Contributo da técnica de perfusão em tomografia computorizada e ressonância magnética no diagnóstico do acidente vascular cerebral: revisão narrativa
DOI:
https://doi.org/10.25758/set.1881Palavras-chave:
Acidente vascular cerebral, Tomografia computorizada, Ressonância magnética, Imagem em perfusão, Mapa paramétricoResumo
Objetivo – Avaliar o contributo e eficiência das técnicas de perfusão por tomografia computorizada (TC) e ressonância magnética (RM) no diagnóstico do acidente vascular cerebral isquémico agudo. Métodos – Efetuou-se uma pesquisa bibliográfica eletrónica de que resultaram 2.224 artigos, sendo que 28 correspondiam aos critérios de inclusão por análise de definições (15 de TC, 11 de RM e 2 de TC e RM), eram estudos prospetivos, de adultos em risco de isquemia cerebral, com avaliação diagnóstica dos estudos de perfusão por TC (TCP) e RM (RMP) após acidente vascular cerebral. Compararam-se protocolos e níveis percentuais de exatidão, sensibilidade e especificidade através de análises métricas de frequência e expressão central. Resultados – Analisaram-se os dados correspondentes a parâmetros e técnicas de aquisição de imagens de perfusão quer em TC quer em RM. Verificou-se que a exatidão, sensibilidade e especificidade foi de 88,5%, 91,5% e 90,5% para RM e de 83%, 86% e 91,7% para TC, respetivamente. Conclusão – Apesar de a RM se manter como o método de imagem com maior valor clínico, a TC vem competir com a RM em situações de emergência médica, uma vez que a sua maior acessibilidade e rapidez permitem diminuir o tempo de espera entre o diagnóstico e a terapêutica.
Downloads
Referências
Sousa-Uva M, Dias CM. Prevalência de acidente vascular cerebral na população portuguesa: dados da amostra ECOS 2013. Bol Epidemiol Observações. 2014;3(9):12-4.
Direção-Geral da Saúde. Programa nacional para as doenças cérebro-cardiovasculares 2017. Lisboa: DGS; 2017.
European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis. 2008;25(5):457-507.
World Health Organization. Cardiovascular diseases mortality: age-standardized death rate per 100,000 population, 2000-2016 [homepage]. Geneva: WHO; 2012 [updated 2018]. Available from: https://gamapserver.who.int/gho/interactive_charts/ncd/mortality/total/atlas.html
Fuentes B, Ntaios G, Putaala J, Thomas B, Turc G, Díez-Tejedor E. European Stroke Organisation (ESO) guidelines on glycaemia management in acute stroke. Eur Stroke J. 2018;3(1):5-21.
Zhang Y, Chapman AM, Plested M, Jackson D, Purroy F. The incidence, prevalence, and mortality of stroke in France, Germany, Italy, Spain, the UK, and the US: a literature review. Stroke Res Treat. 2012;2012:436125.
Martins JF. Conhecimento leigo de sinais e sintomas precedentes de um acidente vascular cerebral (AVC) isquémico [Dissertation]. Porto: Universidade Fernando Pessoa; 2011.
Souza LC, Payabvash S, Wang Y, Kamalian S, Schaefer P, Gonzalez RG, et al. Admission CT perfusion is an independent predictor of hemorrhagic transformation in acute stroke with similar accuracy to DWI. Cerebrovasc Dis. 2012;33(1):8-15.
Lopes L, Sousa R, Ruivo J, Reimão S, Sequeira P, Campos J. O contributo da tomografia computorizada de perfusão no acidente vascular cerebral [The contribution of perfusion CT in stroke]. Acta Med Port. 2006;19(6):484-8. Portuguese
Ho CY, Hussain S, Alam T, Ahmad I, Wu IC, O'Neill DP. Accuracy of CT cerebral perfusion in predicting infarct in the emergency department: Lesion characterization on CT perfusion based on commercially available software. Emerg Radiol. 2013;20(3):203-12.
