領域の可逆性を評価することが, 血栓溶解療法の適応を決定するうえで重要となる. 近年, diffllsion MRIにより得られるapparent diffusion coefficient(ADC)の測定が, 脳虚血領域における水分子の拡散の変化を定量的に評価できるとの報告がある21). われわれは, 臨床上問題となる拡散強調画像(DWI)で淡い高信号を呈する領域を中心に, ADCによる評価が再開通による可逆性を予測可能かどうかをretrospectiveに検討したので報告する. |
|---|---|
| AbstractList | 血栓溶解療法は, 閉塞血管の再開通により急性期脳梗塞患者の神経学的予後を改善させうる1)19). 一方で, すでに脳梗塞に陥った組織を再開通させた場合, 出血性梗塞などの重大な合併症を引き起こす可能性が指摘されており9)10)18), 術前に脳虚血領域の可逆性を評価することが, 血栓溶解療法の適応を決定するうえで重要となる. 近年, diffllsion MRIにより得られるapparent diffusion coefficient(ADC)の測定が, 脳虚血領域における水分子の拡散の変化を定量的に評価できるとの報告がある21). われわれは, 臨床上問題となる拡散強調画像(DWI)で淡い高信号を呈する領域を中心に, ADCによる評価が再開通による可逆性を予測可能かどうかをretrospectiveに検討したので報告する. |
| Author | 鳴海, 治 吉田, 和道 舟木, 健史 後藤, 正憲 土井, 大輔 蔵本, 要二 押本, 剛 沈, 正樹 山形, 専 |
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| References | 21) Ulug AM, Beauchamp N Jr, Bryan RN, et al: Absolute quantitation of diffusion constants in human stroke. Stroke 28: 483-490, 1997 3) Fiehler J, Foth M, Kucinski T, et al: Severe ADC decreases do not predict irreversible tissue damage in humans. Stroke 33: 79-86, 2002 11) Latchaw RE, Yonas H, Hunter GJ, et al: Guidelines and recommendations for perfusion imaging in cerebral ischemia. A scientific statement for healthcare professionals by the writing group on perfusion imaging, from the council on cardiovascular radiology of the American heart association. Stroke 34: 1084-1104, 2003 19) The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group: Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333: 1581-1587, 1995 9) Kidwell CS, Saver JL, Carneado J, et al: Predictors of hemorrhagic transformation in patients receiving intra-arterial thrombolysis. Stroke 33: 717-724, 2002 20) Ueda T, Sakaki S, Yuh WTC, et al: Outcome in acute stroke with successful intra-arterial thrombolysis and predictive value of initial single-photon emission-computed tomography. J Cereb Blood Metab 19: 99-108, 1999 13) Moseley ME, Kucharczyk J, Mintorovitch J, et al: Diffusion-weighted MR imaging of acute stroke: correlation with T2-weighted and magnetic susceptibility-enhanced MR imaging in cats. AJNR Am J Neuroradiol 11: 423-429, 1990 8) Kidwell CS, Saver JL, Mattiello J, et al: Thrombolytic reversal of acute human cerebral ischemic injury shown by diffusion/perfusion magnetic resonance imaging. Ann Neurol 47: 462-469, 2000 12) Minematsu K, Li L, Sotak CH, et al: Reversible focal ischemic injury demonstrated by diffusion-weighted magnetic resonance imaging in rats. Stroke 23: 1304-1311, 1992 16) Sakoh M, Østergaard L, Gjedde A, et al: Prediction of tissue survival after middle cerebral artery occlusion based on changes in the apparent diffusion of water. J Neurosurg 95: 450-458, 2001 2) Desmond PM, Lovell AC, Rawlinson AA, et al: The value of apparent diffusion coefficient maps in early cerebral ischemia. AJNR Am J Neuroradiol 22: 1260-1267, 2001 4) Hoehn-Berlage M, Norris DG, Kohno K, et al: Evolution of regional changes in apparent diffusion coefficient during focal ischemia of rat brain: the relationship of quantitative diffusion NMR imaging to reduction in cerebral blood flow and metabolic disturbances. J Cereb Blood Flow Metab 15: 1002-1011, 1995 17) Schlaug G, Benfield A, Baird AE, et al: The ischemic penumbra operationally defined by diffusion and perfusion MRI. Neurology 53: 1528-1537, 1999 1) del Zoppo GJ, Higashida RT, Furlan AJ, et al: PROACT: a phase II randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke. Stroke 29: 4-11, 1998 14) Oppenheim C, Grandin C, Samson Y, et al: Is there an apparent diffusion coefficient threshold in predicting tissue viability in hyperacute stroke? Stroke 32: 2486-2491, 2001 15) Røhl L, Østergaard L, Simonsen CZ, et al: Viability thresholds of ischemic penumbra of hyperacute stroke defined by perfusion-weighted MRI and apparent diffusion coefficient. Stroke 32: 1140-1146, 2001 22) Wintermark M, Reichhart M, Thiran JP, et al: Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients. Ann Neurol 51: 417-432, 2002 6) Jansen O, Schellinger P, Fiebach J, et al: Early recanalisation in acute ischaemic stroke saves tissue at risk defined by MRI. Lancet 353: 2036-2037, 1999 10) Koizumi J, Yoshida Y, Nishigaya K, et al: Experimental studies of ischemic brain edema: Effect of recirculation of the blood flow after ischemia on post-ischemic brain edema. Jpn J Stroke 11: 11-17, 1989 7) Jones TH, Morawetz RB, Crowell RM, et al: Thresholds of focal cerebral ischemia in awake monkeys. J Neurosurg 54: 773-782, 1981 5) Hossmann KA: Viability thresholds and the penumbra of focal ischemia. Ann Neurol 36: 557-565, 1994 18) Tamura A, Asano T, Sano K: Correlation between rCBF and histological changes following temporary middle cerebral artery occlusion. Stroke 11: 487-493, 1980 |
