CT contrast enhancement in cerebral infarction

Computed tomography was used to study 100 patients with ischemic cerebral infarcts. All cases were documented by autopsy, radionuclide imaging, cerebral angiography, or clinical course. Vascular distribution of infarcts was varied and included infarcts of cerebral hemispheres, basal ganglia, and cerebellum. Distinct patterns of enhancement are seen following administration of intravenous contrast material: predominantly peripheral, central, homogeneous, or heterogeneous. Enhancement of the infarcted area usually occurs 1-4 weeks after the onset of clinical symptoms, but was seen as early as the first day or as late as several months after the onset of symptoms. Infarcts showing contrast enhancement may or may not revert to a nonenhanced pattern on follow-up examination for several months. Lesions demonstrating contrast enhancement in cerebrovascular disease may at times be indistinguishable from tumor. Contrast enhancement was the only manifestation of infarction in some instances, and an infarcted area may be completely missed if a postcontrast examination is not performed.