Akut iskemik strokta difüzyon ve perfüzyon MR lezyonlarının T2MR final infarkt volümü ile korelasyonu
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Dosyalar
Tarih
2010
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Serebral iskemi; beynin belli bir bölgesinde serebral kan akımının normal serebral fonksiyonu sürdürmek için ihtiyaç duyulan seviyenin altına düşmesi sonucu oluşan klinik bir durumdur. İnme dünyada mortalite nedeni olarak 3. sırada yer almaktayken, en sık morbidite nedenidir.Bu çalışmada amacımız inmenin akut döneminde difüzyon ve perfüzyon MR görüntüleri arasındaki uyumsuzluk varlığının tespiti ve bu uyumsuzluğun klinik prognoz ve finalde lezyon büyümesine olan etkisinin incelenmesiydi. Bu nedenle çalışmaya semptom başlangıcından sonraki 24 saat içinde hastaneye başvurmuş olan ve difüzyon MRG ile iskemik inme tanısı alan 27 hasta dahil edildi. Hastalara ilk 24 saatte perfüzyon MR görüntüleme yapıldı ve hastalar ESS, NIHSS, mRS ile klinik olarak değerlendirildi. Ortalama 15 gün sonra hastalara kontrol T2MR çekilerek aynı skalalarla son durum klinik değerlendirmeleri yapıldı. Trombolitik tedavi hiçbir hastaya uygulanmadı ve hastalara uygulanan tedaviler klinikte hastayı takip eden doktor tarafından düzenlendi. Çalışmaya katılan hastaların 2'si kliniğimizde takip edilmekteyken eksitus oldu. Hastalar uyumsuzluk ciddiyetine göre ciddi uyumsuzluğu olanlar, hafif-orta uyumsuzluğu olanlar, uyumsuzluğu olmayanlar olarak sınıflandırıldı.Elde edilen sonuçlara göre; şikayetlerin başlangıcından ilk 24 saat içinde gelen hastaların büyük bir kısmında penumbra alanı görülmüştür. Eğer uyumsuzluk ciddi derecede ise bu durum finalde lezyon büyümesi olan hasta sayısını istatistiksel olarak anlamlı düzeyde etkilemekteyken, finalde gelişecek olan lezyondaki büyümenin derecesini de yine anlamlı oranda etkilemiştir. Ciddi derecedeki uyumsuzluğun İKY ile sonlanıma etkisinin istatistiksel olarak anlamlı olmadığı görülmüş ve bu hastalar genel olarak İKY sonlanmamıştır. Akut dönemdeki ESS skorunun perfüzyon MRG'deki lezyon hacimleriyle ilişkisi, difüzyon MRG'leriyle ilişkisinden istatistiksel olarak daha anlamlı bulunmuştur.Sonuç olarak difüzyon ve perfüzyon MR görüntüleri arasındaki uyumsuzluğun varlığı; klinik ve radyolojik sonuçların öngörülmesinde değerlidir. Ayrıca uygun tedavinin seçimi ve prognozun belirlenmesinde klinisyene değerli bilgiler vermektedir.Anahtar Kelimeler: İskemik inme, difüzyon/perfüzyon MR uyumsuzluğu, finalde lezyon büyümesi ve iyi klinik yanıt.
Cerebral ischemia is defined as decreased cerebral perfusion which is lower than sufficient amount for normal cerebral function in a part of brain. Stroke is the third common cause of mortality in the world, but it is the most common cause of morbidity.The aim of this study is to determine mismatch between the diffusion and perfusion MRI findings in the acute period of stroke and to analyze the effect of this mismatch on clinical prognosis and final lesion increment. Twenty seven patients, who were referred to our hospital in 24 hours period from the beginning of symptoms and also were confirmed the diagnosis of stroke with diffusion MRI, were included the study. Perfusion MRI and several scoring scales (ESS, NIHSS, mRS) were performed on all these patients in first 24 hours period. We also evaluated the patients with T2 MRI and the same clinical scoring scales approximately 15 days later. Thrombolytic treatment was not applied on any patients and treatment options of each patients were arranged by their own clinical doctor. Two patients unfortunately died, when the treatments of them were continuing in the hospital. The patients were grouped into three categories according to the degree of mismatch; 1. Severe mismatch, 2. Mild to moderate mismatch, 3. Absence of mismatchThe results of study revealed that most of the patients diagnosed as stroke in 24 hours period had penumbra according to the diffusion and perfusion MRI findings. Severe mismatch affected final lesion increment in a statistically significant manner. In addition, it positively affected the degree of final lesion increment. Patients with severe mismatch did not have a favorable clinical response, although the effect of severe mismatch to favorable clinical response was found statistically insignificant. ESS was correlated to diffusion and perfusion MRI volumes in acute period. But other clinical scoring scales were not correlated. The association of perfusion MRI volume and ESS was found to be more significant than diffusion MRI volume and ESS association.Finally, mismatch between the diffusion and perfusion MRI is valuable for prediction of the final clinical and radiological results. In addition, it also gives important information to clinicians for determining the true treatment modality and prediction of prognosis.Key Words: Ischemic stroke, diffusion/perfusion mismatch, final lesion increment and favorable clinical response.
Cerebral ischemia is defined as decreased cerebral perfusion which is lower than sufficient amount for normal cerebral function in a part of brain. Stroke is the third common cause of mortality in the world, but it is the most common cause of morbidity.The aim of this study is to determine mismatch between the diffusion and perfusion MRI findings in the acute period of stroke and to analyze the effect of this mismatch on clinical prognosis and final lesion increment. Twenty seven patients, who were referred to our hospital in 24 hours period from the beginning of symptoms and also were confirmed the diagnosis of stroke with diffusion MRI, were included the study. Perfusion MRI and several scoring scales (ESS, NIHSS, mRS) were performed on all these patients in first 24 hours period. We also evaluated the patients with T2 MRI and the same clinical scoring scales approximately 15 days later. Thrombolytic treatment was not applied on any patients and treatment options of each patients were arranged by their own clinical doctor. Two patients unfortunately died, when the treatments of them were continuing in the hospital. The patients were grouped into three categories according to the degree of mismatch; 1. Severe mismatch, 2. Mild to moderate mismatch, 3. Absence of mismatchThe results of study revealed that most of the patients diagnosed as stroke in 24 hours period had penumbra according to the diffusion and perfusion MRI findings. Severe mismatch affected final lesion increment in a statistically significant manner. In addition, it positively affected the degree of final lesion increment. Patients with severe mismatch did not have a favorable clinical response, although the effect of severe mismatch to favorable clinical response was found statistically insignificant. ESS was correlated to diffusion and perfusion MRI volumes in acute period. But other clinical scoring scales were not correlated. The association of perfusion MRI volume and ESS was found to be more significant than diffusion MRI volume and ESS association.Finally, mismatch between the diffusion and perfusion MRI is valuable for prediction of the final clinical and radiological results. In addition, it also gives important information to clinicians for determining the true treatment modality and prediction of prognosis.Key Words: Ischemic stroke, diffusion/perfusion mismatch, final lesion increment and favorable clinical response.
Açıklama
Anahtar Kelimeler
Beyin iskemisi, Brain ischemia, Difüzyon manyetik rezonans görüntüleme, Diffusion magnetic resonance imaging, Manyetik rezonans görüntüleme, Magnetic resonance imaging
Kaynak
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Künye
Şap, H. (2010). Akut iskemik strokta difüzyon ve perfüzyon MR lezyonlarının T2MR final infarkt volümü ile korelasyonu. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Nöroloji Anabilim Dalı, Konya.
