中国实用神经疾病杂志2026，Vol.29Issue(3)：385-389,5.DOI:10.12083/SYSJ.251580
急性缺血性脑卒中再灌注治疗的影像学决策研究进展
Advances in neuroimaging-guided decision-making for reperfusion therapy in acute ischemic stroke
摘要
Abstract
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.关键词
缺血性脑卒中/再灌注治疗/灌注成像/侧支循环/血管成像/预后Key words
Ischemic stroke/Reperfusion therapy/Perfusion imaging/Collateral circulation/Angiogra-phy/Prognosis分类
医药卫生引用本文复制引用
李靖,冒晓文..急性缺血性脑卒中再灌注治疗的影像学决策研究进展[J].中国实用神经疾病杂志,2026,29(3):385-389,5.基金项目
湖南省卫生健康委卫生科研课题资助(编号:20256427,202209013170) （编号:20256427,202209013170）
邵阳市科技计划项目(编号:2022GZ4135) （编号:2022GZ4135）
