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MRI masasakiiwate-med.ac.jp

??????. DIAS-J?????????DIAS-J????????????????. DIAS-J. ????MRI????????????????????????????????????????????DIAS2???????!. . 1. DIAS-J?????????. . DIAS-J????(????). MRA???????????MCA M1M2???????(TIMI 0, 1)????MRI??????60?????????????. TIMI: Thrombolysis in Myocardial Infarction. . DIAS-J????(??

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MRI masasakiiwate-med.ac.jp

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    1. ???????????????? ?????? ?????????? ????MRI???????? ????? masasaki@iwate-med.ac.jp

    2. ?????? DIAS-J????????? DIAS-J?????? ??????????

    3. DIAS-J ????MRI?????????????????? ?????????????????????????? DIAS2???????!

    4. 1. DIAS-J?????????

    5. DIAS-J????(????) MRA???????????MCA M1M2???????(TIMI 0, 1)???? MRI??????60?????????????

    6. DIAS-J????(????) ????>MCA??1/3 ICH, SAH, AVM, ????????* ???????9???????? ??ICA????????VABA?? MRI???? ???????????????

    7. MRI??????? ?????? ????, DWI, T2*WI, MRA, (PWI), FLAIR ???186?? ????, DWI, T2*WI, MRA, (PWI), FLAIR

    8. MRI??????? ?? 1.5 Tesla?? ???????? >20mT/m ????????? >50mT/m/s DWI ???????ADC?????? MRA target MIP?????? DICOM?????????

    9. MRI??????? ???????? ??????????3?????? ??GRE??????????? ??????????????????

    10. MRI??????? DWI SE-EPI, b = 1000 s/mm2 AC-PC???????????(20-24?) 5 (~6) mm?, 0-1.5mm gap FOV 22-24cm, matrix 128x128 trace (isotropic), b0 (T2WI), ADC ???????????????????

    11. MRI??????? T2*WI, FLAIR T2*WI: GRE; FLAIR: FIR AC-PC???????????(20-24?) 5 (~6) mm?, 0-1.5mm gap FOV 22-24cm, matrix 256x192 FLAIR?PWI??

    12. MRI??????? MRA 3D-TOF AC-PC?????ICA????~M2???? (??????????~??) 1~1.5 mm? FOV 22-24cm, matrix ?? (512x192)

    13. MRI??????? PWI (??????) GRE-EPI AC-PC?????MCA?????? ???????, 0-1.5mm gap FOV 22-24cm, matrix 128x96-128 TR < 1500ms, ???? > 60s

    14. MRI??????? PWI (??????) ????? ????????(20G??) Gd??? 0.1 mmol/kg 4~5mL/s +?? 20mL 4~5mL/s ????5~10???????

    15. MRI??????? PWI (??????) ??????????????????????2007 (ASIST-Japan?????)??????????

    19. ???(AC-PC?)?????

    22. 2. DIAS-J??????

    24. ? M1M2??????? TIMI ?? Grade 0 ?????????????? Grade 1 ????????????? ?????????????? ?? Grade 2 ????????????? ??????? Grade 3 ?????????????

    25. TIMI ?? Grade 0 ?? ?????????????? ??????????? Grade 1 ???? ??????????????, ?????????????? ?????????? ??????????????? ?? ? M1M2???????

    27. ? 1/3 MCA rule DWI???????MCA???1/3????????? ????????????????????? ??????????????? ???????????????????

    28. ? 1/3 MCA rule DWI???????MCA???1/3?????????

    29. ? ICH, SAH ICH?SAH???????? ??????? ????(microbleeds)?????? ??????????????ICH?????? T2*WI, b0 (T2WI), FLAIR

    32. ? ??????? ????????9??????????? b0 (T2WI), FLAIR, T2*WI b0, FLAIR??????? ??????T2*WI??????

    34. ? ??ICA?? ??ICA????? MRA ICA?????????????????? (???????????????)

    38. 3. ??????????

    41. Question ?

    42. Case 1 ?? MRA shows left M2 branch occlusion. Normal signal on DWI. The thrombus causes a hypointensity on T2*-WI. Normal signal of brain parenchyma on FLAIR. MRA shows left M2 branch occlusion. Normal signal on DWI. The thrombus causes a hypointensity on T2*-WI. Normal signal of brain parenchyma on FLAIR.

    43. Case 1 ?? Positive inclusion criterion on MRA and neither large nor subacute infarction on DWI & FLAIR Positive inclusion criterion on MRA and neither large nor subacute infarction on DWI & FLAIR

    46. Question ?

    47. Case 2 ?? MRA shows normal flow. Normal signal on DWI, T2*-WI, and on FLAIR. MRA shows normal flow. Normal signal on DWI, T2*-WI, and on FLAIR.

