急性缺血性脑卒中再灌注治疗的影像学决策研究进展OA

Reperfusion therapy(including intravenous thrombolysis,endovascular treatment and their combination)is the standard of care and lead to improved clinical outcomes of patients with acute ischemic stroke(AIS).However,a subset of patients still had poor functional outcomes even when treated within the optimal early time windows.Neuroimaging serves as the primary method for decision-making in AIS reperfusion therapy.Through multimodal imaging techniques,it reflects the pathophysiological changes of AIS from different levels and perspectives,aiming to accurately and rapidly identify more patients with better outcomes,while avoiding severe complications and ineffective treatment.This article reviews the advances in neuroimaging-guided decision-making for AIS reperfusion therapy.Non-contrast CT and ASPECTS are mainly used in the early time window to quickly evaluate ischemic injury.Perfusion imaging is used in the late time window to identify infarct core and ischemic penumbra,extending the treatment time limit to 24 hours.For patients with wake-up stroke or unknown onset time,DWI/FLAIR mismatch and Net water uptake are used to evaluate onset time or salvageable tissue.In addition,the imaging evaluation of patients with large infarct core,collateral circulation-based decision-making,and the application of novel imaging markers are also discussed.At present,neuroimaging is developing from qualitative and semi-quantitative to quantitative and automated.In the future,by optimizing imaging methods and selection criteria,integrating multimodal imaging markers,and exploring innovative markers,it is expected to further improve the accuracy and efficiency of treatment decisions to facilitate precision medicine,to improve stroke outcomes.