/

EY.A.

...

Adapted from: Drouet L. Cerebrovasc Dis 2002; 13(suppl

Adapted from: Drouet L. Cerebrovasc Dis 2002; 13(suppl 1): 16.

 :
a major health problem and a leading killer

Epidemiology

Worldwide stroke prevalence was 7.1 million in 2000 and is rising 1

Incidence: 700,000 strokes/year (USA)2

A major health burden in western countries

Third most common cause of death3
The leading cause of disability in adults3

Health care expenditures

In the USA, $ 57.9 billion for stroke-related medical costs and
disability in 20062

Guillot F, Moulard O. Circulation. 1998: 98(Suppl 1):1421.

American Heart Association. 2002 Heart; Stroke Statistical Update. AHA, 2002;
www.strokeassociation.org - ASA .
1
2

15 24
35 44

1 / 10.000
1 / 5.000

45 54
55 - 64

1 / 1.000
1 / 500

65 74
75 - 84

1 / 100
1 / 50


()

.

Time is brain

 ()

(80%)
(20%)

 ()

80-85%

40-50%
(lacunes)
25%

15%
5%
5%

20%

40-60%
15-25%
10-15%

1-2%
<1%

1%



15%

75%

10%

PICA
ACHA
HEUBNER


(based on etiology)

(lacunes)
18-33%
15-30%
17-25%

12-37%

80%

15%
5-7%

20%

 ()

795,000

1 40
,

CT

(.. )



CT
MRI ,
.

CT
CT 100%
-

:
(Htc <
20%)



CT and MR

.
CT:
,
8
.
FLAIR T2 : 6
12 ,

3 .
:


.

 Diffusion-Weighted Imaging
Brown
.


.
:
DWI

ADC.

ADC
56%
o 6 .

Diffusion-Weighted Imaging

 DWI

FLAIR

DWI

 -
I

T1

T2

DIFFUSION

,
.

Perfusion-Weighted imaging

bolus.

,
( DWI)

DIFFUSION & PERFUSION

IMAGING

Diffusion
15- 30 ,

Perfusion

.

Diffusion/Perfusion Mismatch

penumbra,


.
(DW)


perfusion
.

Diffusion-Perfusion Mismatch
Model

http://spinwarp.ucsd.edu/neuroweb/Text/br-710/br-7104.gif

Acute stroke in a 67-year-old woman with

acute
left hemiplegia 2 hours after carotid
endarterectomy.

agnetic Resonance
Spectroscopy (MRS)

Imaging Findings of Stroke:

Acute Stroke (up to 7 days)
H MR CT .
1a

2a

DW MR (. 1a,2a).
,

.
, DWI
.
( 1f).

5b

,(. 5b),
12 .
( 6d), ( 4b)
1-7 .

6d

Subacute infarct: (1 week to 8 weeks)

, 8
, .

4b

Old Infarct:
( 6e)

.

6e

 ....

PWI/DWI

MR :

www.stroke.gr
1.
2.
3.


()
Bleeding
5%
20%
20%

15%

40%

Carotid
and
vertebral disease
Lacunar
Cardiac diseases
Dissection,
vasculitis etc

:
-

20-30%/

2-3%/

??

().
Amaurosis Fugax - -

.
, stent

.
.

.
.

()

1. Duplex (US)
2. CT (CTA)
3. MR (MRA)
4. (DSA)


()

Fibrous
cap
Lumen

Lipid
Core

(
)

Shoulder

Intima
Media

Elastic
lamin

Internal
External

Doppler
I IIa IIb III

.
TEXNIKH

doppler

Doppler
(+)

(-)

.
.
:


doppler

Doppler
: : 9195%
:
86-97%

CTA +ES ES


..

..
: 0.5-1.25 mm.

(64-Slice CT Scanner)

Willis 5-15 seconds (64-Slice CT Scanner)

: - -
-

T CT

.
,
.

