The clinical case reports the first experience of thrombus extraction in a young patient with ischemic stroke and severe concomitant pathology. The 33-year old patient was admitted to the hospital with stroke 4 hours after its onset. The occlusion of the distal Ml segment of the left middle cerebral artery was documented with MSCT. A satisfactory clinical result of the thrombus extraction in ischemic stroke was achieved, despite the changed treatment strategy commonly used for from this pathology (thrombolytic therapy and thrombus extraction). The refusal of thrombolytic therapy was associated with the presence of destructive pulmonary tuberculosis and a high risk of pulmonary hemorrhage. Successful thrombus extraction from the M1 segment of the left middle cerebral artery segment with the final blood flow in the left internal carotid artery at the level of TICI III was performed. At discharge the patient demonstrated improved neurological status with the modified Rankin score of 3.

The second part of a review article devoted to a detailed consideration of the issues of diagnostic semiotics of acute disorders of cerebral circulation using CT and MR perfusion study techniques. We consider the physiological aspects of formation of the basic parameters of tissue perfusion: of cerebral blood Șow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and time to peak (TTP) contrast, as well as patterns of pathological changes in these parameters (hypo-, hyper- and aperfusion), developing in various degrees of brain ischemic damage and penumbra areas. It is noted that the improvement of MRI using for tissue classi⠇cation of perfusion-diநusion (PWI/DWI) mismatch has a better chance of primary development due to the fact that it non-radiation exposure and is not connected with the need to introduce a large contrast volume, and with the introduction of non-contrast arterial spin labeled technique (ASL). Variants of events in the dynamics of perfusion as a result of reperfusion therapy. There were discussed the problems limiting the use of perfusion techniques in clinical practice.

In the first part of a review article highlights the key moments of the history of the study of cerebral microcirculation, formation of the basic theories and postulates a gradual improvement of the methods of qualitative and quantitative assessment of brain perfusion parameters in science and medical practice. Presented and discussed in terms of advantages and disadvantages of the current methods of assessing cerebral perfusion: transcranial Doppler (TCD), positron emission tomography (PET), single photon emission computed tomography (SPECT) perfusion computer tomography (PCT) and magnetic resonance tomography (PMRI) techniques. Most of all studies related to the use of radioisotopes or contrast media agents. It is noted that the TCD and perfusion CT and MRI prevail today in radiologic practice of cerebral circulation disturbances diagnostics. In recent years, more research is carried out in relation to clinical trial non-contrast MR technique (ASL), associated with endogenous labeling and registration of cerebral blood flow, which considering the absolute safety in the absence of external contrast makes it attractive for clinical use in the near future is possible. The second part of this article will devoted to a detailed consideration of the issues of diagnostic semiotics different clinical forms of violations of cerebral circulation using CT and MR perfusion study techniques that are by far the most accessible to a wide network of healthcare system. There will discuss the physical basis of blood flow parameters changes of brain tissue on the cards of cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT ) and time to peak (TT P) contrast in the «classical» and the «difficult» clinical cases on the basis of the works of the most respected researchers in the field.

The cerebral venous congestion is the primary factor in damaging the brain with cerebral venous thrombosis. Ischemia in stroke associated with cerebral venous sinusthrombosis (CVST) is secondary, developing as a result of externally induced constriction of the blood vessels feeding the area of stasis in vasogenic edema, which leads to necrosis is less likely than with arterial ischemic stroke. Stroke associating CVST more often accompanied by hemorrhagic transformation than atherothrombotic. Venous congestion is detected in cardioembolic stroke in the perifocal zone of the ischemic focus, and probably plays a role in the courses and outcomes of stroke, contributing to the development of vasogenic edema and early secondary hemorrhage. Identify venous stasis in principle possible using the technique of determining the ultrasound index arteriovenous ratio and sighting in the ischemic focus and perifocal zone as hyperperfusion using perfusion techniques MSCT or MRI of the brain.

Poster: ECR 2014 / C-0117 / Signs of routine CT and MRI in differential diagnostics of venous and arterial stroke’s genesis by: S. E. Semenov, A. A. Khromov, I. V. Moldavskaya, A. N. Khromova, E. A. Zhuchkova, M. G. Shatokhina; Kemerovo/RU

Purpose. Analysis of the own experience with multislice computed tomography (MSCT) in the diagnosis of congenital heart disease (CHD) in children in the first years of life and determine the effectiveness of this technique. Materials and methods. We analyzed MSCT data of patients with CHD (n = 156, mean age 3,5 (2; 9,7 mo), which was conducted on a 64-slice CT scanner with a bolus of X-ray contrast. Results. We found excellent information content of MSCT in morphometry of coarctation of the aorta, ductus arteriosus in patients before and after surgical intervention. Possibilities of the method have been presented for patients with tetralogy of Fallot and anomalous pulmonary venous drainage. Pathological changes in the bronchopulmonary system were revealed in 55 patients with CHD by MSCT. Conclusion. The use of MSCT in the diagnosis of CHD in children during the first years of life to get accurate morphometric data of the anatomy of CHD and assessment of concomitant noncardial pathology for determining treatment strategy, planning, operational correction and control of the results of surgery.

Purpose. The study was aimed at detecting the signs of focal and perifocal injury in venous strokes and their differences from those in arterial strokes by urgent CT and MRI. Materials and methods. The diagnosis of a venous stroke was verifi ed by neurovisualization (native MSCT, perfusion CT or CT angiography, conventional MRI and MR-angiography) and during autopsy (in case of a fatal outcome). Results. Patients with venous strokes had a hyperdense (by routine CT) stroke-related vessel, compensatory venous distention on the side of the occlusion, early haemorrhagic transformation, the changes localized in the region of the affected vein. Conclusions. The study allowed to detect CT and MRI signs, which can help to differentiate arterial and venous strokes.

CT and MR patterns of focal perfusion and diffusion disorder are compared in groups of patients with nonhemorrhagic venous and ischemic stroke, as well as in control group with chronic brain ischemia. The rMTT(+ vs. ++), rCBF (± vs. – –), rCBV (+ vs. ±), rDWI (± vs. +), and rADC (+ vs. –) patterns are determined as reliably distinguishable (p < 0.05), which is indicative of congestion in venous stroke focus as a releaser of pathophysiological mechanism of development of secondary ischemia.