Neurological Surgery No Shinkei Geka Volume 28, Issue 4 (April 2000)

Diffusion-weighted MRI in Patients with Occlusive Cerebrovascular Disease : the initial DWI findings within 6 hours afer onset Tohru INAGAKI 1 , Koji SAITO 1 , Tohru OKUYAMA 1 , Akira HIRANO 1 , Shinsuke IRIE 1 , Shigeru INAMURA 1 1Department of Neurosurgery, Kushiro Neurosurgical Hospital Keyword: magnetic resonance imaging , diffusion-weighted imaging(DWI) , acute cerebral ischemia pp.329-336
Published Date 2000/4/10
  • Abstract
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We performed this study to evaluate the accuracy of diffusion-weighted iamging (DWI) in detecting foc-al ischemia, and to predict the role of DWI in the management of patients with ischemia in the superacute phase.

99 patients with clinically diagnosed acute occlusive cerebrovascular disease were studied. with DWI within 6 hours after onset of symptoms. In 88 of 99 patients, early ischemic lesions were identified on ini-tial DWI as hyperintensity areas. The initial DWI findings were classified into 4 types according to the location and extent of the hyperintensity area. The patients with type 1 (no hyperintensity area) were clini-cally diagnosed as TIA or complete stroke within 2 hours after the onset. 28 patients out of the patients with type 2 (hyperintensity area in the perforator's territory) were diagnosed with lacunar infarction, and the remaining 13 patients were diagnosed as victims of stroke caused by main trunk occlusion. Except for 2 patients with TIA, the patients with type 3 (scattered hyperintensity areas in the cortex) had main trunk occlusion and showed a more extended ischemic area on SPECT than hyperintensity area on DWI. All the patients with type 4 (extended hyperintensity area) had main trunk occlusion and showed severe hypoper-fusion in the affected area on SPECT, and the area of hypoperfusion was well matched with the hyperin-tensity area on DWI.

Comparing DWI findings with rCBF on SPECT, a significant difference was noted in rCBF between hyperintensity and non-hyperintensity area. We considered that emergence of hyperintensity on DWI was related to both the time of duration and the degree of hypoperfusion, and the reduced perfusion area where DWI showed no hyperintensity was thought to be the “ischemic penumbra”. Our study indicated DWI had high diagnostic accuracy in superacute occlusive cerebrovascular disease and could furnish useful information to reveal the pathologic condition. In addition, DWI is expected to be available for selection as a therapeutic strategy.

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Neurological Surgery 脳神経外科
28巻4号 (2000年4月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院