MIP

SSD
Maximum
Intensity
Projection

Shaded Surface Display

DSA




Maximum Intensity Projection ()

I IIa IIb III

(+)

stent

(-)

>

( -> ,
)

CT
RADIATION EXPOSURE

Effective Dose of Selected

Radiologic Examinations
PA/Lateral CXR
0.04-0.06
mSv
Head CT
1-2 mSv
Chest CT
5-7 mSv
Abd/Pelvis CT
8-11 mSv
Diagnostic Cor Angiogram 3-5 mSv
MSCT angiography
9.3-11.3 mSv
*Average annual background radiation in U.S ~ 3.6 mSv
Morin et al. Circulation 2003;107:917-22.

 i.v.

(CE 3D-MRA)

i.v.
(CE 3D-MRA)
I IIa IIb III

(+)

->
, ,

(-)

Gadolinium use in individuals with an eGFR

<60 mL/min has been associated with
nephrogenic systemic fibrosis
(NSF)/nephrogenic fibrosing dermopathy

CE-MRA

240 arteries
Overall grading agreement:
89%
Severe stenosis (70-99%):
93%
Occlusions: 100%
AJNR2002;23:213219

102 arteries
Sensitivity: 9091%
Specificity: 7677%
Occlusions:
100%
Radiology2003;228:677682

DSA
I IIa IIb III

(+)

(-)

0.7%

0.16%
Gold standard?

Treatment planning for peripheral arterial disease based on duplex ultrasonography and
computed tomography angiography: consistency, confidence and the value of
additional imaging. de VosMS Surgery.2014 Aug;156(2):492-502.


()

()

1. Duplex (US)
2. CT (CTA)
3. MR (MRA)
4. (DSA)



:
/
/
/

Doppler
I IIa IIb III

Doppler (+)

80-90%
()

Doppler (-)


-
(Helical-Spiral CT)

Single Slice - Multislice

Y.T.- (CTA)

I IIa IIb III

Computed Tomographic Angiography

(CTA)

CTA

I IIa IIb III

CTA

MRA

MRA
75-98% ()

Maximum Intensity Projection ()
I IIa IIb III
III

(+)

stent

75-98%
(
)

(-)

>

( -> ,
)

75-98% (

CTA +

 i.v.

(CE 3D-MRA)

I IIa IIb III

Magnetic Resonance Angiography

(MRA)
MRA

I IIa IIb III

MRA

iv

i.v.
(CE 3D-MRA)
I IIa IIb III

(+)

2D/3D TOF (Time of

flight)
2D/3D PC (Phase contrast)

->
, ,

(-)

Gadolinium use in individuals with an eGFR

<60 mL/min has been associated with
nephrogenic systemic fibrosis
(NSF)/nephrogenic fibrosing dermopathy

DSA

(+)

(DSA)

(-)

0.7%

0.16%

DSA

Covered stents

-

1.

2.

3.

Doppler US

(+)
(+) , , -
(-) ,

(-)

CTA

(+)
(+) //

(+)
(-)

(-)

MRA

(+)
(+)
(-)

4.DSA

(+) ( )

(+) /

(-)

(-)

IMT
(
)

Fibrous
cap
Lumen

Lipid
Core

Shoulde

Intima
Media

Elastic Internal
lamin External

Schematic Time Course of Human

Atherogenesis
Ischemic Heart
Disease
Cerebrovascular
Disease
Peripheral
Vascular
Disease

Lesion
initiation
No
symptoms

+ Symptoms

Time (y)

Symptoms

(=/- )

IVUS

MRI

( )

Coronary Disease
Progression
Calcified Plaque Detected by CT

? Role for CTA

>60% stenosis
(+)
stress/imaging

Intravascular Ultrasound
(IVUS)
Intravascular delivery catheter
system (3-10F)
12-40 MHz transducers
Excellent visualization of plaques,
dissections & post PTA/stenting
vessels

Feinstein S, AM J Cardiol 2002;89:31C-44C

IMT ()


ARIC STUDY
7289 , 5552 , 4-7

Cardiovascular Health Study

5800
(>1mm)

Am J Epidemiol 1997;146:483-494
J Am Geriatric Soc 2000;48:256-263

IMT (II)

Cholesterol Lowering Atherosclerosis Study
8

0.03mm/

3.4

Ann Intern Med 1998;128:262-269