American Stroke Association. 5 Fast facts about stroke [homepage]. Dallas: www.strokeassociation.org; 2018. Available from: https://www.strokeassociation.org/en/about-the-american-stroke-association/american-stroke-month/5-fast-facts-about-stroke-infographic?s=q%253DWith%252520a%252520stroke%25252C%252520time%252520lost%252520is%252520brain%252520lost%2526sort%253Drelevancy
De Freitas GR, De H Christoph D, Bogousslavsky J. Topographic classification of ischemic stroke. In: Fisher M, editor. Handbook of clinical neurology Vol. 93). 3rd ed. Amsterdam: Elsevier Health Sciences; 2008. p. 425-52.
Habib M. Bases neurológicas dos comportamentos. Lisboa: Climepsi Editores; 2000. ISBN 9789728449599
Miles KA. Perfusion CT for the assessment of tumour vascularity: which protocol? Br J Radiol. 2003;76 Spec No 1:S36-42.
Eckert B, Küsel T, Leppien A, Michels P, Müller-Jensen A, Fiehler J. Clinical outcome and imaging follow-up in acute stroke patients with normal perfusion CT and normal CT angiography. Neuroradiology. 2011;53(2):79-88.
Asdaghi N, Hill MD, Coulter JI, Butcher KS, Modi J, Qazi A, et al. Perfusion MR predicts outcome in high-risk transient ischemic attack/minor stroke: a derivation-validation study. Stroke. 2013;44(9):2486-92.
Dani KA, Thomas RG, Chappell FM, Shuler K, MacLeod MJ, Muir KW, et al. Computed tomography and magnetic resonance perfusion imaging in ischemic stroke: definitions and thresholds. Ann Neurol. 2011;70(3):384-401.
Thierfelder KM, Sommer WH, Baumann AB, Klotz E, Meinel FG, Strobl FF, et al. Whole-brain CT perfusion: reliability and reproducibility of volumetric perfusion deficit assessment in patients with acute ischemic stroke. Neuroradiology. 2013;55(7):827-35.
Wintermark M, Flanders AE, Velthuis B, Meuli R, van Leeuwen M, Goldsher D, et al. Perfusion-CT assessment of infarct core and penumbra: receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke. Stroke. 2006;37(4):979-85.
Scharf J, Brockmann MA, Daffertshofer M, Diepers M, Neumaier-Probst E, Weiss C, et al. Improvement of sensitivity and interrater reliability to detect acute stroke by dynamic perfusion computed tomography and computed tomography angiography. J Comput Assist Tomogr. 2006;30(1):105-10.
Lopes L. Perfusion CT: additional diagnostic and clinical information in MCA stroke. Neuroradiol J. 2010;23(6):651-8.
Wintermark M, Fischbein NJ, Smith WS, Ko NU, Quist M, Dillon WP. Accuracy of dynamic perfusion CT with deconvolution in detecting acute hemispheric stroke. AJNR Am J Neuroradiol. 2005;26(1):104-12.
Schaefer PW, Barak ER, Kamalian S, Gharai LR, Schwamm L, Gonzalez RG, et al. Quantitative assessment of core/penumbra mismatch in acute stroke: CT and MR perfusion imaging are strongly correlated when sufficient brain volume is imaged. Stroke. 2008;39(11):2986-92.
Allder SJ, Moody AR, Martel AL, Morgan PS, Delay GS, Gladman JR, et al. Differences in the diagnostic accuracy of acute stroke clinical subtypes defined by multimodal magnetic resonance imaging. J Neurol Neurosurg Psychiatry. 2003;74(7):886-8.
Reiser MF, Becker CR, Nikolaou K, Glazer G, editors. Multislice CT. 3rd ed. Berlin: Springer; 2009. ISBN 9783540331254
Teasdale E. Multidetector CT: new horizons in neurological imaging. Imaging. 2007;19(2):153-72.
Wintermark M, Reichhart M, Cuisenaire O, Maeder P, Thiran JP, Schnyder P, et al. Comparison of admission perfusion computed tomography and qualitative diffusion- and perfusion-weighted magnetic resonance imaging in acute stroke patients. Stroke. 2002;33(8):2025-31.
Kleinman JT, Mlynash M, Zaharchuk G, Ogdie AA, Straka M, Lansberg MG, et al. Yield of CT perfusion for the evaluation of transient ischaemic attack. Int J Stroke. 2015 Oct;10 Suppl A100:25-9.
