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目的评估磁共振弥散加权成像(DWI)和灌注加权成像(PWI)诊断急性缺血性卒中的临床证据。方法系统性分析1966年—2008年1月的文献,探讨DWI和PWI在急性缺血性卒中诊断和预后判断方面的价值。结果和推荐意见DWI是诊断急性缺血性卒中的有效手段。在卒中首发症状出现12 h内,DWI的诊断价值优于CT平扫。DWI能够最准确地诊断急性缺血性卒中(A级推荐);但DWI的敏感性在诊断普通人群疑似卒中时,并不是最佳。本指南并不讨论DWI对脑出血的诊断价值。Ⅱ级和Ⅲ级证据的研究显示,根据基线DWI上病灶大小,预测前循环卒中早期病情严重程度的价值较高(B级推荐),对后循环卒中似乎缺乏预测价值(C级推荐)。基线DWI上病灶大小可预测最终梗死灶的大小(B级推荐)及早期、后期的临床转归(C级推荐)。与DWI相比,基线PWI上病灶大小对病情严重程度的预测价值较低(C级推荐)。目前尚无足够的证据支持或否定PWI对急性缺血性卒中的诊断价值(U级推荐)。
Objective To evaluate the clinical evidence of magnetic resonance diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) in the diagnosis of acute ischemic stroke. Methods The literature of 1966 - January 2008 was systematically analyzed to explore the value of DWI and PWI in the diagnosis and prognosis of acute ischemic stroke. Results and Recommendations DWI is an effective method of diagnosing acute ischemic stroke. In the first symptom onset of stroke within 12 h, the diagnostic value of DWI is better than CT scan. DWI is the most accurate diagnosis of acute ischemic stroke (Grade A recommendation); however, the sensitivity of DWI is not optimal in the diagnosis of suspected stroke in the general population. This guide does not discuss the diagnostic value of DWI for intracerebral hemorrhage. Studies of grade II and III evidence suggest that predicting the severity of anterior circulation stroke is of higher value (Grade B recommendation) based on the size of the lesion on baseline DWI and appears to lack predictive value for posterior circulation stroke (Level C recommendation). The size of the lesion on the baseline DWI predicts the size of the final infarct (Grade B recommendation) and early and late clinical outcome (Grade C recommendation). Compared with DWI, the baseline PWI lesion size on the severity of the prognosis is low (C-level recommended). There is not enough evidence to support or deny the diagnostic value of PWI in acute ischemic stroke (U-level recommendation).