Zusammenfassung
Das klinische Bild eines Schlaganfalles kann durch sehr unterschiedliche Erkrankungen verursacht sein. Grundlage einer spezifischen und effektiven Therapie stellt die sofortige Durchführung einer bildgebenden Diagnostik dar, um die Ursache zu klären. Die Computertomographie (CT) ist die am weitesten verfügbare Methode zur bildgebenden Diagnostik. Ihre entscheidende Bedeutung liegt in der schnellen und einfachen Durchführbarkeit sowie in der schnellen Darstellung einer intrakraniellen Blutung oder einer Ischämie. Die MRT mit Diffusions- und Perfusionsbildgebung ist ausreichend sensitiv in der Darstellung einer intrakraniellen Blutung und liefert schnell den Nachweis einer Ischämie, da die diffusionsgewichtete Bildgebung eine extrem sensitive Methode für früheste ischämische Veränderungen darstellt. Gerade die Diffusion ermöglicht auch die Darstellung kleiner Schlaganfälle, die mit der CT nicht oder nur ungenügend nachweisbar sind. Sowohl die CT als auch die MR-Angiographie lassen Gefäßstenosen oder Verschlüsse im zervikalen oder intrakraniellen Bereich sicher erkennen. Die Einführung der Perfusionsbildgebung hat in den letzten Jahren das Verständnis der Pathophysiologie der zerebralen Ischämie deutlich verbessert und neue diagnostische und therapeutische Möglichkeiten eröffnet. Somit könnte Perfusionsbildgebung, die sowohl mit der CT als auch mit der MRT möglich ist, in Zukunft wesentlich zur Indikationsstellung einer Lysetherapie beitragen.
Abstract
The clinical presentation of stroke can be caused by many different diseases. The basis of a specific and effective treatment of stroke is, therefore, immediate effective diagnostic imaging to clarify the exact cause. CT is the most widely available method for diagnostic imaging. Because it can be performed quickly and easily, the CT is of decisive importance in the identification of intracranial hemorrhage or ischemia. Thus, it allows within the first 3 h, the indication for the implementation of intravenous thrombolytic therapy. The MRI with diffusion and perfusion imaging is sufficiently sensitive in the depiction of intracranial hemorrhage and also provides rapid detection of ischemia, since diffusion-weighted imaging is an extremely sensitive method for early ischemic changes. Diffusion-weighted imaging is especially important in the detection of small strokes, for example, in the brainstem. These lesions are extremely difficult to detect by CT. Both CT and MR angiography make it possible to reliably detect vascular stenoses or occlusions in the cervical or intracranial area. The introduction of perfusion imaging in recent years has significantly improved the understanding of the pathophysiology of cerebral ischemia and new diagnostic and therapeutic possibilities. Especially perfusion imaging, which is possible with both with CT and MRI, may make a substantial contribution for the indication of thrombolytic therapy in the future.
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Struffert, T., Saake, M., Ott, S. et al. Bildgebung beim Schlaganfall. Intensivmed 47, 161–168 (2010). https://doi.org/10.1007/s00390-009-0118-0
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DOI: https://doi.org/10.1007/s00390-009-0118-0