大面积大脑中动脉脑梗死取栓后弥散加权成像高信号逆转1例报告

Diffusion-weighted imaging hyperintensity is reversible in large middle cerebral artery infarction following thrombectomy:a case report

弥散加权成像(DWI)被认为是诊断早期缺血性脑梗死最敏感的技术,DWI高信号区域通常被认为是不可逆的梗死核心区域。然而,最近的研究表明在小的栓塞病变上,DWI高信号是可逆的。本文报告1例63岁老年男性,因"突发左侧肢体无力伴意识障碍"转入我院急诊。转入我院约6.8 h前,患者突然出现左侧肢体无力。急诊头颅磁共振(MRI)及磁共振血管成像(MRA)显示右侧大脑中动脉(MCA)阻塞,DWI提示大面积脑梗死。尽管基线DWI病变体积达91.5 m L,评估后仍进行了血管内取栓手术。在发病后8.5 h,右侧的MCA开通。术后1周,DWI病变体积减少到了11.58 m L。大面积前循环病变中DWI异常信号的逆转,提示DWI高信号的含义应该被谨慎解读。此外基线DWI上的大面积病变可能不是取栓手术的禁忌,但是还需要大的随机对照研究来证实这一结论。

Diffusion-weighted imaging(DWI) is currently the most sensitive technique to diagnose early ischemic stroke. DWI signal hyperintensity is usually considered to suggest irreversible infarct core, but recent studies demonstrated that DWI hyperintensity signal could be reversible on small embolic lesions. Herein we present a case in a 63-year-old male patient, who was admitted to the emergency department with altered mental status and complaint of weakness in the left arm and leg 6.8 h prior to the admission. Emergency cranial magnetic resonance imaging(MRI) and angiography(MRA) revealed occlusion of his right middle cerebral artery(MCA) and large lesions on DWI. The patient underwent intra-artery thrombectomy after evaluation in spite of the large volume of the DWI lesions up to 91.5 m L at the baseline. His right MCA was recanalized at 8.5 h from symptom onset. One week after the procedure, the patient showed reduced DWI lesion volume to 11.58 m L. In this case we observed the reversibility of a large lesion of the anterior artery circulation presenting with hyperintensity on DWI,suggesting that the clinical implication of DWI hyperintensity should be interpreted with caution, and a large volume of baseline DWI hyperintensity may not be a contraindication to thrombectomy. This conclusion, however, awaits further validation by future large-scale randomized controlled trials.