Huisa BN, Neil WP, Schrader R, Maya M, Pereira B, Bruce NT, et al. Clinical use of computed tomographic perfusion for the diagnosis and prediction of lesion growth in acute ischemic stroke. J Stroke Cerebrovasc Dis. 2014;23(1):114-22.
Haynes RB, Sackett DL, Guyatt GH, Tugwell P. Clinical epidemiology: how to do clinical practice research. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2006. ISBN 9780781745246
Glass GV. Primary, secondary, and meta-analysis of research. Educ Res. 1976;5(10):3-8.
Moher D, Liberati A, Tetzlaff J, Altman DG, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
Fortin MF. Fundamentos e etapas do processo de investigação. Loures: Lusodidacta; 2009. ISBN 9789898075185
Bisdas S, Konstantinou GN, Gurung J, Lehnert T, Donnerstag F, Becker H, et al. Effect of the arterial input function on the measured perfusion values and infarct volumetric in acute cerebral ischemia evaluated by perfusion computed tomography. Invest Radiol. 2007;42(3):147-56.
Esteban JM, Cervera V. Perfusion CT and angio CT in the assessment of acute stroke. Neuroradiology. 2004;46(9):705-15.
Dittrich R, Kloska SP, Fischer T, Nam E, Ritter MA, Seidensticker P, et al. Accuracy of perfusion-CT in predicting malignant middle cerebral artery brain infarction. J Neurol. 2008;255(6):896-902.
Lee IH, You JH, Lee JY, Whang K, Kim MS, Kim YJ, et al. Accuracy of the detection of infratentorial stroke lesions using perfusion CT: an experimenter-blinded study. Neuroradiology. 2010;52(12):1095-100.
Asdaghi N, Hameed B, Saini M, Jeerakathil T, Emery D, Butcher K. Acute perfusion and diffusion abnormalities predict early new MRI lesions 1 week after minor stroke and transient ischemic attack. Stroke. 2011;42(8):2191-5.
Kloska SP, Nabavi DG, Gaus C, Nam EM, Klotz E, Ringelstein EB, et al. Acute stroke assessment with CT: do we need multimodal evaluation? Radiology. 2004;233(1):79-86.
Parsons MW, Pepper EM, Bateman GA, Wang Y, Levi CR. Identification of the penumbra and infarct core on hyperacute noncontrast and perfusion CT. Neurology. 2007;68(10):730-6.
Drier A, Tourdias T, Attal Y, Sibon I, Mutlu G, Lehéricy S, et al. Prediction of subacute infarct size in acute middle cerebral artery stroke: comparison of perfusion-weighted imaging and apparent diffusion coefficient maps. Radiology. 2012;265(2):511-7.
Fan Zhu, Rodriguez Gonzalez D, Carpenter T, Atkinson M, Wardlaw J. Lesion area detection using source image correlation coefficient for CT perfusion imaging. IEEE J Biomed Health Inform. 2013;17(5):950-8.
Kalowska E, Rostrup E, Rosenbaum S, Petersen P, Paulson OB. Acute MRI changes in progressive ischemic stroke. Eur Neurol. 2008;59(5):229-36.
Fletcher RH, Fletcher SW. Clinical epidemiology: the essentials. 5th ed. Philadelphia: Lippincott William & Wilkins; 2012. ISBN 978-1451144475
Sakaie KE, Shin W, Curtin KR, McCarthy RM, Cashen TA, Carroll TJ. Method for improving the accuracy of quantitative cerebral perfusion imaging. J Magn Reson Imaging. 2005;21(5):512-9.
Seitz RJ, Meisel S, Weller P, Junghans U, Wittsack HJ, Siebler M. Initial ischemic event: perfusion-weighted MR imaging and apparent diffusion coefficient for stroke evolution. Radiology. 2005;237(3):1020-8.
Zlatareva DK, Traykova NI. Modern imaging modalities in the assessment of acute stroke. Folia Med (Plovdiv). 2014;56(2):81-7.
Tan JC, Dillon WP, Liu S, Adler F, Smith WS, Wintermark M. Systematic comparison of perfusion-CT and CT-angiography in acute stroke patients. Ann Neurol. 2007;61(6):533-43.
