急性期脳梗塞診療における画像診断：適切な再灌流療法を行うために
要旨：脳梗塞の診断にはCTもしくはMRIによる画像評価が必須である．再開通療法の可能性があれば速やかに最低限必要な画像評価で再灌流療法の適応を決定することが重要である．2018年に改訂された米国のガイドラインでは，来院から20分以内に画像診断を行うことが推奨されたが，わが国のガイドラインには画像診断までの時間の推奨はない．わが国では普及率が高いMRIで急性期脳梗塞を評価している施設が多い．機械的血栓回収療法の適応判定には脳実質の評価に引き続き速やかな頭頸部血管評価が必要である．米国では発症6時間超の脳梗塞に対してCTもしくはMRIを使用した脳虚血コア体積や灌流異常の評価による機械的血栓回収療法...
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| Published in | 脳卒中 Vol. 42; no. 6; pp. 495 - 501 |
|---|---|
| Main Authors | , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脳卒中学会
2020
日本脳卒中学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0912-0726 1883-1923 |
| DOI | 10.3995/jstroke.10776 |
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| Abstract | 要旨：脳梗塞の診断にはCTもしくはMRIによる画像評価が必須である．再開通療法の可能性があれば速やかに最低限必要な画像評価で再灌流療法の適応を決定することが重要である．2018年に改訂された米国のガイドラインでは，来院から20分以内に画像診断を行うことが推奨されたが，わが国のガイドラインには画像診断までの時間の推奨はない．わが国では普及率が高いMRIで急性期脳梗塞を評価している施設が多い．機械的血栓回収療法の適応判定には脳実質の評価に引き続き速やかな頭頸部血管評価が必要である．米国では発症6時間超の脳梗塞に対してCTもしくはMRIを使用した脳虚血コア体積や灌流異常の評価による機械的血栓回収療法の適応を推奨しているが，わが国では灌流画像評価や迅速解析に対応した自動画像解析ソフトウェアが普及していない．急性期脳梗塞に対する適切な再灌流療法を行うための，わが国の医療環境にあわせた画像診断指針が必要であろう． |
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| AbstractList | 要旨：脳梗塞の診断にはCTもしくはMRIによる画像評価が必須である．再開通療法の可能性があれば速やかに最低限必要な画像評価で再灌流療法の適応を決定することが重要である．2018年に改訂された米国のガイドラインでは，来院から20分以内に画像診断を行うことが推奨されたが，わが国のガイドラインには画像診断までの時間の推奨はない．わが国では普及率が高いMRIで急性期脳梗塞を評価している施設が多い．機械的血栓回収療法の適応判定には脳実質の評価に引き続き速やかな頭頸部血管評価が必要である．米国では発症6時間超の脳梗塞に対してCTもしくはMRIを使用した脳虚血コア体積や灌流異常の評価による機械的血栓回収療法の適応を推奨しているが，わが国では灌流画像評価や迅速解析に対応した自動画像解析ソフトウェアが普及していない．急性期脳梗塞に対する適切な再灌流療法を行うための，わが国の医療環境にあわせた画像診断指針が必要であろう． 要旨: 脳梗塞の診断にはCTもしくはMRIによる画像評価が必須である. 再開通療法の可能性があれば速やかに最低限必要な画像評価で再灌流療法の適応を決定することが重要である. 2018年に改訂された米国のガイドラインでは, 来院から20分以内に画像診断を行うことが推奨されたが, わが国のガイドラインには画像診断までの時間の推奨はない. わが国では普及率が高いMRIで急性期脳梗塞を評価している施設が多い. 機械的血栓回収療法の適応判定には脳実質の評価に引き続き速やかな頭頸部血管評価が必要である. 米国では発症6時間超の脳梗塞に対してCTもしくはMRIを使用した脳虚血コア体積や灌流異常の評価による機械的血栓回収療法の適応を推奨しているが, わが国では灌流画像評価や迅速解析に対応した自動画像解析ソフトウェアが普及していない. 急性期脳梗塞に対する適切な再灌流療法を行うための, わが国の医療環境に合わせた画像診断指針が必要であろう. |
| Author | 池之内, 初 古賀, 政利 猪原, 匡史 塩澤, 真之 工藤, 與亮 山上, 宏 井上, 学 板橋, 亮 福田, 哲也 田中, 寛大 岡田, 敬史 佐藤, 徹 園田, 和隆 豊田, 一則 |
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| DOI | 10.3995/jstroke.10776 |
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| References_xml | – reference: 38) Schellinger PD, Jansen O, Fiebach JB, et al: A standardized MRI stroke protocol: comparison with CT in hyperacute intracerebral hemorrhage. Stroke 30: 765–768, 1999 – reference: 19) Xian Y, Xu H, Lytle B, et al: Use of strategies to improve door-to-needle times with tissue-type plasminogen activator in acute ischemic stroke in clinical practice: Findings from Target: Stroke. Circ Cardiovasc Qual Outcomes 10: e003227, 2017 – reference: 22) Meretoja A, Strbian D, Mustanoja S, et al: Reducing in-hospital delay to 20 minutes in stroke thrombolysis. Neurology 79: 306–313, 2012 – reference: 37) Patel MR, Edelman RR, Warach S: Detection of hyperacute primary intraparenchymal hemorrhage by magnetic resonance imaging. Stroke 27: 2321–2324, 1996 – reference: 16) Aghaebrahim A, Streib C, Rangaraju S, et al: Streamlining door to recanalization processes in endovascular stroke therapy. J Neurointerv Surg 9: 340–345, 2017 – reference: 27) Demchuk AM, Hill MD, Barber PA, et al: Importance of early ischemic computed tomography changes using ASPECTS in NINDS rtPA Stroke Study. Stroke 36: 2110–2115, 2005 – reference: 36) Wardlaw JM, West TM, Sandercock PA, et al: Visible infarction on computed tomography is an independent predictor of poor functional outcome after stroke, and not of haemorrhagic transformation. J Neurol Neurosurg Psychiatry 74: 452–458, 2003 – reference: 43) Manwani B, Rath S, Lee NS, et al: Early magnetic resonance imaging decreases hospital length of stay in patients with ischemic stroke. J Stroke Cerebrovasc Dis 28: 425–429, 2019 – reference: 14) Saver JL, Goyal M, van der Lugt A, et al: Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. JAMA 316: 1279–1288, 2016 – reference: 8) Boulanger JM, Lindsay MP, Gubitz G, et al: Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018. Int J Stroke 13: 949–984, 2018 – reference: 42) Wardlaw J, Brazzelli M, Miranda H, et al: An assessment of the cost-effectiveness of magnetic resonance, including diffusion-weighted imaging, in patients with transient ischaemic attack and minor stroke: a systematic review, meta-analysis and economic evaluation. Health Technol Assess 18: 1–368, v–vi, 2014 – reference: 2) Powers WJ, Rabinstein AA, Ackerson T, et al: 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. 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| Snippet | 要旨：脳梗塞の診断にはCTもしくはMRIによる画像評価が必須である．再開通療法の可能性があれば速やかに最低限必要な画像評価で再灌流療法の適応を決定することが重... 要旨: 脳梗塞の診断にはCTもしくはMRIによる画像評価が必須である. 再開通療法の可能性があれば速やかに最低限必要な画像評価で再灌流療法の適応を決定することが重... |
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| SubjectTerms | acute ischemic stroke diagnostic imaging door to imaging time reperfusion therapy |
| Title | 急性期脳梗塞診療における画像診断：適切な再灌流療法を行うために |
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