| References_xml | – reference: 14) Oppenheim C, Grandin C, Samson Y, et al: Is there an apparent diffusion coefficient threshold in predicting tissue viability in hyperacute stroke? Stroke 32: 2486-2491, 2001 – reference: 5) Hossmann KA: Viability thresholds and the penumbra of focal ischemia. Ann Neurol 36: 557-565, 1994 – reference: 2) Desmond PM, Lovell AC, Rawlinson AA, et al: The value of apparent diffusion coefficient maps in early cerebral ischemia. AJNR Am J Neuroradiol 22: 1260-1267, 2001 – reference: 7) Jones TH, Morawetz RB, Crowell RM, et al: Thresholds of focal cerebral ischemia in awake monkeys. J Neurosurg 54: 773-782, 1981 – reference: 19) The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group: Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333: 1581-1587, 1995 – reference: 13) Moseley ME, Kucharczyk J, Mintorovitch J, et al: Diffusion-weighted MR imaging of acute stroke: correlation with T2-weighted and magnetic susceptibility-enhanced MR imaging in cats. AJNR Am J Neuroradiol 11: 423-429, 1990 – reference: 9) Kidwell CS, Saver JL, Carneado J, et al: Predictors of hemorrhagic transformation in patients receiving intra-arterial thrombolysis. Stroke 33: 717-724, 2002 – reference: 10) Koizumi J, Yoshida Y, Nishigaya K, et al: Experimental studies of ischemic brain edema: Effect of recirculation of the blood flow after ischemia on post-ischemic brain edema. Jpn J Stroke 11: 11-17, 1989 – reference: 15) Røhl L, Østergaard L, Simonsen CZ, et al: Viability thresholds of ischemic penumbra of hyperacute stroke defined by perfusion-weighted MRI and apparent diffusion coefficient. Stroke 32: 1140-1146, 2001 – reference: 6) Jansen O, Schellinger P, Fiebach J, et al: Early recanalisation in acute ischaemic stroke saves tissue at risk defined by MRI. Lancet 353: 2036-2037, 1999 – reference: 17) Schlaug G, Benfield A, Baird AE, et al: The ischemic penumbra operationally defined by diffusion and perfusion MRI. Neurology 53: 1528-1537, 1999 – reference: 16) Sakoh M, Østergaard L, Gjedde A, et al: Prediction of tissue survival after middle cerebral artery occlusion based on changes in the apparent diffusion of water. J Neurosurg 95: 450-458, 2001 – reference: 11) Latchaw RE, Yonas H, Hunter GJ, et al: Guidelines and recommendations for perfusion imaging in cerebral ischemia. A scientific statement for healthcare professionals by the writing group on perfusion imaging, from the council on cardiovascular radiology of the American heart association. Stroke 34: 1084-1104, 2003 – reference: 12) Minematsu K, Li L, Sotak CH, et al: Reversible focal ischemic injury demonstrated by diffusion-weighted magnetic resonance imaging in rats. Stroke 23: 1304-1311, 1992 – reference: 20) Ueda T, Sakaki S, Yuh WTC, et al: Outcome in acute stroke with successful intra-arterial thrombolysis and predictive value of initial single-photon emission-computed tomography. J Cereb Blood Metab 19: 99-108, 1999 – reference: 18) Tamura A, Asano T, Sano K: Correlation between rCBF and histological changes following temporary middle cerebral artery occlusion. Stroke 11: 487-493, 1980 – reference: 22) Wintermark M, Reichhart M, Thiran JP, et al: Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients. Ann Neurol 51: 417-432, 2002 – reference: 1) del Zoppo GJ, Higashida RT, Furlan AJ, et al: PROACT: a phase II randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke. Stroke 29: 4-11, 1998 – reference: 21) Ulug AM, Beauchamp N Jr, Bryan RN, et al: Absolute quantitation of diffusion constants in human stroke. Stroke 28: 483-490, 1997 – reference: 3) Fiehler J, Foth M, Kucinski T, et al: Severe ADC decreases do not predict irreversible tissue damage in humans. Stroke 33: 79-86, 2002 – reference: 8) Kidwell CS, Saver JL, Mattiello J, et al: Thrombolytic reversal of acute human cerebral ischemic injury shown by diffusion/perfusion magnetic resonance imaging. Ann Neurol 47: 462-469, 2000 – reference: 4) Hoehn-Berlage M, Norris DG, Kohno K, et al: Evolution of regional changes in apparent diffusion coefficient during focal ischemia of rat brain: the relationship of quantitative diffusion NMR imaging to reduction in cerebral blood flow and metabolic disturbances. J Cereb Blood Flow Metab 15: 1002-1011, 1995 |
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| Title | Apparent diffusion coefficientを用いた急性期脳虚血領域の可逆性評価 |
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