Campbell BC, Weir L, Desmond PM, Tu HT, Hand PJ, Yan B, et al. CTP improves diagnostic accuracy and confidence in acute ischaemic stroke. J Neurol Neurosurg Psychiatry. 2013;84(6):613-8.
Roldan-Valadez E, Gonzalez-Gutierrez O, Martinez-Lopez M. Diagnostic performance of PWI/DWI MRI parameters in discriminating hyperacute versus acute ischaemic stroke: finding the best thresholds. Clin Radiol. 2012;67(3):250-7.
Obach V, Oleaga L, Urra X, Macho J, Amaro S, Capurro S, et al. Multimodal CT-assisted thrombolysis in patients with acute stroke: a cohort study. Stroke. 2011;42(4):1129-31.
Ma HK, Zavala JA, Churilov L, Ly J, Wright PM, Phan TG, et al. The hidden mismatch: an explanation for infarct growth without perfusion-weighted imaging/diffusion-weighted imaging mismatch in patients with acute ischemic stroke. Stroke. 2011;42(3):662-8.
Poppe AY, Coutts SB, Kosior J, Hill MD, O'Reilly CM, Demchuk AM. Normal magnetic resonance perfusion-weighted imaging in lacunar infarcts predicts a low risk of early deterioration. Cerebrovasc Dis. 2009;28(2):151-6.
Arkuszewski M, Swiat M, Opala G. Perfusion computed tomography in prediction of functional outcome in patients with acute ischaemic stroke. Nucl Med Rev Cent East Eur. 2009;12(2):89-94.
Pepper EM, Parsons MW, Bateman GA, Levi CR. CT perfusion source images improve identification of early ischaemic change in hyperacute stroke. J Clin Neurosci. 2006;13(2):199-205.
Maruya J, Yamamoto K, Ozawa T, Nakajima T, Sorimachi T, Kawasaki T, et al. Simultaneous multi-section perfusion CT and CT angiography for the assessment of acute ischemic stroke. Acta Neurochir (Wien). 2005;147(4):383-92.
Rose SE, Janke AL, Griffin M, Finnigan S, Chalk JB. mproved prediction of final infarct volume using bolus delay-corrected perfusion-weighted MRI: implications for the ischemic penumbra. Stroke. 2004;35(11):2466-71.
Schramm P, Schellinger PD, Klotz E, Kallenberg K, Fiebach JB, Külkens S, et al. Comparison of perfusion computed tomography and computed tomography angiography source images with perfusion-weighted imaging and diffusion-weighted imaging in patients with acute stroke of less than 6 hours’ duration. Stroke. 2004;35(7):1652-8.
Barber PA1, Parsons MW, Desmond PM, Bennett DA, Donnan GA, Tress BM, et al. The use of PWI and DWI measures in the design of ‘proof-of-concept’ stroke trials. J Neuroimaging. 2004;14(2):123-32.
Downloads
Publicado
Edição
Secção
Licença
Direitos de Autor (c) 2022 Saúde & Tecnologia
Este trabalho encontra-se publicado com a Licença Internacional Creative Commons Atribuição-NãoComercial-SemDerivações 4.0.
A revista Saúde & Tecnologia oferece acesso livre imediato ao seu conteúdo, seguindo o princípio de que disponibilizar gratuitamente o conhecimento científico ao público proporciona maior democratização mundial do conhecimento.
A revista Saúde & Tecnologia não cobra, aos autores, taxas referentes à submissão nem ao processamento de artigos (APC).
Todos os conteúdos estão licenciados de acordo com uma licença Creative Commons CC-BY-NC-ND. Os autores têm direito a: reproduzir o seu trabalho em suporte físico ou digital para uso pessoal, profissional ou para ensino, mas não para uso comercial (incluindo venda do direito a aceder ao artigo); depositar no seu sítio da internet, da sua instituição ou num repositório uma cópia exata em formato eletrónico do artigo publicado pela Saúde & Tecnologia, desde que seja feita referência à sua publicação na Saúde & Tecnologia e o seu conteúdo (incluindo símbolos que identifiquem a revista) não seja alterado; publicar em livro de que sejam autores ou editores o conteúdo total ou parcial do manuscrito, desde que seja feita referência à sua publicação na Saúde & Tecnologia.