    48. Case 2 ??

    51. Question ?

    52. Case 3 ?? MRA shows right M1 occlusion. Nearly the entire right MCA territory is hyperintense on DWI. In addition a small hemorrhage is in the dorsal part of right putamen causing a hypointensity on T2*-WI. Matched hyperintense signal of infarcted brain parenchyma on FLAIR. MRA shows right M1 occlusion. Nearly the entire right MCA territory is hyperintense on DWI. In addition a small hemorrhage is in the dorsal part of right putamen causing a hypointensity on T2*-WI. Matched hyperintense signal of infarcted brain parenchyma on FLAIR.

    53. Case 3 ?? Positive inclusion criterion on MRA, but excluded for large (>1/3 MCA ) , hyperintense signal of infarction FLAIR and intraparenchymal hemorrhage. Positive inclusion criterion on MRA, but excluded for large (>1/3 MCA ) , hyperintense signal of infarction FLAIR and intraparenchymal hemorrhage.

    56. Question ?

    57. Case 4 ?? MRA shows a right ICA aneurysm. Intraventricular hematoma causes isointense signal in the right ventricle on DWI. On T2*-WI, the hematoma has a hypointense rim. Motion artefacts due to bad conditions of the patient. SAH increases signal of CSF spaces on FLAIR images. MRA shows a right ICA aneurysm. Intraventricular hematoma causes isointense signal in the right ventricle on DWI. On T2*-WI, the hematoma has a hypointense rim. Motion artefacts due to bad conditions of the patient. SAH increases signal of CSF spaces on FLAIR images.

    58. Case 4 ?? Negative inclusion criterion on MRA secondary to large aneurysm and presence of SAH is an exclusion criterion Negative inclusion criterion on MRA secondary to large aneurysm and presence of SAH is an exclusion criterion

    61. Question ?

    62. Case 5 ?? MRA shows right sided M2 branch occlusion. Limited infarction on DWI. No signal abnormality on T2*-WI. Subtle hyperintensity of infarcted brain parenchyma on FLAIR. MRA shows right sided M2 branch occlusion. Limited infarction on DWI. No signal abnormality on T2*-WI. Subtle hyperintensity of infarcted brain parenchyma on FLAIR.

    63. Case 5 ?? Positive inclusion based on MRA and neither large nor subacute infarction on DWI & FLAIRPositive inclusion based on MRA and neither large nor subacute infarction on DWI & FLAIR

    66. Question ?

    67. Case 6 ?? MRA shows normal flow. Normal signal on DWI, T2*-WI, and on FLAIR. MRA shows normal flow. Normal signal on DWI, T2*-WI, and on FLAIR.

    68. Case 6 ?? Negative inclusion criterion based on MRA Negative inclusion criterion based on MRA

    71. Question ?

    72. Case 7 ?? MRA shows right M1 occlusion. Large right MCA territory hyperintensity on DWI. Normal signal on T2*-WI. Subtle signal increase of infarcted brain parenchyma on FLAIR. MRA shows right M1 occlusion. Large right MCA territory hyperintensity on DWI. Normal signal on T2*-WI. Subtle signal increase of infarcted brain parenchyma on FLAIR.

    73. Case 7 ?? Positive inclusion criterion based on MRA but excluded due to a large infarction on DWI (>1/3 of MCA territory). Positive inclusion criterion based on MRA but excluded due to a large infarction on DWI (>1/3 of MCA territory).

    76. Question ?

    77. Case 8 ?? MRA shows right ICA occlusion and normal flow in distal MCA arteries. Small right insular hyperintensity on DWI. The thrombus causes a hypointensity on T2*-WI and a hyperintense signal on FLAIR. * Intravascular thrombus causes signal loss on T2*-WI but does not indicate hemorrhage MRA shows right ICA occlusion and normal flow in distal MCA arteries. Small right insular hyperintensity on DWI. The thrombus causes a hypointensity on T2*-WI and a hyperintense signal on FLAIR. * Intravascular thrombus causes signal loss on T2*-WI but does not indicate hemorrhage

    78. Case 8 ?? Exclusion criterion based on ICA occlusion on MRA. Exclusion criterion based on ICA occlusion on MRA.

    81. Question ?

    82. Case 9 ?? MRA shows normal flow. Small infarction on DWI with matching hyperintensity on FLAIR indicating subacute infarction. No evidence of hemorrhage on T2* WI. MRA shows normal flow. Small infarction on DWI with matching hyperintensity on FLAIR indicating subacute infarction. No evidence of hemorrhage on T2* WI.

    83. Case 9 ?? Negative inclusion criterion based on MRA and signs of subacute infarction on FLAIR. Negative inclusion criterion based on MRA and signs of subacute infarction on FLAIR.

    86. Question ?

    87. Case 10 ?? MRA shows normal flow. Hemodynamic or borderzone lesion pattern on DWI. Normal signal on T2*-WI. FLAIR shows chronic lesions. MRA shows normal flow. Hemodynamic or borderzone lesion pattern on DWI. Normal signal on T2*-WI. FLAIR shows chronic lesions.

    88. Case 10 ?? Negative inclusion criterion based on MRA. Negative inclusion criterion based on MRA.

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