Challenging the Ischemic Core Concept in Acute Ischemic Stroke Imaging

被引：170

作者：

Goyal, Mayank ^{[1
,2
]}

Ospel, Johanna M. ^{[1
,3
]}

Menon, Bijoy ^{[1
,2
]}

Almekhlafi, Mohammed ^{[1
,2
]}

Jayaraman, Mahesh ^{[4
]}

Fiehler, Jens ^{[5
]}

Psychogios, Marios ^{[3
]}

Chapot, Rene ^{[6
]}

van der Lugt, Aad ^{[7
]}

Liu, Jianmin ^{[8
]}

Yang, Pengfei ^{[9
]}

Agid, Ronit ^{[10
]}

Hacke, Werner ^{[11
]}

Walker, Melanie ^{[12
]}

Fischer, Urs ^{[13
]}

Asdaghi, Negar ^{[14
]}

McTaggart, Ryan ^{[4
]}

Srivastava, Padma ^{[15
]}

Nogueira, Raul G. ^{[16
]}

Moret, Jacques ^{[17
]}

Saver, Jeffrey L. ^{[18
,19
]}

Hill, Michael D. ^{[1
,2
]}

Dippel, Diederik ^{[20
]}

Fisher, Marc ^{[21
]}

机构：

[1] Univ Calgary, Dept Clin Neurosci, Calgary, AB, Canada

[2] Univ Calgary, Dept Radiol, Calgary, AB, Canada

[3] Univ Basel, Univ Hosp Basel, Clin Radiol & Nucl, Div Neuroradiol, Basel, Switzerland

[4] Brown Univ, Warren Alpert Med Sch, Dept Intervent Radiol, Providence, RI 02912 USA

[5] Univ Med Ctr Hamburg Eppendorf, Dept Diagnost & Intervent Neuroradiol, Hamburg, Germany

[6] Alfred Krupp Krankenhaus, Dept Neuroradiol, Essen, Germany

[7] Erasmus MC, Dept Radiol & Nucl Med, Rotterdam, Netherlands

[8] Naval Med Univ, Changhai Hosp, Dept Neurosurg, Shanghai, Peoples R China

[9] Second Mil Med Univ, Dept Neurosurg, Changhai Hosp, Shanghai, Peoples R China

[10] Univ Toronto, Dept Med Imaging, Toronto, ON, Canada

[11] Univ Hosp Heidelberg, Dept Neurol, Heidelberg, Germany

[12] Univ Washington, Sch Med, Dept Neurol Surg, Seattle, WA 98195 USA

[13] Univ Bern, Inselspital, Univ Hosp Bern, Dept Neuroradiol, Bern, Switzerland

[14] Univ Miami, Miller Sch Med, Dept Neurol, Coral Gables, FL 33124 USA

[15] All India Inst Med, Dept Neurol, New Delhi, India

[16] Emory Univ, Sch Med, Dept Neurol, Atlanta, GA 30322 USA

[17] Baujon Univ Hosp, Brain Vasc Ctr, Paris, France

[18] Univ Calif Los Angeles, David Geffen Sch Med, Dept Neurol, Los Angeles, CA 90095 USA

[19] Univ Calif Los Angeles, David Geffen Sch Med, Comprehens Stroke Ctr, Los Angeles, CA 90095 USA

[20] Erasmus Univ, Med Ctr, Dept Neurol, Rotterdam, Netherlands

[21] Beth Israel Deaconess Med Ctr, Dept Neurol, Boston, MA 02215 USA

来源：

STROKE | 2020年 / 51卷 / 10期

关键词：

computed tomography; magnetic resonance imaging; thrombectomy; CEREBRAL-BLOOD-FLOW; HEALTH-CARE PROFESSIONALS; COMPUTED-TOMOGRAPHY; EARLY MANAGEMENT; 2018; GUIDELINES; INFARCT VOLUME; PERFUSION; DIFFUSION; THROMBECTOMY; REPERFUSION;

D O I：

10.1161/STROKEAHA.120.030620

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Endovascular treatment is a highly effective therapy for acute ischemic stroke due to large vessel occlusion and has recently revolutionized stroke care. Oftentimes, ischemic core extent on baseline imaging is used to determine endovascular treatment-eligibility. There are, however, 3 fundamental issues with the core concept: First, computed tomography and magnetic resonance imaging, which are mostly used in the acute stroke setting, are not able to precisely determine whether and to what extent brain tissue is infarcted (core) or still viable, due to variability in tissue vulnerability, the phenomenon of selective neuronal loss and lack of a reliable gold standard. Second, treatment decision-making in acute stroke is multifactorial, and as such, the relative importance of single variables, including imaging factors, is reduced. Third, there are often discrepancies between core volume and clinical outcome. This review will address the uncertainty in terminology and proposes a direction towards more clarity. This theoretical exercise needs empirical data that clarify the definitions further and prove its value.

引用

页码：3147 / 3155

页数：9

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