Detecting the subregion proceeding to infarction in hypoperfused cerebral tissue: a study with diffusion and perfusion weighted MRI

• Published in: Neuroradiology Vol. 45; no. 6; pp. 345 - 351
• Main Authors: LIU, Y, KARONEN, J. O, VANNINEN, R. L, NUUTINEN, J, PERKIÖ, J, VAINIO, P. A, SOIMAKALLIO, S, ARONEN, H. J
• Format: Journal Article
• Language: English
• Published: Berlin Springer 01-06-2003; Springer Nature B.V
• Subjects: Aged; Biological and medical sciences; Blood Volume - physiology; Brain Ischemia - diagnosis; Brain Ischemia - physiopathology; Cerebral Infarction - diagnosis; Cerebral Infarction - physiopathology; Cerebrovascular Circulation - physiology; Diffusion Magnetic Resonance Imaging; Female; Follow-Up Studies; Humans; Magnetic Resonance Angiography; Male; Medical sciences; Middle Aged; Neurology; Retrospective Studies; Statistics as Topic; Time Factors; Tissue Survival - physiology; Vascular diseases and vascular malformations of the nervous system; Human; Nervous system diseases; Stroke; Cardiovascular disease; Ischaemic penumbra; Medical screening; Nuclear magnetic resonance imaging; Cerebral disorder; Vascular disease; Ischemia; Magnetic resonance imaging; Perfusion; Central nervous system disease; Medical imagery; Diffusion; Ischemic penumbra; Cerebrovascular disease; Brain (vertebrata)
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/s00234-003-0959-3

Diffusion and perfusion weighted MRI have been widely used in ischaemic stroke. We studied 17 patients in whom ischaemic areas showed an ischaemic core, an area of infarct growth and hypoperfused but ultimately surviving tissue. Apparent diffusion coefficients (ADC) were measured on days 1, 2, and 8 in the three subregions and in contralateral control areas. Cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) were measured in these regions on day 1 perfusion maps. On day 1, the ischaemic core had very low ADC and CBF and increased MTT. The ADC in the ischaemic core gradually increased during the week. The area of infarct growth on day 1 had slightly but significantly decreased ADC (96% of control, P=0.028), moderately decreased CBF and increased MTT. On day 1 the hypoperfused but surviving tissue had slightly but significantly increased ADC (103% of control, P=0.001), mildly decreased CBF and increased CBV and MTT. The ADC of the area of infarct growth decreased to the same level as in the ischaemic core on days 2 and 8. That of surviving tissue was still above normal on day 2 (103% of control), but had returned to the normal level by day 8. Measurement of ADC combined with perfusion MRI may help distinguish different subregions in acutely hypoperfused brain.